Trabalho, Educação e Saúde - TES (Work, Education and Health) is an open access scientific journal, edited by the Joaquim Venâncio Polytechnic School of Health, from Oswaldo Cruz Foundation.
Trabalho, Educação e Saúde (TES) publishes original contributions on the fields of education and health, discussing them from the perspective of contemporary work organization, from a critical and interdisciplinary perspective. To submit a text, please consult the Editorial Policy and the Instructions to Authors.
Editorial
Editorial
Dossiê
Sexism and racism operate in tandem in the production and reproduction of social inequalities. Systems of oppression, discrimination, and exploitation sustain the privileges of a dominant social group in Brazil, to the detriment of ensuring the rights of all individuals. This paper presents a brief historical overview of the Fundação Oswaldo Cruz (Fiocruz), an institution that has been collectively and systematically working toward building a new institutional culture—one that challenges normalized practices and behaviors that uphold the status quo. We share insights into the Foundation’s experience and ongoing struggle against all forms of discrimination, with particular emphasis on the fight against institutional racism. We conclude by highlighting key milestones in Fiocruz’s journey toward equity, including: the establishment of the Committees for Gender and Race Equity and for Accessibility and Inclusion of Persons with Disabilities; the formation of similar collectives across units and offices; the creation of the Accessibility and Inclusion Policy for Persons with Disabilities (2019), the Ethnic-Racial and Gender Equity Policy (2023); the establishment of the Coordination for Equity, Diversity, Inclusion, and Affirmative Policies (2023); and the expansion of affirmative action policies and continuous education initiatives.
Dossiê
Aquilombamento, from a mental health perspective, proposes an approach attentive to the social determinants of health, grounded in ethical and committed work with marginalized groups. It aims to produce knowledge and practices aligned with the paradigms of the Brazilian sanitary and psychiatric reforms. This article seeks to demonstrate how ethnic-racial issues gain relevance and expression, transforming the possibilities of providing health and mental health care for Black women, based on a Permanent Health Education activity. The study analyzed the discourse of 31 health professionals from a municipality in Ceará (Brazil) regarding mental health care practices offered to Black women who use public health services. This was an intervention-research conducted between October 2023 and February 2024, which identified the following categories of analysis: perceptions of care for Black women within mental health services; collection of race/color data and the invisibilization of racial relations; and Permanent Health Education as a tool to confront institutional racism. Therefore, we argue that Permanent Health Education can serve as a valuable instrument within the mental health aquilombamento framework, fostering not only racial literacy among professionals and users but also promoting ethics, political engagement, and affection in everyday care practices for Black women and the broader Black population.
Dossiê
We approach the link between work and social policies from an anti-racist and anti-capitalist perspective, taking racial relations and racism as structural elements of social formation, structuring the State and dependent capitalism in Brazil and, finally, the connection of these processes in the context of the contemporary crisis of capital.
Dossiê
This essay uses the notion of enchantment to build an anti-racist and decolonial dialogue with the field of mental health and psychosocial care. It problematizes the racist foundations that produce the silencing, erasure, and homogenization of experiences within the Psychiatric Reform and the Anti-Asylum Struggle in Brazil and highlights the need to utilize quilombola (inhabitant-like) as a guiding component of the ethical-political dimension and the construction of a clinical-political praxis that empowers life and produces enchantment. From an intersectional, decolonial, Marxist feminist perspective, three problematizing questions are raised: the urgency of the enchantment of Psychiatric Reform and the Anti-Asylum Struggle; quilombola (inhabitant-like) as a component of the ethical-political dimension; the clinical practice of delicacy as praxis. In this sense, the essay aims to instigate debate by bringing new perspectives to the field of mental health, proposing another theoretical, political and clinical approach to psychosocial care based on Afro-diasporic experiences.
Article
Anxiety has become an increasing concern, especially following the COVID-19 pandemic, which led to a 25% rise in cases worldwide and established it as the fourth leading cause of work absenteeism in Brazil. This quantitative study examined reports of work-related anxiety disorders in the state of São Paulo, focusing on the changes post-pandemic. Using trend analysis, linear regression, and unsupervised machine learning (clustering and association rules), the study explored the growth, pattern changes in notifications, and the demographic and behavioral profiles of affected workers between 2020 and 2023. The results identified four main profiles of individuals with anxiety disorders. The largest cluster consisted of workers aged 30 to 39, primarily from the retail sector, followed by a cluster of workers in the administrative sector aged 40 to 49. While most were not users of psychoactive drugs, alcohol, or tobacco, many had previously used psychotropic substances and/or medications, which was linked to temporary disability. Therefore, prevention policies and psychological support are essential for promoting wellbeing and productivity in the workplace.
