Dental care for persons with disabilities: discretion on the frontline

Authors

DOI:

https://doi.org/10.11606/s1518-8787.2023057005318

Keywords:

Public Policy, Dental Care, Disabled Persons

Abstract

OBJECTIVE: To depict the influence of discretionary actions exercised by frontline professionals and organizations on the implementation of diverse modalities of access to specialized dental care within the Care Network for Persons with Disabilities. METHODS: A case study conducted in two Brazilian health regions characterized by distinct means of access to specialized dental care employing documentary analysis and interviews with key stakeholders across the period spanning from July to December 2019. RESULTS: In the referenced access region, there was a notable centrality of Primary Health Care (PHC) in caregiving, wherein planning and assessment were integral components of institutional routines. Where spontaneous demand scheduling was accepted, sporadic exchanges of information were evident between PHC units and specialized facilities. The coordination role in caregiving was not vested in PHC teams, and activities such as planning and assessment were not assimilated into organizational routines. CONCLUSIONS: The implementation of policies for specialized dental care for persons with disabilities relied on the coordination furnished by PHC and the orchestration of planning and assessment endeavors aimed at establishing an integrated care network. This implementation proved subject to the discretionary authority of frontline professionals and organizations, highlighting the significant role of relational and institutional environments in the context of public policy implementation within a decentralized and regionalized healthcare system.

References

Guimarães L, Giovanella L. Entre a cooperação e a competição: percursos da descentralização do setor saúde no Brasil. Revista Panamericana Salud Pública, 2004; 16(4). https://doi.org/10.1590/S1020-49892004001000012

Lipsky M. Burocracia do nível de rua: dilemas do indivíduo nos serviços públicos. Brasília, DF: ENAP; 2019.

Hupe P. Dimensions of discretion: specifying the object of street-level bureaucracy research. Z Public Policy. Recht Manag. 2013 Dec;6(2):425-40. 0168-ssoar-59188-7.

Lotta G. Teorias e análises sobre implementação de políticas públicas no Brasil. Brasília, DF: Enap; 2019.

Loyens K. Networks as unit of analysis in street-level bureaucracy research. In: Hupe P, editor. Research handbook on street-level bureaucracy: the ground floor of government in context. Massachusetts: Elgaronline; 2019.

Lotta G. Burocracia, redes sociais e interação: uma análise da implementação de políticas públicas. Rev Sociol Polit. 2018;26(66):145-73. https://doi.org/10.1590/1678-987318266607.

Mota AG, Frazão P. Street-level implementers of population-based oral health policies: the case of water fluoridation supply in Brazil’s small towns. Community Dent Health. 2021 Aug;38(3):187–91. https://doi.org/10.1922/CDH_00332Mota05

Viana AL, Bousquat A, Ferreira MP, Cutrim MA, Uchimura LY, Fusaro ER, et al. Região e redes: abordagem multidimensional e multinível para análise do processo de regionalização da saúde no Brasil. Rev Bras Saúde Mater Infant. 2017;17 Supl. 1:S17-26. https://doi.org/10.1590/1806-9304201700s100002

Carneiro JD, Bousquat A, Frazão P. A implementação da rede de cuidados à pessoa com deficiência no âmbito da saúde bucal a partir do modelo de coalizão de defesa em duas regiões de saúde no Brasil. APGS. 2022 abr-jun;14(2):1-17. https://doi.org/10.21118/apgs.v14i2.12731

Figueiredo N, Goes PS, Martelli PJ. Os caminhos da saúde bucal no Brasil: um olhar qualie quanti sobre os Centro de Especialidades Odontológicas (CEO) no Brasil. Recife: Editora UFPE; 2016.

Yin RK. Estudo de caso: planejamento e métodos. 2a ed. Porto Alegre: Bookman, 2001.

Viana AL, Bousquat A, Pereira AP, Uchimura LY, Albuquerque MV, Mota PH, et al. Tipologia das regiões de saúde: condicionantes estruturais para a regionalização no Brasil. Saude Soc. 2015;24(2):413-22. https://doi.org/10.1590/S0104-12902015000200002

Bardin L. Análise de conteúdo. São Paulo: Edições 70; 2016.

Jagannath HP; Street-level collaboration. perception, power, and politics on the frontlines of collaboration. Int J Public Sector Management. 2020;33(4):461-76. https://doi.org/10.1108/IJPSM-07-2019-0194

Souza GC, Sousa Lopes ML, Roncalli NG, Medeiros-Júnior A, Clara-Costa ID. Referência e contra referência em saúde bucal: regulação do acesso aos centros de especialidades odontológicas. Rev Salud Publica (Bogota). 2015 May;17(3):416-28. https://doi.org/10.15446/rsap.v17n3.44305

Dubois V. Políticas no guichê, políticas do guichê. In: Pires RR, editor. Implementando desigualdades: reprodução de desigualdades na implementação de políticas públicas. Brasília, DF: IPEA; 2019. p. 105-25.

Freeman T, Baum F, Javanparast S, Ziersch A, Mackean T, Windle A. Challenges facing primary health care in federated government systems: implementation of primary health networks in Australian states and territories. Health Policy. 2021 Apr;125(4):495-503. https://doi.org/10.1016/j.healthpol.2021.02.002

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Published

2023-09-29

Issue

Vol. 57 No. 1 (2023)

Section

Original Articles

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Copyright (c) 2023 Joana Danielle Brandão Carneiro, Ana Paula Chancharulo de Moraes Pereira, Aylene Bousquat, Paulo Frazão

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This work is licensed under a Creative Commons Attribution 4.0 International License.

How to Cite

Carneiro, J. D. B., Pereira, A. P. C. de M., Bousquat, A., & Frazão, P. (2023). Dental care for persons with disabilities: discretion on the frontline. Revista De Saúde Pública, 57(1), 74. https://doi.org/10.11606/s1518-8787.2023057005318

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