IT IS WITH GREAT PLEASURE AND JOY THAT WE PRESENT this special issue of the journal ‘Saúde em Debate’ of the Brazilian Center for Health Studies (Cebes), where it is possible to make available formulations and reflections, products of several years of experimentation in meetings between the people who are involved in the daily lives of health networks. Those meetings were provided by the course directed to the Primary Care Management of the Fluminense Federal University (UFF), which focused on daily policies as well as work micro-politics. We have always spoken of the idea that the ‘shop floor’ of health services, that is, the meeting place for users and workers, is a place where innovations germinate, through the creative power and force of health work itself. Supported by this conviction, we seek to bring to the debates the scenarios of practices, the multiple relationships at work, the daily exercise of care, all brought to the first production plan of the course. Thus, the courses became life laboratories in their daily activity of production of care.
The course has traveled throughout the Brazilian territory, it was invaded by various accents, experiences, of different realities, and the many faces of the huge Unified Health System (SUS) were present. It was the production of a multitude, which, in its multiplicity, brought to the scene what is common to all of us: the work of welcoming, caring, protecting the bodies that come to be cared for in health care networks. Care has the function of giving way to its powers.
With all the diversity present, we see that what we all have in common is caring. From this idea, we find the same grammar in the production of life, which directs the actions of work, whether linked to daily health care, or the processes of administration and management of health services for the same purpose, which is the defense of life whatever it may be. All work activities always converge to the same plan, which is the production of care11 Franco TB. Produção do cuidado e produção pedagógica: integração de cenários do sistema de saúde no Brasil. Interface (Botucatu). 2007; 11(23): 427-438..
The meetings we experience in health management blend with the care proposals drawn by the teams. In the daily routine of services, the intense production of ways of relieving pain, of building life-enhancing tools and therapeutic projects with the user is mixed with proposals for better service performance, health planning, and health indicators, that is, different regimes of producing truth22 Foucault M. Verdade e poder. In: Micropolítica do poder. Rio de Janeiro: Graal; 2004. are presented in a same scenario that calls for manager and worker to share the user’s life, carrying out, through this weaving, arrangements that highlight or not the multiplicities of existence.
Management and care conform important dimensions to be faced, mainly for subsuming ways of sustaining and expanding the life power in its production process. It is not a matter of applying concepts, but rather that they are experienced as tools capable of deepening and formulating questions that operate in the daily routine of services.
The defense of the production of subjectivities as a characteristic to be analyzed in the spaces in which management and assistance operate can be translated as a set of conditions that make it possible for individual and/or collective instances to be in a position to emerge as a self-referential existential territory, in adjacency or relation of delimitation with an alterity that is itself subjective33 Guattari F. Caosmose: um novo paradigma estético. 3. ed. São Paulo: Editora 34; 1992.. A procedural dynamic in which there are forces that establish relationships with other forces and with itself, producing processes of subjectivation; forces in relation.
Subjectivities that express themselves concretely and are materialized in the work, in the construction of ideas, in spreadsheets, protocols, in acts of care in the construction of bonds, in the construction of negotiations between professionals. Such materiality produces different arrangements and offers of assistance and management capable of either expanding or restricting access to health care in different care networks.
We make a bet that looking at this territory of production of subjectivity as multiple processes of production of life, management, and care incorporates a powerful source for thinking about the different problems inherent to these dimensions. Institutional movements constantly go through the generation, the management, and the care of health services. In the production of subjectivities, tensions are created and deserve to be analyzed insofar as they are identified.
The constitution of collectives based on models focused on shared experiences of management, dealing with dependency networks, makes it possible to trigger co-responsibility processes, promoting a way of managing that leaves room for the dynamics of singularization and, therefore, of autonomy of the subject involved44 Merhy EE. Em busca do tempo perdido: a micropolítica do trabalho vivo em saúde. In: Merhy EE, Onocko R, organizadores. Agir em saúde: um desafio para o público. 3. ed. São Paulo: Hucitec; 2007..
We can see, then, that it is not a matter of establishing hierarchies regarding the production of health constructed by the teams, nor even of taking them in opposition, since each process is composed of multiple directions and institutions that cross each other producing infinite encounters. Different paths are always crossing the plan of health management and production of teams. The continuous flow of the subjectivation process in which invention is present makes up the landscape. Approaching this territory requires tools that are able to, by penetrating between the molecules of management, assistance, analyzing their flows, provoke ‘pororocas’55 Abrahão AL. Produção de subjetividade e gestão em saúde: cartografias da gerência [tese]. Campinas: Universidade Estadual de Campinas; 2004. 190 p..
Proposing movements of analysis about the process that operates in the management and production of health teams is not a routine action that we identify in services. Quite often, what we find are conflicts from different sources and a low ability to confront them as matter: the generating. These are processes that agitate the life of the services that cut out the activities and call us for the analysis, an invitation that we almost always leave for later. These are points that agitate our process of operating through the various logics established as analyzers. Taking the daily work in its different networks and forms of care and management requires an exercise of looking at the use of technologies that are incorporated in this process in their different dimensions: operative, political, communicational, symbolic, subjective.
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- 1Franco TB. Produção do cuidado e produção pedagógica: integração de cenários do sistema de saúde no Brasil. Interface (Botucatu). 2007; 11(23): 427-438.
- 2Foucault M. Verdade e poder. In: Micropolítica do poder. Rio de Janeiro: Graal; 2004.
- 3Guattari F. Caosmose: um novo paradigma estético. 3. ed. São Paulo: Editora 34; 1992.
- 4Merhy EE. Em busca do tempo perdido: a micropolítica do trabalho vivo em saúde. In: Merhy EE, Onocko R, organizadores. Agir em saúde: um desafio para o público. 3. ed. São Paulo: Hucitec; 2007.
- 5Abrahão AL. Produção de subjetividade e gestão em saúde: cartografias da gerência [tese]. Campinas: Universidade Estadual de Campinas; 2004. 190 p.
- Publication in this collection
10 July 2020
- Date of issue