Análise do discurso oficial sobre a Estratégia Saúde da Família.

Abstract

The Unified Health System (UHS) is the result of political action by a movement recognized as the Brazilian Sanitary Reform Movement (BSRM), conducted within the scope of civil society. In 2017, the third edition of the National Primary Care Policy was published, under extensive controversy, establishing the review of guidelines for the organization of Primary Care in Brazil. The core of the controversy was the implantation process of the Family Health Strategy - FHS, mobilizing and sustaining the divergent meanings, of advance or regression, about the same phenomenon. The FHS received incentives and investments of different orders and expanded in different dimensions, which can be considered as one of the main health policies implemented from the UHS. However, in the historical process, since its launch, discourses have circulated that criticize the effective possibility of that strategy to promote a change in the healthcare model. The clash over the senses mobilized around the FHS is something complex since its institutional origin. Therefore, we believe that we are facing the historical contradiction of the CapitalLabour relationship, which, as such, mobilizes senses and meanings that can constitute a material force, within the scope of the class struggle, for its conservation (production and reproduction) or transformation (revolution). We carried out a study guided by the historical materialist method based on the Discourse Analysis (DA) of the French tradition, with the objective of analysing the effects of meaning on the ESF, at the origin of the development of the official discursive process in Brazil. We constituted a heterogeneous corpus composed of discursive sequences of the official discourse, mobilized by theoretical-analytical devices of DA, having as fundamental concepts/categories conditions of discourse production, Interdiscourse, Discursive Formation - DF and Ideological Formation - IF. The discourse studied was enunciated in a context in which the country was deepening its adherence to the neoliberal prescription economically and, also, deologically, after the period of great effervescence, in the throes of the military regime, especially in the late 1970s and until the mid-1980s; at the same time that it reorganizes the hegemonic system on and with the rubble of what collapsed with the democratic opening. The analyzes showed marks of fittings and articulations of interdiscourse processes that allow considering a discourse affiliated with the neoliberal discourse that has “Capital” as its Universal Subject, personified in the fraction of the Brazilian cosmopolitan bourgeoisie, in the expression of its contemporary development to the enunciation, the neoliberal. Such affiliation was expressed in the “reading” of the problem that was intended to be faced, “the structural crisis of the public sector”, therefore on the basis of the syllogistic support of the speech, almost as a “genetic determination” associated with the affiliation of the speech to the DF of the Ministry of State Reform. It is a discourse directed at the needs of the hegemonic system in reconfiguration, facing the contradictions “posed” by the MRSB discourse, in the debate on the development of health policies, in a context in which the State, in reform, implements a neoliberal economic model , oriented towards the shrinking of state public structures. “FHS” is configured as a paradoxical ideological object, acting in the Ideological Apparatus of Health to saturate the meanings related to the organization of health services, showing itself at the same time as a strategy for transformation and conservation of the care model The most immediate contribution of this study is perhaps to allow, for those organizations that recognize themselves as supporters of the Universal Right to Health under the aegis of the RSB project, strategic reconsiderations of movements in the ideological class struggle.