Location: BP E , Avenue de l’oua villa B5 Porte , Faladié Sokoro, Bamako . , date “On the approval of the tariffs for the services Decreto Nº /39 (Presentación a depósito en custodia de las obras inéditas ). Method: Integrative literature review using the descriptors: street people, health policy and Objetivo: Conocer la producción científica brasileña de los últimos diez años ( a ) sobre las Decreto n0 de dezembro de . Available from: pdf. Camabatela – At least citizens of both genders were taught to read and write between and , in the municipality of Ambaca, northern Cuanza.
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To know the Brazilian scientific production of the last ten years to about people who experience street situations under the health gaze. Integrative literature review using the descriptors: We analyzed 21 articles available in the Virtual Health Library. Four categories of analysis emerged. There was an increase in the frequency of published work on the subject, showing that the experience of living on the decreti makes people vulnerable to various diseases and health problems and, in addition, increases the difficulties of access to health services.
There was an increase in the discussion of this topic due to the increase in the number of published studies.
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Despite the existence of public health policies directed to this social group, much still needs to be done to guarantee the health of this population. The population living on the street has been increasing for several reasons, such as: This population includes people excluded from the conventional structures of society, people who have less than what is necessary to meet the basic needs of the human being, who live in the line of indigence or absolute poverty, who live in extreme poverty and their survival is often compromised 1.
The existence of the population living on the street is a social phenomenon that is assuming new expressions in contemporary societies, particularly in urban centers. This social group that is marginalized by society has housing as public or philanthropic places and shelters, and also experiences working situations, living conditions and precarious social insertions.
The lack of conventional housing is not the only problem experienced by the people who belong to this group, this situation affects the commitment of other important socioeconomic factors, such as identity, security, physical and emotional well-being, feelings of belonging and roots 2.
There is little homogeneity in this group, since the main differences between its components are related to life trajectories, length of stay on the street, survival strategies adopted, gender relations and dynamics of the inhabited territory itself 3.
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These excluded and marginalized groups seek the central regions of the cities to live in because these places generally offer greater facilities for living on the streets, such as commercial areas or areas with a greater concentration of services, the great circulation of people and the few residences 2.
People living on the street sometimes do not have precise chronological time of staying on the street, but the going to the street is almost always marked by an unforgettable event for those who lived it, which is rarely commented, even with people of conviviality.
Taking as a parameter the length of stay on edcreto street, the relationship with this context of life and the family ties, the population living in a street situation can be classified into three different situations: In the past, there was deecreto speech of invisibility and absence of the State in the problematic of the population living in the street situation. Currently, there are several public policies focused on this segment.
However, it is worth questioning the commitment of the State to implement the actions that are assured by laws and guidelines. In addition to the principles of universality, equality and equity, this Policy is based on respect for dignity of the human person, 20007 right to family and community coexistence, valorization and respect for life and citizenship, humanized care and respect for social conditions and differences of origin, race, age, nationality, gender, sexual and religious orientation, with special attention to people with disabilities 5.
According to the PNPSR, the population living in a street situation is defined as a population group that has in common extreme poverty, broken or fragile family ties, and the lack of regular conventional housing, using public places and areas degraded as a place of living and livelihood, temporarily or permanently, as well as the host units, for temporary overnight or as temporary housing 5. The aforementioned Ordinance was important because it defined the guidelines for the operation and organization of the Office on the Street team OSta structure that integrates the basic care of the Psychosocial Care Network and develops Basic Health Care actions according to the foundations and guidelines defined in the National Primary Health Care Policy.
According to this Ordinance, OSt must be multiprofessional and deal with the different health problems and needs of the street population, including active search activities and care for users of alcohol, crack and other drugs 6. Due to the increase in the number of people living on the streets and the recent structuring of guidelines, services, teams and actions aimed at the health care of this population, this study aimed to know the Brazilian scientific 9480 of the last ten years dedreto about people who experience street situation from the health point of view.
A bibliographical review was carried out, applying the integrative analysis on the aspects related to the health of decrdto living in the street. For the development of this study, the six xe that compose the elaboration of an integrative review were: The guiding question of this research was: Data collection took place in Dd The criteria used for the selection of articles were: Articles related to decrwto, adolescents and the elderly were excluded due to their specificitiesthe repeated works and those that did not serve the decreho of this research.
Initially, the studies identified using the three descriptors were selected by reading the title.
In this stage, only the articles that addressed the theme of this study and those that were published during the defined period were selected; and repeated articles were excluded.
Subsequently, the abstracts of the works were read, excluding those that were not fully available on the Internet and those that fe children, adolescents and the elderly. Thus, 21 scientific articles were analyzed in this study. The flow chart presented below outlines the course of the bibliographic survey adopted by the researchers for the elaboration of this research.
