Abstract

Introduction

In the context of Brazilian universities, technical schools, teaching centers and health services, there is a critical emphasis that is worked daily through practices based on the pedagogy of Popular Education (PE), as substantiated by the theoretical assumptions unveiled by Paulo Freire¹1 Freire P. Pedagogia do oprimido. 17a ed. Rio de Janeiro: Paz e Terra; 1987.. Recent publications, such as those of Nespoli et al.²2 Nespoli G, Goldschmidt IL, Lima LO, Travassos R, Bornstein VJ, organizadores. Saberes da experiência: sistematização do curso de aperfeiçoamento em educação popular em saúde. Rio de Janeiro: EPSJV; 2020., David et al.³3 David HMSL, Pina JA, Stotz EN, Lima Júnior IA, Vasconcellos LAV, Mattos LV, et al. Curso para a formação histórico-política na graduação em saúde: análise de uma construção partilhada. Trab Educ Saúde [Internet]. 2018 [citado 17 Jul 2020]; 16(3):997-1015. Disponível em: https://www.scielo.br/pdf/tes/v16n3/1678-1007-tes-1981-7746-sol00141.pdf
https://www.scielo.br/pdf/tes/v16n3/1678... , Cruz & Vasconcelos⁴4 Cruz PJSC, Vasconcelos EM. Caminhos da aprendizagem na extensão universitária: reflexões com base em experiência na Articulação Nacional de Extensão Popular (ANEPOP). São Paulo: Hucitec; 2017., Bornstein et al.⁵5 Bornstein VJ, Alencar A, Leandro BBS, Matielo E, Nespoli G, Goldschimdt IL, et al., organizadores. Formação em educação popular para trabalhadores da saúde. Rio de Janeiro: EPSJV; 2017. and Vasconcelos, Cruz & Prado⁶6 Vasconcelos EM, Cruz PJSC, Prado EV. A contribuição da educação popular para a formação profissional em saúde. Interface (Botucatu). 2016; 20(59):835-8., emphasize the growth and development of such initiatives and analyze their significance for the reorientation of health education towards a critical, integral and humanizing action.

By being oriented by this perspective, the conception of PE considers education as an inseparable process of the emancipation of society’s disadvantaged sectors. In the words of Paludo⁷7 Paludo C. Educação popular em busca de alternativas: uma leitura desde o campo democrático popular. Porto Alegre: Tomo Editorial; 2001., the PE provides “pedagogical ideas and concepts that support educational practices, [in which] there is a class option that refers to a view of the historical process, to an understanding of human beings and their role in history” (p. 75). This conception has its origins in the 1950s, based on learnings in the field of Youth and Adult Education, especially through the work of Paulo Freire and his team, which has spread to different Brazilian contexts over the years⁸8 Scocuglia AC. A história das ideias de Paulo Freire e atual crise de paradigmas. 7a ed. João Pessoa: UFPB; 2019.. Between the 1960s and 1980s, from the military dictatorship to the democratic reopening, the PE was present in the ways of conducting education processes on several fronts, such as the Movement for the Brazilian Sanitary Reform. It had a fundamental role in the construction of processes that dialogued on behalf of the construction of a universal system that would guarantee the right to health for all⁴4 Cruz PJSC, Vasconcelos EM. Caminhos da aprendizagem na extensão universitária: reflexões com base em experiência na Articulação Nacional de Extensão Popular (ANEPOP). São Paulo: Hucitec; 2017.,⁸8 Scocuglia AC. A história das ideias de Paulo Freire e atual crise de paradigmas. 7a ed. João Pessoa: UFPB; 2019..

