Transformações no trabalho dos agentes comunitários de saúde nos anos 1990-2016: a precarização para além dos vínculos

Abstract

In this study we discuss the process of precarization of the work of the Community Health Agent (CHA) - a worker who operates in the Family Health Strategy (FHS), within the Unified Health System (SUS) -, and whose work was fundamental for the expansion of the right to health, in the last thirty years, in Brazil. In our understanding, the phenomenon of precarization, predominantly addressed in the health field as regards the regularity of contracting forms and the guarantee of the rights associated with work, transcends the contractual relationship and encompasses several dimensions of the life of the man-who- works. The research has developed through two movements: the comprehension of the theoretical basis on the social precarization of work and the composition of the analytical categories and the analysis of the empirical material. The empirical work covered the identification and analysis of the political documents of the Primary Health Care, with inflections about the work of the CHA, or that have as specific object their work, and the analysis of the material resulting from interviews with nineteen CHA, about the conditions under which they carry out their work activities, and the recording of field observations. The CHA interviewed were from eight northeastern municipalities: Laje (BA); Tauá and Maracanaú (EC); São Mateus do Maranhão (MA); Abreu e Lima, Garanhuns and Recife (PE); Piripiri (PI). We perceive that the work of the agents has been transformed both in the normative plane of the prescribed work, and in practice, in the real work plan. We conclude that the changes that have been changing the scope of attributions and practices of the CHA are related to changes in the hegemonic conceptions about the attention model and the principles of the SUS. They express the diffusion of rationality and managerial practices in health services, that have produced suffering and subtracted power from the work of the agents. We confirm our hypothesis that the process of de-precarization of work, by limiting itself to the questions related to the regularization of the forms of hiring, does not elide the problem of the social precarization of the work of the CHA, conditioned by other determinations proper to the work process in the field of social policies, configured from capitalist sociability. Recently, since the political-legislative coup, started in 2016, the regressive meaning in relation to the work of the CHA has deepened, following the privatizing offensive against the SUS and the right to health