Article
This study analyzed racism expressions in the work experiences of Black Community Health Agents working in Rio de Janeiro and São Gonçalo municipalities, through qualitative research using a focus group. The agents’ vocalization of their racism experiences is representative of both their positions as workers and users of the Unified Brazilian Health System. In general, in the territories where they work and live, the historical absence of public policies is one of the dimensions on the process of social determination of health. Racism extends across multiple dimensions of the relationships between users, health workers, and management, and is embedded in institutional and organizational structures to subjugate subjects based on their race/color. The findings point on two axes of analysis: the first, regarding the construction of subjectivity under racism; and the second on experiences of racism, the latter divided into four sub-items: the issue of self-declaration and the collection of race/color data, whitening strategies, the relationship between race/class, and the ideology of domination. It concludes by highlighting the convergence of this debate with intersectional approaches and recognizing both the structural dimension of racism and the importance of changing everyday practices.
Article
The fragmentation of care makes it difficult to achieve the guidelines proposed for the Brazilian Unified Health System, especially comprehensiveness, and users experience discontinuity of care. This study aimed to analyze coordination between levels of care, based on the perceptions of users and specialized care professionals, in the context of two healthcare networks in Brazil that have implemented the Health Care Planning Strategy, with a focus on maternal and child care. This was an evaluative and descriptive study involving 16 participants (six users and ten professionals). Semi-structured interviews were analyzed, addressing three dimensions of care coordination: information, clinical and administrative management. Progress was observed in the creation of care plans, matrix support actions and the role of Primary Health Care in ordering care. However, there was a dependency on users to exchange information, a lack of integration with hospital care, a shortage of specialists and high professional turnover. Despite the progress made by the Health Care Planning Strategy in organizing care flows, fragmentation in information sharing and coordination between levels compromises continuity of care.
Article
Primary Health Care is a strategic approach aimed at transforming the model of health care and service delivery, characterized by four essential attributes: first contact, comprehensiveness, continuity, and care coordination. The Family Health Support Center, established in 2008 to broaden the scope of health care, has undergone structural and financial changes over the years. This study aims to analyze the impact of the “Previne Brasil” Program on health care delivery within the territory, from the perspective of the Family Health Support Center. A single- case, qualitative study was conducted, based on normative documents and interviews with Primary Health Care professionals in the municipality of Recife. The findings suggest that the 2016 shift in policy, marked by the ongoing dismantling of Primary Health Care, undermines the commitment to the principles of the Unified Health System. The “Previne Brasil” Program exposed these disruptions, and despite the continued presence of Family Health Support Center teams in Recife, the theoretical model remains unestablished, becoming increasingly ambiguous and a source of insecurity for professionals. Curative actions have intensified, distancing professionals from the core promotional and preventive activities of Primary Health Care, resulting in a decline in the quality of care.
Article
This study investigates the implementation of the 2017 National Curriculum Guidelines in pharmacy programs offered by Brazilian federal universities. A quantitative descriptive approach was employed, utilizing official databases of courses and higher education institutions. The analysis focused on the number of subjects, syllabi, and internships exclusively related to the health care axis as defined by the guidelines. A total of 47 pharmacy programs were identified, of which only 25 (53.2%) had publicly accessible curricula or political-pedagogical projects available in accordance with the 2017 guidelines. The Southeast region accounted for the highest number of included universities (n=10). A limited workload dedicated to pharmaceutical care was observed, and in some institutions, this component was entirely absent. Additionally, there was a notable lack of subjects addressing integrative and complementary practices in the Central-West, South, and Southeast regions. Despite the publication of the guidelines in October 2017, the findings reveal a persistent lack of systematization, organization, and formalization in the structuring of pharmacy programs across Brazilian federal universities.