In the subsequent decades, the Popular Education in Health (hereafter EPS) began to guide the construction of participatory and humanizing ways of performing health within the scope of the government public policies. Since then, various EPS practices and ideas have contributed to the qualified expansion of the Unified Health System (SUS)⁹9 Brasil. Ministério da Saúde. Secretaria de Gestão Estratégica e Participativa. Departamento de Apoio à Gestão Participativa. Caderno de educação popular e saúde. Brasília: Ministério da Saúde; 2007.,¹⁰10 Brasil. Ministério da Saúde. Secretaria de Gestão Estratégica e Participativa. Departamento de Apoio à Gestão Participativa. II Caderno de educação popular em saúde. Brasília: Ministério da Saúde; 2014.. Between 2003 and 2016, EPS gained interest in the management of the Federal Government. Thus, several exercises were initiated aimed at enabling social policies, as well as reorienting those that already existed, which led to an expanded and participatory view of health¹¹11 Bonetti OP, Odeh MM, Carneiro FF. Problematizando a institucionalização da educação popular em saúde no SUS. Interface (Botucatu). 2015; 18 Supl 2:1413-26.. With this process, the National Policy for Popular Education in Health in the sphere of SUS (PNEPS-SUS) was developed. It was consolidated by means of the publication in the legal structure of SUS, through Ordinance GM/MS 2.761/2013¹¹11 Bonetti OP, Odeh MM, Carneiro FF. Problematizando a institucionalização da educação popular em saúde no SUS. Interface (Botucatu). 2015; 18 Supl 2:1413-26..

One of the axes of this Policy consists of “education, communication and knowledge production”. It takes into account the urge to intensify the education of SUS actors in the perspective of EPS, in order to strengthen critical awareness and the mobilization of social processes in the health field⁶6 Vasconcelos EM, Cruz PJSC, Prado EV. A contribuição da educação popular para a formação profissional em saúde. Interface (Botucatu). 2016; 20(59):835-8.,¹²12 Lima LO, Silva MRF, Cruz PJSC, Pekelman R, Pulga VL, Dantas VLA. Perspectivas da Educação Popular em Saúde e de seu Grupo Temático na Associação Brasileira de Saúde Coletiva (ABRASCO). Cienc Saude Colet [Internet]. 2020 [citado 16 Jul 2020]; 25(7):2737-42. Disponível em: https://www.scielo.br/pdf/csc/v25n7/1413-8123-csc-25-07-2737.pdf
https://www.scielo.br/pdf/csc/v25n7/1413... .

This article aims to present three experiences of the implementation of this PNEPS-SUS axis: the Popular Education Course on Health for Community and Health Surveillance Agents (EDPOPSUS), the Research and Extension Project “Extension Experiences in Popular Education and Health in SUS” (VEPOP-SUS), and Historical and Political Education Course for Students of the Health Care Area (FHP).

The present manuscript constitutes an experience report. Its development was guided by fundamentals from the methodological perspective of the systematization of experiences, according to Jara Holliday¹³13 Holliday OJ. Para sistematizar experiências. 2a ed. Brasília: Ministério do Meio Ambiente; 2006.. The report sought to contemplate a description of each of the experiences. It also seeks to reference the insights of researchers in the light of a critical analysis on the aforementioned methodological perspective. Its elaboration was made possible through a bibliographic review, conducted with the participation of protagonists in the coordination of the three experiences. They consulted published productions about such initiatives, undertaking an intentional selection of those bibliographic sources which would support the analysis of the experiences for the implementation of the PNEPS-SUS education axis. Then, contextualization and details of these experiences were pointed out, as well as approximation, complementarities and distances between them.

The Popular Education Course on Health for Community and Health Surveillance Agents (EDPOPSUS)

The development of disease prevention and health promotion are conducive in Primary Care (PC), where health education is one of the fundamental strategies. However, investment in educational work is small and favors vertical educational practices, legitimized by the biomedical knowledge¹⁴14 Bornstein VJ, Morel CM, Pereira IDF, Lopes MR. Desafios e perspectivas da educação popular em saúde na constituição da práxis do Agente Comunitário de Saúde. Interface (Botucatu). 2014; 18 Supl 2:1327-40..

