Trabalho da Enfermagem na Atenção Primária em Saúde: aspectos do processo de trabalho no Brasil e na Espanha na crise estrutural do capitalismo

Abstract

This study investigates the work of nursing in Primary Health Care in the context of the structural crisis of capitalism, in a comparative perspective between Brazil and Spain. It analyzes the changes in the configuration of nursing work in Primary Care in Brazil and Spain, based on the flow of historical, political, and economic determinations of the structural crisis of capitalism, from the definitions of the organization of work in health and its respective influence on configuration of the nursing work process in Primary Care, from the perspective of social totality, that is, its social practice. It seeks to broaden the view of work in its concrete manifestation, seeking to capture the dialectical relationship between the macro-political and micro-political dimensions, in the predominant moment that we find ourselves in capitalism in crisis. The study analyzed framework documents from international organizations, mainly the World Health Organization (WHO), together with official data from the Ministries of Health and Professional Councils. In addition, it included immersion in health facilities in Brazil and Spain for data collection through participant observation, interviews, and a structured questionnaire. Immersion in the research field lasted from 1 to 2 months, in at least 3 health units in Spain and Brazil. A total of 63 nursing professionals (31 nurses and 32 nursing technicians/auxiliaries) in both countries participated in this stage. The research project received funding from the Institutional Internationalization Program of the Coordination for the Improvement of Higher Education Personnel (CAPES/PRINT) between the periods of January 2020 and March 2020; January 2021 and March 2021, period of the sandwich doctorate. Nursing is considered a central workforce for sustaining health systems in the context of demographic, epidemiological and technological transition at an international level. Nevertheless, the process of configuring the work of these professionals is permeated by productive restructuring in the health sector, as an effect of the structural crisis of capitalism, implying the commodification of public health services through administrative reforms of the State, health systems and care Primary. In this sense, it lists central aspects of the crisis for nursing work in three axes: "configuration of the nursing work process in Primary Care", "productive restructuring" and "crisis, manifestations in health and confrontation by nursing". The results point to common aspects in the configuration of the work process, precariousness, and intensification of nursing work in the countries, however, they point to the differences in the social division of work, intensities in labor exploitation and the workers' resilience to the advance of capital for the sector in Primary Care.