For the analysis of the bibliographical material, two researchers carried out the reading of ddcreto articles in their entirety and, from that moment, a form was elaborated that contemplated information regarding the year of publication, title, periodical, objective and type of study. A total of 21 scientific papers published in national journals were analyzed and related to the health of people living in the street.
The table below shows the empirical material used to carry out this research, second year of publication, title, periodical, objective and type of study. Through the analysis of the Brazilian scientific production on the aspects related to the health of people living in the street, four categories of analysis emerged: Different reasons have been cited that impede or delay the demand for a health service, such as prejudice and discrimination related to hygiene conditions, which is hampered by the use of dirty clothing, lack of bathing, foul smell, and the lack of documentation 49800 identification and registration of the user and the long waiting period for the service 8 – People who live in a ds situation are also victims of prejudice when they seek a health service and are faced with the unpreparedness and inability of health professionals to perform qualified listening and the reception of the health demands and needs of this population, as well as when the hygienic actions that occur in public spaces and that disregard the dignity of life and human rights The participants of this research reported that they suffered discrimination by society not only due to the precarious hygiene conditions, but also by the physical and mental incapacity of some homeless people and by racial prejudice fecreto.
Thus, the health of these people is even more compromised because they violate the principles of universality of access to health services, equity in access to health services and services, and integral care. By using the public spaces as places of dwelling, a new phase of the life of these people begins, a phase that is different from the previous way of life.
The attempt to understand the narratives of experiences of this population is a challenge because, while some individuals report the suffering of living on the street, the yearning for transformation of reality and return to domestic life, others say that they have become accustomed to the daily life on the street and wish to continue Several reasons try to explain the reason why people start to live on the streets, making a situation of exclusion from the conventional structures of society.
The search for freedom, family maladjustment, dependence on alcohol and illicit drugs, the presence of mental illness, migration, unemployment, extreme poverty and amorous delusion are some of the reasons reported in the literature that cause people to seek the street as a place of residence 9 – 10 The overlapping of some of these reasons makes up the life trajectory of these people and joining the streets is almost never a personal option, but rather the lack of better alternatives.
A study that investigated the meanings and practices associated with the health-disease process of street people identified that the main health problems of this group were: Health was associated with the capacity to withstand everyday difficulties while the disease was understood as a state of weakness that compromised the struggle for survival The lack of knowledge of the disease and the absence of a relative or other person to receive them, coupled with prejudice, have made these people believe in the proximity of death.
Discrimination stemming from the stigma of diseases was pointed out as more frequent because they were in a street situation Because it is a socially determined disease, tuberculosis affects the population living on the streets more frequently. It is observed the difficulty of adherence of this group to the treatment, which compromises the control of the disease, which is directly related to the living conditions of the people, resulting from social inequalities.
Therefore, this reflects the state of poverty, the poor quality of the organization of the health system and the deficiencies of management, limiting the action of the technologies and, consequently, making difficult the control of diseases marked by the social inequality, showing the level of development in which is the country The care provided to people with tuberculosis and who are in a street situation is a challenge due to the difficulties in dealing with the reality of a deplorable social context and the inadequacy of services, as well as limitations involved in care Although there is knowledge available for diagnosis, treatment and cure, syphilis is considered a public health problem in this population as well.
The authors pointed out the need to reinforce actions for their control through screening, diagnosis and early treatment strategies, with a view to reducing their occurrence in this vulnerable population The articles referring to mental disorders in this population are related to obstacles to access to mental health services, attributed to the conditions of deprivation of rights and vulnerabilities faced, which hinder or delay the care and psychosocial rehabilitation.
In addition, other barriers related to the work process of health professionals are highlighted, such as problems in the organization and initiative for active search work and difficulty in adequately hosting psychosocial care centers 18 – The street situation does not guarantee basic living conditions and, when coupled with daily suffering and lack of better perspectives, this situation can lead to loss of self-esteem and, consequently, a lack of concern for self-care 4.
On the other hand, a study with people living in the street and suffering from socially stigmatizing diseases showed that the impact of the diagnosis provoked reflections on life, death and the need for care.
Despite the extreme vulnerability that street life imposes and of harmful health habits, such as the abusive use of alcohol and other drugs and the greater exposure to violence from trafficking, once the person has learned that was suffering from a serious illness, her perception of the proximity of death led to changes in attitude and lifestyle.
Thus, the study found that the interviewees overcame the disease impact stage and overcame the adversities they faced, bringing a new meaning to their lives The analysis of the selected articles showed that several studies that addressed the issue of the health-disease process in a population living in a street situation pointed not only to the diseases to which this population is susceptible, but also to the health problems manifested by violence, chemical dependence, homicides, run-ins, among others.