Article
This article addresses the health needs of LGBTI+ individuals living in rural areas and the main barriers they face in accessing different services within the public healthcare network. It begins by acknowledging the invisibility and vulnerabilities experienced by these individuals, shaped by intersecting factors such as rural identity, race, and gender identity, and aligns with the National Policy for Comprehensive LGBTI+ Health. A diagnostic questionnaire was administered through an online form, including questions on access to social rights, experiences of LGBT-phobic violence, and involvement in the Landless Rural Workers’ Movement. A total of 171 participants took part, predominantly young and Black (77%), with diverse sexual orientations (37% gay, 34% bisexual, 21% lesbian) and gender identities (including trans and non-binary individuals), covering 159 agrarian reform territories across 21 states. Findings reveal significant barriers to healthcare access, such as heteronormativity in services, institutional violence, and the impact of conservative policies. The study highlights the need for anti-LGBT-phobic professional training, effective implementation of the National LGBTI+ Policy, and stronger articulation with social movements. The LGBTI+/MST Collective undertakes actions against LGBT-phobia and fosters partnerships with public institutions, reinforcing the struggle for a universal and equitable Unified Health System. Overcoming these challenges requires collective mobilization and an intersectional approach in public policies.
Article
We sought to understand the perspectives of Primary Health Care professionals regarding care transitions, as well as the work contexts that influence the continuity of such care. This is a qualitative research study, employing content analysis of interviews conducted with 15 health professionals from Primary Care units affiliated with a public hospital group in southern Brazil, within the framework of the Health Care Networks concept. The findings were organized into three thematic axes: communication and care transitions between health services; the role of Primary Health Care in the organization and coordination of care; and the relationship between users, families, and care networks. The study identified isolated practices of care transition between hospitals and Primary Care, revealing challenges ranging from limited referral options to other services to the lack of information regarding hospital admissions. Despite these challenges, Primary Health Care is highlighted as a potentially central coordinator of care within the organization of Health Care Networks, even though it faces difficulties in fulfilling this role. The study underscores the need to rethink care transitions between health services, aiming to improve the quality of care and promote better integration across the health system.
Article
With the aim of analyzing the repercussions of current management and financing policies of Primary Healthcare services in Brazil on the work of occupational therapists, an action research was carried out, operationalized as a community of practice, with 14 meetings, in which six occupational therapists from different regions participated, from April to October 2023. The transcripts of the meetings were thematically analyzed and the results were organized into three themes: the overloads and dehumanization of work in Primary Healthcare; the desire to offer quality care, learned in initial training, in contrast to the high demand for adaptability in fragmented work processes; and coping with these contingencies. The participating occupational therapists demonstrate the diversity of employment relationships, in a variety of services and populations served. The meetings in the community of practice enabled access to multiple realities of the work of occupational therapists, with repercussions on personal and professional daily life and health. In addition, tensions between training for community care in Primary Healthcare and the reality of individualized, fragmented work driven by goals are highlighted – evidencing contradictions between the policy of training for Primary Healthcare, the policy of implementation, and the execution of this work.
Article
Considering the challenges in implementing emergency measures related to workforce management during the COVID-19 pandemic, this documentary and qualitative study gathered official documents produced by the governments of Brazil, Canada, and Portugal to address this disease, focusing on the regulation of health workforce management from 2020 to 2022, and described the proposed interventions. The research included 31 regulations, whose analysis was guided by the document “Health workforce policy and management in the context of the COVID-19 pandemic response,” revealing changes in the structural organization of environments, allocation and reallocation of professionals, and the use of information and communication technologies in health to adapt organizational decisions and guide work. Similarities include recommendations to reorganize work environments and conditions to minimize exposure to SARS-CoV-2 contamination risks. Distinctive measures in Canada included strengthening primary health care and exceptional funding for remote work. Portugal opted for adjustments in labor relations, flexibility in hiring foreign professionals and retired volunteers. Brazil recommended recruiting residents and health students. Common findings suggest evidence of pathways to strengthen health workforce management policies in the post-pandemic scenario.
Article
We analyze the provision of care to women experiencing gender-based violence within two Primary Health Care units located in a peripheral area of Rio de Janeiro, Brazil. It focuses on the narratives and practices of “street-level bureaucrats,” agents who operate at the interface between users and the State. The methodological procedures adopted included participant observation of care-related activities and semi-structured interviews with professionals between 2022 and 2023. In their daily work within Primary Health Care, these agents often face challenges such as inadequate infrastructure and lack of integration within the care network, which necessitate discretionary actions in various situations. The actions of these public agents can either facilitate or hinder access to health services, directly influencing the critical pathways in the care provided to women. The analysis considers that the experiences of these operators, along with the complex interactions between institutional and social aspects, are crucial for understanding the field of public policies aimed at addressing gender-based violence and the limitations encountered in their implementation.
