Avaliação das Ações de Vigilância Sanitária a partir da Atuação da Agência de Fiscalização do Município de Fortaleza

Abstract

Health Surveillance (VISA) plays an important role in the structuring and operationalization of the UnifiedHealth System (SUS) in the pursuit of the realization of the social right to health. However, VISA’s objects of action bring a conflicting relationship between health and the market. Thus, for a better evaluation of Health Surveillance, it is essential to understand how it fits in the context of the Capitalist State, and how to approach the elements of promotional paradigm, highlighting social participation and health education actions, if necessary to overcome these conflicts. Thus, this research aims to evaluate the actions of Health Surveillance based on the work of the Inspection Agency (AGEFIS) in the city of Fortaleza. A historical rescue was carried out, both at federal and municipal levels, considering the political, economic, social and cultural aspects that só influence this area and relating them to the neoliberal context of fiscal adjustments, State reforms, deregulation, of privatizations that have been experienced in the last decades in Brazil. As a methodology, a qualitative approachwas carried out, based on the perspective oh in-depth assessment, which considers four analytical axes: content analysis, context analysis, institutional trajectory and temporal and territorial spectrum. For the realization of such methodology, a dialogue with the literature, document analysis and interviews with VISA professionals and managers were carried out. Documents directed to VISA actions were revised, such as: the Pluriannual Plans of the municipality of Fortaleza for the quadrenniums (2014 – 2017) and (2018 – 2021), as well as the VISA Fortaleza Action Plans for the period (2015 – 2019). The interviews were fundamental and represent the basis of the axis of the institutional trajectory and the temporal-territorial spectrum. Eleven interviews were conducted with VISA professionals and four interviews with VISA managers. The data were analyzed based on the content analysis thecnique divided into four stages: pre-analysis, definition of hypotheses; elaboration of analysis and interpretation categories. The analysis categories formed from the analysis of the interview were: weaknesses in the insertion of VISA actions in AGEFIS; understanding of social participation; spaces for social participation in AGEFIS; understanding of health education; health education spaces at AGEFIS; contributions of professionals and managers to carry out VISA actions. The results showed that VISA's actions are not priorities for AGEFIS and management. There is a disorganization in relation to the performance of VISA in Multiyear Plans. In the quadrennium (2014 - 2017) VISA is classified in a different axis from health, already in the context of AGEFIS. And in the quadrennium (2018 - 2021) VISA returns to health, being inserted in Health Surveillance. Regarding the VISA Action Plans for the period (2015 - 2019), it was observed that health education and social participation activities are the responsibility of CEVISA, and AGEFIS is responsible for inspection actions. What exists is a partnership between the agencies, but not officially documented. The main potentialities of the insertion of VISA actions in AGEFIS reported by the interviewees were: standardization of inspection actions; elaboration of inspection plans; better integration of inspection; expansion of training, among others. The weaknesses stand out: use of taxi for inspection; lack of structure in GEREFIS; few VISA inspectors in management and lack of health promotion actions. It is concluded that the actions of health education and social participation in AGEFIS are insufficient. For the interviewees, AGEFIS has a great potential to guarantee health promotion actions, in addition to its inspection nature, since VISA inspectors working at this agency are in direct contact with society and the diferente territories, thus, the main responsible for carrying out health education and social participation actions.