Unidades Básicas de Saúde Prisionais: estratégias e práticas no SUS para o cuidado de pessoas privadas de liberdade no Complexo Penitenciário da Papuda – DF

Abstract

The population deprived of liberty in Brazil is among the largest in absolute numbers when compared to other countries, with 849,860 people serving sentences in 2024 (SISDEPEN, 2024). Providing access to quality, dignity, and equitable healthcare for people deprived of liberty is a challenge for the Unified Health System, especially respecting the principle of equivalence, in which the provision of services for this population must have acceptable levels and be compatible with those offered to people at liberty. Intersectoral coordination between health, security, and justice is essential for organizing these networked healthcare services in prison establishments. The aim of this study is to discuss the strategies and practices of health work in the prison subsystem of the Papuda Penitentiary Complex, in the Federal District, in order to understand how workers in the Prison Basic Health Units (UBSP) seek ways to strengthen health care and network articulation, as well as to reveal the challenges that emerge in the daily routine of this work for the implementation of comprehensive care as a right to health. This is qualitative exploratory research, whose data collection techniques were: review of national and international literature on Prison Health, Health Work and Comprehensiveness and Primary Health Care; use of focus groups (FG) with teams from the Prison Basic Health Units of the Papuda Penitentiary Complex, Federal District; semi-structured interviews (ESE); and Participant Observation (PO). The use of health narratives was used as a support element for participant observation. To interpret the collected data, the Content Analysis methodology was used, in order to dialogue with what emerges from the research field with evidence already produced in the field of prison health. Documentary and policy analysis were useful tools to relate guidelines present in prison health policies (prescribed work) with elements of the daily life of services and teams (work in action). The analysis of the results included document analysis, analysis of policies on the prison health system and content analysis of the collected data. The categories used for analysis were: access, coordination of care, comprehensiveness, longitudinality, family, interpersonal relationships and connections, territory, culture and community and mental health. It was observed that prison health policies at the national level and in the Federal District allow institutionalization and organization of joint actions between the Penitentiary Administration Department (SEAPE) and the Health Department (SES-DF), allowing support to the work process of the health teams of the Papuda Complex. Communication with the points of the care network is challenging and can be improved. There are points to be explored by health teams in the provision of care, such as case management, the use of singular therapeutic projects, the expansion of collective and intersectoral actions, the expansion of integrative and complementary practices, with a view to comprehensiveness and demedicalization. The territory is complex, full of vulnerabilities and institutional restrictions, in addition to intersections in the interpersonal relationships between professionals and patients due to the condition of deprivation of liberty. It is believed that the present study gives visibility to prison health care practices forged in daily life and can provide subsidies for the improvement of useful policies and practices for the better performance of the health system for the population deprived of liberty in the Federal District and in Brazil.