Article
Women’s health education empowers professionals to address issues focused on diagnosis and treatment, sexual and reproductive health, gender-based violence, and mental health, aiming to improve the quality of care provided and strengthen the relationship between professionals and their patients, promoting a woman-centered health approach. The objective was to develop, implement, and evaluate a digital training plan for public health workers in Rio Grande do Sul, Southern Brazil, focused on women’s health. A cross-sectional qualitative and quantitative study was conducted on the live sessions organized between October 2022 and December 2023, held in a synchronous virtual format. Additionally, a qualitative and descriptive analysis of the chat questions and a profile analysis of the participants were undertaken. A total of 436 people participated live in the 12 thematic sessions. Over 80% of the participants were health professionals, and the sessions have accumulated 3,523 views to date. Regarding the questions, 36.4% referred to access to health services. There is a need for new educational technologies that promote accessible and flexible learning, as access to information about women’s health must be continuous.
Article
Precarization is situated within the context of transformations in the world of work that have unfolded over the past forty years, driven by the process of productive restructuring supported by the neoliberal political and economic project. In this scenario of intensified attacks on the working class and social policies, the first undergraduate programs in collective health emerged in 2008. This study analyzed the professional integration of graduates from these programs, who completed their degrees between 2016 and 2021 at public universities in Pernambuco (Brazil), considering the phenomena of labor precarization and the regulation of the profession. This is a descriptive study with a qualitative approach, carried out on 85 questionnaires sent to all graduates and eight semi-structured interviews with alumni, program coordinators, and a representative from the State Council of Municipal Health Secretariats. Insecure jobs, lacking social protection and offering low wages, are realities faced by some graduates in collective health. Law N. 14.725/2023, which regulates the profession of the sanitarista (public health professional), was enacted 11 years after the first professionals were trained, although it does not resolve the issue of precarious employment. The strategies for developing this new profession failed to consider the preexisting impacts on professional labor markets, which are consequences of the neoliberal agenda.
Article
The pharmaceutical workforce in municipal Primary Care has proven to be relevant, given the healthcare needs. The aim of this study was to analyze the rates of pharmacists working in Primary Care in municipalities and their relationship with investments in aquisition of medicines, considering the Municipal Human Development Index and the population size of Brazilian municipalities. The study includes primary data from 2021, which corresponds to Brazilian municipalities on a national scale, and secondary data from national databases. The average rate of pharmacists is 1.85 per 10,000 inhabitants. Municipalities with higher development indices have higher rates of pharmacists. Municipalities with low development indices, small size, in the North and Northeast regions are associated with none or one pharmacist per 10,000 inhabitants. Small municipalities showed a positive relationship between investment in medicines and the rate of pharmacists, meaning that places that invest more in medicines also have higher rates of pharmacists. However, municipalities with high development indices show a correlation with higher rates of pharmacists and invest more in medicines.
Article
The pharmacist’s role in managing self-limiting health conditions presents challenges related to clinical skills and confidence in providing effective care. The integration of simulations in education is one of the tools to enhance these clinical competencies. This research, conducted in Brasília in 2022, aimed to evaluate the clinical competencies of pharmacy professionals and students through remote realistic simulations, using a validated assessment instrument. The study occurred in three stages: development and provision of educational material with a description of the clinical case; remote realistic simulation of pharmaceutical consultations and peer evaluation; and quantitative analysis of participants’ performance. The research included 96 participants (professionals and students), and 40 clinical simulations were conducted, totaling 1,020 peer evaluations. Predominantly, the evaluations of clinical skills were positive, highlighting ‘verbal communication’ (88.6%), ‘definition of the health problem’ (86.4%), and ‘non-verbal communication’ (85.5%). However, the item on ‘vital signs measurement’ achieved only 57.3% satisfactory performance. Significant improvement in participants’ confidence was observed after accessing the material and simulation. Clinical simulations contribute to the development of clinical competencies, strengthening the capacity for pharmaceutical intervention in managing self-limiting health problems.
