Avaliação da política Brasil Sorridente em Fortaleza-Ceará: uma avaliação em profundidade

Abstract

This study aimed to evaluate the National Oral Health Policy "Brasil Sorridente" within the context of the Unified Health System (SUS) in the municipality of Fortaleza, Ceará. The research sought to identify the policy’s advancements, challenges, and limitations since its implementation in 2004, with an emphasis on expanding access to dental services, improving the quality of care, and reducing regional inequalities. The methodology adopted was in-depth evaluation, which combines different analytical strategies to capture the complexity of the processes under assessment. Document analysis was carried out using meeting minutes from the Fortaleza Municipal Health Council and Annual Management Reports (RAG) from the Municipal Health Department (SMS), covering the period from 2004 to 2024. In parallel, interviews were conducted with key actors involved in the implementation of the policy in the municipality, including dentists and oral health assistants working in the Regional Health Coordination I (CORES I), technicians and managers from the SMS responsible for the Oral Health Care Network, and a user of the Carlos Ribeiro Primary Health Care Unit (UAPS). The qualitative approach enabled the understanding of perceptions, experiences, and tensions experienced by these actors, revealing transformations in the service network throughout three different municipal administrations. The results highlighted an initial consolidation process, marked by professional recognition and expanded coverage, followed by periods of fragility regarding the maintenance of supplies, precarious employment conditions, and discontinuity of actions. The COVID-19 pandemic also negatively impacted the visibility of oral health, although some activities were maintained. The analysis further revealed that social control participation fluctuated according to the local political context, directly influencing the planning and effectiveness of oral health actions. The research pointed to the existence of territorial inequalities in service coverage and oral health indicators, particularly in the city's peripheral areas. Based on the findings, recommendations were formulated to strengthen the oral health care network in the municipality, with emphasis on investment in infrastructure, valuing health teams, enhancing management capacity, and expanding social control mechanisms. The results of this study may contribute to the improvement of public policies in the field of oral health, providing technical and political support for managers, professionals, and researchers committed to equity and comprehensive health care within the SUS.