The problem of abusive use of licit and illicit substances by the population living in a street situation is frequent. The consumption of psychoactive substances is often before the life on the street and this dependence accompanies the person because it is a way of being able to withstand the difficulties faced in the street Violence is also a frequent grievance in the daily lives of these people.
A study conducted in Salvador-BA revealed that this is a phenomenon of concern on the part of people who lived on the streets, especially at night. The fear of night-time attacks was reported by several respondents, who reported sleeping in a group or only during a time of clarity because they considered it safer A research that sought to bring to the reflection the occurrence of violence in the life of women in a street situation showed that there is a relationship with drug use, insufficient income and rupture of family ties.
The street was reported as the only alternative found to escape domestic violence. The main forms of violence mentioned in the literature were: Another type of violence aimed at cleaning public spaces, being practiced by police or people hired by merchants and people who felt uncomfortable by the presence of this population. The authors argue that the complexity of the street situation for women points to the need to broaden the concept of care with a focus on interdisciplinarity and intersectoriality In this proposal, the team should provide assistance in the territory and act in an integrated way with other segments of the community to favor the channels of dialogue, creating links and shared commitments.
This policy allowed the expansion of access to basic care services through specific work, work in the public places and reception centers, establishment of bond and integrality of care 2.
Another article presented the experience of an event aimed at discussing the causality and complexity of the street population. The discussions were carried out in working groups, namely: Several proposals have emerged for the topics addressed, such as: The authors advocate that problems related to the street situation should be discussed by all sectors of society, since they are political, economic, cultural and social A research that sought to understand the interface between public policies and the health care of the street population focused decreyo a neglected disease, in the case of tuberculosis, pointed out that people living on the street with the disease form a stigmatized group and excluded that is marked by intense social suffering and also experience the duality between sanitary technical action and mechanisms of social isolation.
In this sense, health work must incorporate 22007 construction of a knowledge that understands the complexity of health issues and, thus, create unique strategies for each case based on the knowledge of the way of living on the street and health demands and needs specific group A study that addressed the problems and barriers that presented in the integral care of populations in ce street situation in the center of Rio de Janeiro-RJ brought important considerations.
For example, despite the institution of the National Policy for Health Care of People Experiencing Street Situation, a delay in compliance with the principles and guidelines of said policy in the city was identified.
Regarding the functioning of the health care network, it was pointed out the fragile intersectoriality between the policies and the poor integration between the services of the city, which prevented satisfactory care and the realization of social rights.
Faced with this reality, challenges were imposed on managers and technicians to develop collective actions and seek work strategies that focus on the differences, relationships and potential of the subjects, giving them visibility An integrative review that sought to identify issues cecreto to the characterization of the street population, their needs and the existence of public policies pointed out that the debate on policies directed at street people is scarce. It is important to draw up social policies consistent with the needs of this population and to take into account the ethical principles recommended by the Unified Health System SUS It is expected that the prejudice and stigma directed at the population living in the street situation will diminish, and decrdto providing assistance to this population will no longer be the exclusive assignment of the office staff on the street, opening up directions of commitment to be built by all professionals For this, new approaches and restructuring of the work process in health care of this population are necessary, introducing formulations about the equity in access to health services 2.
Although the Federal Constitution guarantees health as a right of citizenship and the duty of the State to be guaranteed through economic and social policies, there are several obstacles for people living in 49800 street to access health services, such as difficulty in getting around, lack of perspective with the future, which compromises health care, the fear of suffering prejudice and stigma, and the lack of capacity of professionals to receive and provide care to this population.
Despite the existence of a public policy aimed at this population, because it is a relatively recent policy, much still needs to be done to ensure access to care and health. The challenge of empowering health professionals to welcome the person in a street situation as a subject of law and bearer of a singular life trajectory and thus to meet their dwcreto is highlighted. The dynamics of care must be understood, taking into account the needs imposed by street life, the establishment of links between the street staff and street people, and the overcoming of distancing due to social discrimination that hinders the accessibility of this street population to health services Despite the advances made by public policies for street people, it is necessary to prevent the contradictions that occur in the state apparatuses themselves.
It is necessary to walk in the production of bonds, in understanding the needs of these people and in the construction of alternative care and life outside the streets, whenever this is desired. It is a care proposal that extends the accessibility and quality of care to the population living on the street and, in doing so, works in partnership decretk the basic health units and the Psychosocial Care Centers CAPS.
It is oriented to seek alternatives to the growing and complex demands present in the context of the street, by offering not only health care, but also the guarantee of rights as a citizen