Article
This is a cross-sectional study aimed at evaluating the knowledge, self-efficacy, and collective efficacy of professionals working in multidisciplinary teams in the public service of the city of Campinas, Brazil, regarding the recommendations of the Dietary Guidelines for the Brazilian population. Validated selfadministered questionnaires were used to collect data and linear regressions were used to compare groups and identify factors influencing outcomes. The study involved a sample of 141 professionals from the health and education sectors, mostly women, aged 35 to 45 years, with a municipal employment contract of up to ten years. About half of the professionals knew the Guide, but only 28.9% of health professionals and 19.5% of education professionals used it. Nutritionists scored the highest in knowledge, with an overall average of 64.6 points. Health professionals had a higher proportion of high self-efficacy compared to education professionals. Nutritionists from both sectors and health professionals had higher collective efficacy scores than education professionals. Those with higher self-efficacy and longer careers were more likely to achieve high collective efficacy. The diagnosis highlighted the need for training on the Guide to increase knowledge and empower professionals for intersectoral work.
Article
This article aimed to discuss gender, race, and education as social markers that influence the participation of community health workers in matrix support in mental health in Belo Horizonte, Brazil, in 2023. The results are from a qualitative research study, using semi-structured interviews and participant observations as data production techniques. Intersectionality was used as an analytical tool. In the researched teams, it was observed that the majority of the agents were black women with high school education, while the majority of the professionals offering matrix support were white women with higher education. These racial and educational differences influence the relationships established between agents and supporters, being related to some mechanisms of exclusion of community health workers from the spaces of matrix support in mental health.
Article
In Myanmar, during the civil war following the February 2021 military coup many medical students suspended their studies. The University of Parma is committed to organize alternative courses for Myanmar medical students. The aim of this study was to examine through a mixed method the current educational needs of Myanmar medical students and the feasibility of alternative training courses. The quantitative research revealed that many students can attend educational activities online. The main difficulty concerns training through clinical practice, although some of them believe in the possibility that online simulation can partially make up for this deficiency. The training areas of main interest are: Mental Health, Emergency Medicine, Public Health, Healthcare Management. The qualitative study revealed that the students are confident that foreign universities can provide online training activities not only during the civil war, but also when peace has been established, and that such activities may be legally acknowledged. These results, in addition to documenting the resilience of the students involved in this research, respond well to the need to direct training to the effective actual needs whilst addressing the need to understand the specific context in which students will have to benefit from training, even in war situations.
Article
During the pandemic caused by the SARS-CoV-2 virus, associations and social movements belonging to rural populations have taken various actions to ensure the survival of their communities. The aim of the study was to analyze the effects of associative practices in guaranteeing the health of the rural population in the context of the pandemic. This is a qualitative case study in which the Landless Rural Workers’ Movement and three quilombola associations took part, covering three regions of Brazil (South, Southeast and Northeast). A total of 15 interviewswere conductedwith members of these movements between 2021 and 2022. The data was examined using thematic analysis. The actions organized in the territories were based on principles of solidarity, the management of community life and the defence of life, making responsibility for health and social rights a community matter. Popular organization during the pandemic has led to greater commitment within associations, settlements and encampments in the fight for health and rights, provoking community mobilization and political training that has made collectives stronger to build their struggle. Associativism, through grassroots organization, has fostered solidarity, political education and collective care, acting from an emancipatory health perspective.
Article
The National Policy for Integrative and Complementary Practices of the Brazilian Unified Health System is a set of norms and guidelines created to implement such practices. The study aimed to analyze the trajectory of this policy through official documents, focusing on the challenges related to health training and the impact of the hegemony of the biomedical model on the implementation of such practices. The study used descriptive documentary analysis and discursive textual analysis as data collection tools. Four documents were analyzed. The results showed that the most recent document details the trajectory of professional experiences with the practices, justifying the officialization of the policy. We identified the existence of a field of knowledge about practices before the regulation of the policy. However, the approach to teaching was considered incipient. The other documents analyzed presented only a description of the practices included in the policy. Encompassing the cultural dimension in teaching integrative and complementary practices can contribute to a diversified view of such practices in the Unified Health System, in order to break away from the scientific exclusivity of the biomedical model.
