FORUM

Forum: comprehensiveness from the perspective of health training, practices, and evaluation

Virginia Alonso Hortale

Departamento de Administração e Planejamento em Saúde,Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
virginia@ensp.fiocruz.br

Since the 1980s, and more recently with the implementation of the Unified National Health System in 1990, the term integralidade (integrality, or comprehensiveness) has been used in Brazil with various hues: as a linkage between different tiers in health services provision, as integration between the public and private sectors, as an important guideline in services management, and as a proposal for the health care model. Dicionário Aurélio, the standard Brazilian Portuguese-language dictionary, provides only proximate terms for its definition: integral as an adjective (total, whole, global); to integrate as a direct transitive verb (to complete, to make whole, to inform completely), and totality as a noun (a set of parts that constitute a whole; a sum). Despite this apparent non-definition, we note that various planes converge in such a way that the definition of integrality is "nearly perfect". Among such planes are those of the stakeholders (managers, health professionals, and system clients or users), training and management, policy-making, and health care itself.

We chose to base this forum on three planes in hopes of contributing to the debate. The first is that of training. For this purpose we invited Professor Ricardo Burg Ceccim of the Federal University in Rio Grande do Sul and Laura Feuerwerker, a researcher at Rede Unida, both currently with the Department of Health Education Management in the Brazilian Ministry of Health. They bring arguments to the debate that aim to strengthen the definition of a public policy for training health professionals based on comprehensiveness, and suggest the various competencies of the education and health sectors in this construction process Coincidentally, Brazil is currently involved in a discussion of university reform, with the possibility of materializing undergraduate Curriculum Guidelines for the health professions with comprehensiveness as the motor force.

On the second plane of discussion, that of practices, we have invited Ruben Araújo de Mattos, researcher at Rio de Janeiro State University and one of the coordinators of the projected entitled Comprehensiveness: Forms of Knowledge and Practice in the Daily Work of Health Institutions. Mattos provides his thoughts on how comprehensiveness is expressed in health practice and how we can recognize the experiences and subsequently analyze them.

Finally, for the third plane, that of evaluation, we have invited Professor Eleonor M. Conill of the Federal University in Santa Catarina, who discusses comprehensiveness as an essential attribute of evaluating quality of care and health systems, offering us a set of validated methodologies for research on the various dimensions of the health system.

We hope that readers will take full advantage of these reflections and ideas, as well as the doubts expressed by this forum, and will join actively in the debate.