As a strategic action in the implementation of PNEPS-SUS, the EDPOPSUS aimed to favor the transformation of this situation, with a predominance of a banking focus on health education. In addition, the EDPOPSUS – although not a technical education, as proposed by the Curriculum Reference for the Technical Course for Community Health Agents (ACS) – provided the training of agents in the educational dimension, which is a fundamental aspect in their work. On the other hand, it strengthened such professional category in its demands and in its organization, allowing the critical reflection on its work.

In a first experiment, the EDPOPSUS was characterized as a 53-hour awareness course (2013/2014), coordinated by the National School of Public Health (ENSP/Fiocruz), part of this course being held in distance learning.

In its second version, the course was coordinated by the Joaquim Venancio Polytechnic School of Health (EPSJV/Fiocruz), held in 2016/2019. It had as its primary target audience health agents (community and surveillance) and included other PC workers, community leaders and members of social movements, becoming a 160-hour further training course. The course also aimed to contribute to the qualification of the participants’ educational practices. Approximately 10,000 students from 15 different states enrolled in the course. Both versions of the course were financed by the Ministry of Health.

The curriculum was collectively built through workshops with representatives of social movements and EPS, SUS technical schools, State Health Secretariats, and other health institutions²2 Nespoli G, Goldschmidt IL, Lima LO, Travassos R, Bornstein VJ, organizadores. Saberes da experiência: sistematização do curso de aperfeiçoamento em educação popular em saúde. Rio de Janeiro: EPSJV; 2020.,¹⁵15 Dantas MA, Silva MRF, Castro Júnior AR. Aprendizagens com o corpo todo na (trans)formação de educadores (as) populares do Curso Livre de Educação Popular em Saúde (EdPopSUS). Interface (Botucatu) [Internet]. 2020 [citado 27 Jul 2020]; 24:e190205. Disponível em: https://www.scielo.br/pdf/icse/v24/1807-5762-icse-24-e190205.pdf
https://www.scielo.br/pdf/icse/v24/1807-... . According to Nespoli, Bornstein and Goldschimdt¹⁶16 Nespoli G, Bornstein VJ, Goldschmidt I. Reflexões sobre um currículo argiloso e o potencial da educação popular na formação de trabalhadores e movimentos sociais em defesa do SUS. Rev Debates Insubmissos. 2019; 2(4):48-59., “the systematization of this experience indicates the richness of PE, considering its porosity to the unpredictable, the subjects’ experience, and the reality of the different territories where the course is held” (p. 48).

Six thematic axes were defined: participative management and experience as the common thread of the educational process; PE in the process of health work; right to health and promotion of equity; territory, history and memory; social and popular participation; territory, health-disease process and care practices.

Each class was comprised of 35 students and two educators, one with a complete degree and teaching experience in the health field, and the other with complete elementary education and EP experience. Both played similar roles in the development of the course, without hierarchy.

Most of participants were women. The integration between the educators and the class was very rich, with mutual learning²2 Nespoli G, Goldschmidt IL, Lima LO, Travassos R, Bornstein VJ, organizadores. Saberes da experiência: sistematização do curso de aperfeiçoamento em educação popular em saúde. Rio de Janeiro: EPSJV; 2020.,¹⁵15 Dantas MA, Silva MRF, Castro Júnior AR. Aprendizagens com o corpo todo na (trans)formação de educadores (as) populares do Curso Livre de Educação Popular em Saúde (EdPopSUS). Interface (Botucatu) [Internet]. 2020 [citado 27 Jul 2020]; 24:e190205. Disponível em: https://www.scielo.br/pdf/icse/v24/1807-5762-icse-24-e190205.pdf
https://www.scielo.br/pdf/icse/v24/1807-... . Many of the health agents who had previously been students started to act as educators.

The decentralized implementation of the course required the development of a didactic material with national guidelines, open to local innovations, as well as the use of technologies for didactic follow-up and systematization of the experience²2 Nespoli G, Goldschmidt IL, Lima LO, Travassos R, Bornstein VJ, organizadores. Saberes da experiência: sistematização do curso de aperfeiçoamento em educação popular em saúde. Rio de Janeiro: EPSJV; 2020..