Article
The objective of the study was to analyze the guidelines for organizing work with the inclusion of digital technologies in the health sector, as presented in official documents from Brazil and Portugal. The document review, conducted in May 2024, included documents from the year 2011 onwards, resulting in 11 documents from Portugal and ten from Brazil. The findings indicate similarities in the regulatory frameworks of the two countries, including the process of semantic interoperability of information systems, electronic health record systems, the use of telehealth to support health and management decisions, and the promotion of electronic prescriptions. The differences are related to the definition of the support network for the implementation of technologies, as well as the use of artificial intelligence for epidemiological surveillance and triage and screening consultations in teledermatology within primary care units in Portugal. In Brazil, notable aspects include the institutionalization of the Digital Health Secretariat within the Ministry of Health and the establishment of the Digital Basic Health Unit in the context of Primary Health Care. By revealing the use of technologies to support practices, a thorough analysis of the documents can contribute to the implementation of public policies and to a democratic and inclusive digital transformation in both countries.
Article
This article discusses a proposal for the supervision of Primary Health Care workers who provide direct care to women in situations of domestic violence, through a space for debate on what they do and the emerging affections, considering issues of gender, women’s human and social rights. This proposal was part of an intervention research, offered after training on the subject in four Primary Health Care services in the municipality of São Paulo, Brasil, from 2020 to 2022. The technique used was participant observation with field diary records of monthly supervisions and semi-structured interviews with workers and managers. Through content analysis, the data was divided into the following axes: discussion of work - listening to women, gender perspective and human rights; the worker and her process; organization of work and teamwork; intersectoral network and organization of the supervision itself and the need for a framework. The supervision qualified theidentification and care of the cases, highlighting its dual character: monitoring care and critical reflection on ethical and political issues. It has an impact beyond the specific topic and is fundamental to the safety and practical success of the intervention, with management being essential in maintaining it. Supervision is advocated as part of Primary Care protocols for the care of cases of violence.
Article
The aim of the article is to conduct a historical analysis of the Federal Network’s role in offering technical health courses between 2017 and 2023, based on data obtained from the Nilo Peçanha Platform of the Ministry of Education. It starts from the inherent problematization of the low indicators of public sector participation in the training of health technicians, the curricularization of health through the pedagogy of competencies, and the advances of neoliberal policies that alter the relationships of human and professional training. The article is guided by the theoretical and methodological framework of historical and dialectical materialism, understanding that the relationship between work, education, and health constitutes a determination of social reality. The results corroborated the low participation of the Federal Network in offering technical courses and enrollments in health and the intense representativeness of the private sector. However, they revealed an important data point that endorses the political and social role of the Federal Network and, mainly, of the Federal Institutes: the continuous increase in the number of enrollments in integrated high school health education.
Interview
Eduardo Sá Barreto é professor associado no Departamento de Economia e no Programa de Pós-graduação em Economia da Universidade Federal Fluminense (UFF), e pesquisador do Núcleo Interdisciplinar de Estudos e Pesquisas sobre Marx e o Marxismo (Niep-Marx). Possui doutorado e mestrado em Economia pela UFF e graduação em Ciências Econômicas pela Universidade Federal de Minas Gerais (UFMG). É autor dos livros Ecologia Marxista Para Pessoas Sem Tempo (Usina Editorial, 2022); O Capital na Estufa: Para a Crítica da Economia das Mudanças Climáticas (Editora Consequência, 2019); Marxism in the Age of Ecological Catastrophe: Theory and Praxis (Editora Routledge, 2024); entre outros, com temas relacionados à crise ecológica, crítica da economia política, história do pensamento econômico e filosofia da ciência. Nesta entrevista, Eduardo aborda o ecossocialismo como contrapartida à crise do Capital.
Imagem: Larissa Guedes(EPSJV/FIOCRUZ)
Review
SOUZA, Henrique R. C.; SOUZA, Rolf M. R. (org.). Diálogos contemporâneos sobre homens negros e masculinidades. 2. ed. São Paulo: Hucitec, 2024. 243 p.
Review
MAIA, João R.; REIS, José R. F.; CRUZ, Leandra B. (org.). Pensar a loucura: trilhas literárias, culturais, históricas. Rio de Janeiro: Editora Fiocruz, 2023, 312 p.
Acknowledgements