Trabalho e educação de profissionais da Atenção Primária durante e após a pandemia de COVID-19: análise comparativa entre Brasil, Portugal, Espanha e Itália

Abstract

This doctoral thesis investigates Permanent Health Education (PHE) within the work processes of Primary Healthcare (PHC) professionals, comparing the realities of Brazil, Portugal, Spain, and Italy during and after the COVID-19 pandemic. The research delves into the analysis of social and political forces in dispute within PHC, examining their implications for workers' PHE. The study is grounded in the Historical-Dialectical Materialism (HDM) framework, seeking to capture within the macro and microstructural dimensions the historical-political-economic determinations of the structural crisis of capitalism, which influence the work and education of PHC professionals. The adopted methodology was organized into three complementary paths. The first involved a scoping review to map existing production on the research topic, along with documentary analysis of regulatory norms from the participating countries. The second path included technical visits to health services, utilizing the technique of participatory observation, accompanied by active professionals in the services. Finally, the third path consisted of conducting individual semi- structured interviews with PHC professionals. The Critical Discourse Analysis (CDA) of 49 normative documents (11 from Brazil, 14 from Portugal, 14 from Spain, and 10 from Italy) and 95 interviews with health workers (51 from Brazil, 13 from Portugal, 15 from Spain, and 16 from Italy) resulted in the identification of 13 representative analytical discourse categories, distributed into two major groups: 8 textual analytical categories, encompassing linguistic and semantic aspects of the statements, and 5 ideological and discursive categories, related to the meanings produced in the discourse. Based on this analysis, the thesis results are organized into four thematic categories: (I) The political macrostructures that guide the work and education of Primary Healthcare workers in Brazil, Portugal, Spain, and Italy; (II) Discursive practices of Primary Healthcare professionals regarding permanent and continuing education processes in pandemic and post-pandemic contexts in Brazil, Portugal, Spain, and Italy; (III) Work and Education in Primary Healthcare: Continuities and Ruptures; (IV) Between normative and worker discourses on Permanent Education in Primary Healthcare: Ruptures between Proposal and Execution. Based on these categories, the thesis asserts that the COVID-19 pandemic acted as a historical catalyst, driving transformations in PHE practices within PHC. The antithesis, dialectically revealed, manifested in the subordination of training to the logic of capital. The resulting synthesis is a scenario of contradictions, where the construction of more effective policies and the preparation of National Health Systems (NHS) for future crises require the State to move beyond rhetoric, seeking the objective and material guarantee of educational actions, thus preventing the subordination of human development to the imperatives of accumulation. The struggle for a Permanent Education with a radically transformative character is, fundamentally, a struggle for the des-alienation of labor in health.