Territory and health large technological system: the phytotherapy programs in the Unified Health System (Sistema Único de Saúde)

Author(s)

Luis Henrique Leandro Ribeiro

• Document type: Doctoral Thesis
• Press: Campinas, SP.
• Institution: Universidade Estadual de Campinas (UNICAMP). Instituto de Geociências
• Defense date: 2015-06-26

Examining board members

Márcio Antonio Cataia; Catia Antonia da Silva; Nelson Ibanez; Raul Borges Guimarães; Fabricio Gallo

• Advisor: Márcio Antonio Cataia

Abstract

Since a long time ago, medicinal herbs have been used in Brazil, coming from indigenous, African and European practices, which are the matrix of popular medicine in Brazil. In the second half of the twentieth century, there is a global appreciation movement of new uses for medicinal herbs that contributed to the diffusion of traditional, complementary and alternative medicine, among them, phytotherapy, in Brazil in the 1980s. In the 1990s, after the creation of the Unified Health System (SUS), the number of municipal programs of phytotherapy increases, which has been intensified since 2006, dude to the National Policy of Medicinal Herbs. How does the territory determinate the existence of phytotherapy programs in SUS? In which manner the SUS integrates the several practices and health subsystems, among them, phytotherapy? We intend to analyze how the territory in use determine the existence of the phytotherapy subsystem in the SUS and how it promotes a major technical synergy (local knowledge and universal knowledge) and policy (strategy and actors) in the production, circulation, distribution and dispensation of medicinal herbs by the SUS, under the perspective of the critical geography. The research involves: bibliographic, conceptual and thematic revision; document analysis; primary and secondary research; fieldwork with semi-structures interviews conducted in Concentrated Region, Central -West, Northeast; and Amazon Region, contemplating 24 municipalities in eight states and three administrative divisions of Federal District, totalizing 81 interviews. A number of 14 phytotherapy programs were selected under the following criteria: representative programs, with visibility and reference, of the different modes of production and dispensation of medicinal herbs; programs in large municipalities (capital and metropolitan area); and small municipalities (or associated small cities) with their own programs. We managed to identify two phases on the diffusion of phytorerapy subsystem in SUS: one that preceded the National Policy, in which the programs were permeated by the popular systematic; and a second phase that became after the National Policy, whit a more accentuated growth on the number of the programs, which tended to have the prevalence of the binomial biomedicine / medical-industrial complex. Diffusion marked by conflicted relations and cooperation between the drag power of large technological system and the popular systematic. We verified also that the Brazilian health large technological system is at the same time centralized and decentralized, product and producer of geographic situations which restricts and are restricted by the phytotherapy programs, different combinations between: circulation movements and global impulse in appreciation of the phytotherapy (verticality); and forces of the regional iconographies of popular uses (horizontality). We defend there is a health large technological system in Brazilian, in which the main structural strength is the SUS, as it meets the requirements of a large technological system: integrates a wide and diversified material bases and organizes and manages the distribution of the fluxes of such base. Beyond these attributes, we identified two other which turn it into a specific and distinct: great awareness to the specificity of the places; political and technical centralization and decentralization of actions and services (AU)

• FAPESP's process: 11/12491-3 - Territory use and municipalization of the pharmaceutical assistance politics of the Unified Health System (SUS): the analyses of the phytotherapy and herbal medicines in the Brazilian regions
• Grantee: Luís Henrique Leandro Ribeiro
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)