Burocracia a nível de rua e autonomia profissional: implementação de políticas públicas de saúde no trabalho de agentes comunitários de saúde no semiárido nordestino

Abstract

Introduction: The development of public policies involves a cycle - problem identification, policy formulation, decision/policy enactment, policy implementation, evaluation - necessary to understand the decisions taken and their consequences. In the implementation, planned decisions are consolidated into final actions. Street Level Bureaucrats (SLBs) are implementing agents responsible for the direct delivery of policies to citizens. In the Unified Health System (SUS), professionals from the Family Health Strategy are considered SLBs of reference in health actions. In the exercise of their functions, they use their professional autonomy as a strategy to meet the population's needs. Objective: The present study aimed to analyze how the Community Health Agents (CHAs) of a municipality in the Brazilian semi-arid region historically establish their professional autonomy as SLBs in their work routines. Methods: consists of an exploratory qualitative study that, through interviews using the Thematic Oral History method and content analysis (Bardin), allowed the construction of analytical categories associated with individual and collective dimensions and the environment of action of these workers. Results: The development of mechanisms of autonomy by CHAs in decision-making was observed when implementing public health policies. Conclusion: The performance of these SLBs can directly influence the implementation of these policies.