Abstract
Abstract Objective: To understand the constitutive elements of the work process and care production in an Indigenous Health Support Service. Methods: Case study. Systematic observation and semi-structured interviews were conducted in January and February of 2012. The participants were 10 nursing professionals of an Indigenous Health Support Center, located in Mato Grosso do Sul state, Brazil. The work process was used as a conceptual and analytical category. Results: Through interpretative analysis, the data were organized into three categories. The results showed that care production was focused on procedures and guided by rigid institutional rules and bureaucracy. The prioritization of institutional rules and procedures was detrimental to the provision of person-centered care. Conclusion: The temporary employment contracts and rigid bureaucratic organization generated a tense work environment. These aspects do not maximize the efforts of the nursing staff to provide person-centered care.
Highlights
Contact with surrounding societies over time has inserted indigenous peoples into contexts permeated by interrelated environmental, cultural, and epidemiological impacts.[1,2,3] In Brazil, indigenous societies continue to experience the consequences of historical intervention from European colonization
Together with the lack of guidance of some municipal managers and political and economic interests, have led to an increase in recruitment through partnerships with non-governmental organization, and cooperatives.[28]. The effects of this recruitment context are enhanced in the indigenous healthcare system, as the Brazilian government has transferred actions related to indigenous healthcare to the private sphere with little or no regulation.[4]. These findings indicate that, for indigenous health services, the state does not mean "public"; the private service and its logic can be predominant in the public indigenous services.[29]
The work process arrangement impacted the quality of care provide by nursing staff at the indigenous health center
Summary
Contact with surrounding societies over time has inserted indigenous peoples into contexts permeated by interrelated environmental, cultural, and epidemiological impacts.[1,2,3] In Brazil, indigenous societies continue to experience the consequences of historical intervention from European colonization. The result is their social marginalization, in relation to access to public health services.[2,3,4]. Healthcare for indigenous populations is affected by cultural, social, historical, economic, and political factors. At healthcare centers, the quality of the provision of care is affected by the organization of the work process, such as the technological material and non-material instruments, the type of work contract, the professional training, the flexibility of work rights, and the technical division of the labor.[9,10]
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