Política nacional de atenção à saúde dos povos Indígenas : origem e mudanças

Abstract

This dissertation is a case study about the National Policy of Health Care of Indigenous Peoples (PNASPI), which aims to understand the inclusion of this issue in the Brazilian government agenda, its formation and its implementation. The research was undertaken through documentary analysis (relevant legislation, official documents and reports) bibliographic analysis (research by anthropologists and public health specialists were used) as well as the analysis of interviews. In-depth interviews were conducted with actors selected for their experience and knowledge of the topic, being: indigenous, managers and health professionals from different Special Indigenous Sanitary Districts, in addition to employees and former employees of the National Indian Foundation (Funai), the National Health Foundation (Funasa), the Special Secretariat for Indigenous Health (Sesai) and the Ministry of Health from Special Health Secretariat. The analyzed processes are understood as interdependent and without very precise temporal delimitation, but for didactic purposes they have been separated into two moments (emergence and implementation) and under the light of different theories. In the agenda setting and in the formation of PNASPI, the first state actions aimed at indigenous health were analyzed within the scope of the Indian Protection Service (SPI), passing by the Funai and the Funasa, from the theoretical perspectives of John W. Kingdon's Multiple Flow Model and the Punctuated Equilibrium Model developed by James L. True, Bryan D. Jones and Frank R. Baumgartner. The results found in this research’s part are the description of the process by which the health of indigenous peoples became a public policy, the identification of the institutions and actors involved, the construction of the image of the differentiated health policy of indigenous peoples and the prevailing political conditions, historical context and “national mood”. In the implementation, it is understood that PNASPI is still in political dispute and there is a constant process of reformulation, through institutional changes that have not stopped. Theoretical arguments of the Institutional Arrangement and Policy Instruments, by Roberto Pires e Alexandre Gomide, the Implementation Network, by Pedro Luiz B. Silva and Marcus André B. Melo, and the Policy Execution Interactive Model, by Merilee Grindle and John W. homas, supported the analysis, being refined due to the peculiarities of this study of case. It is concluded that the constitution of PNASPI and its persistence in the government agenda are due to the effective participation of indigenous peoples in health councils and conferences and its acting in the different forms of claim mobilizations. In addition, institutional changes have either been in the direction of giving concrete form to the proposal for a differentiated policy for indigenous peoples, and, in the opposite sense, promoting the integration of indigenous peoples with the rest of Brazilian society, ignoring Brazilian multiculturalism.