The didactic material consisted of a Guidebook¹⁷17 Bornstein VJ, Alencar A, Leandro BBS, Matielo E, Nespoli G, Goldschimdt IL, et al., organizadores. Guia do curso de aperfeiçoamento de educação popular em saúde. Rio de Janeiro: EPSJV; 2016., aimed to propose activities and content for each meeting, in addition to Supporting Texts¹⁸18 Bornstein VJ, Alencar A, Leandro BBS, Matielo E, Nespoli G, Goldschimdt IL, et al., organizadores. Textos de apoio para o curso de aperfeiçoamento em educação popular em saúde. Rio de Janeiro: EPSJV; 2016., which addressed the issues of the thematic axes. In the 40-hours educator course, the idea of modifying activities and content according to local needs was reinforced, as long as the themes of the axes were addressed. During the systematization of the course experience, the educators were noticed to have been able to work on specific issues that arose in the classes throughout the discussions.

The experience was accompanied by the national coordination and the state teams, based on the Academic Management System, in which educators recorded attendance, grades, and fed a class diary, narrating the experience of each meeting. Educators and Coordinators also elaborated a final report. All this material was part of a research project which had its results published in 2020²2 Nespoli G, Goldschmidt IL, Lima LO, Travassos R, Bornstein VJ, organizadores. Saberes da experiência: sistematização do curso de aperfeiçoamento em educação popular em saúde. Rio de Janeiro: EPSJV; 2020.. Groups on the text messaging application WhatsApp were created at various levels and an Internet website(^f(f)Available in: www.edpopsus.epsjv.fiocruz.br ) was also established, with important information for the process.

The course was organized in 17 meetings, lasting 8 hours in total, interspersed with 2-hour fieldwork, which were the starting points of the subsequent meetings, allowing participants to reflect on their own practice. Local or state exhibitions shared the course experiences, with the participation of the local population at squares, schools, and clubs, which consisted of moments of celebration and systematization of the experiences.

As a result, it is possible to emphasize the feeling of belonging that enabled the organization of new class entities, the reinforcement of the association of residents, and even the various T-shirts created on their own in each class. Such results were mentioned in the publication Saberes da Experiência²2 Nespoli G, Goldschmidt IL, Lima LO, Travassos R, Bornstein VJ, organizadores. Saberes da experiência: sistematização do curso de aperfeiçoamento em educação popular em saúde. Rio de Janeiro: EPSJV; 2020..

The opening of the course to the reality of educators and students made it possible to include topics of their own interest and dynamics in each class, as indicated in the systematization report of Paraíba²2 Nespoli G, Goldschmidt IL, Lima LO, Travassos R, Bornstein VJ, organizadores. Saberes da experiência: sistematização do curso de aperfeiçoamento em educação popular em saúde. Rio de Janeiro: EPSJV; 2020.:

As repercussions of the experience, the following stand out: the breaking of prejudices, especially through the discussion on diversity; the mobilization to face iniquities; the discovery of unknown characteristics of the territories, such as fundamental knowledge, cultures, and traditional practices in the context of PC. In a focus group held in the State of Pará²2 Nespoli G, Goldschmidt IL, Lima LO, Travassos R, Bornstein VJ, organizadores. Saberes da experiência: sistematização do curso de aperfeiçoamento em educação popular em saúde. Rio de Janeiro: EPSJV; 2020., the repositioning of a student is clear due to the course.

Another relevant aspect was the opportunity to express feelings and affections, creating bonds of belonging in the groups, which was corroborated by this record, manifested in the publication of results of a focus group²2 Nespoli G, Goldschmidt IL, Lima LO, Travassos R, Bornstein VJ, organizadores. Saberes da experiência: sistematização do curso de aperfeiçoamento em educação popular em saúde. Rio de Janeiro: EPSJV; 2020. with students from Pará:

The biggest challenge after completing the course was the continuity of the articulation between the participants and the promotion of the strengthening of movements and PNEPS-SUS. The course became part of the EPSJV/Fiocruz curriculum and continues to be offered by means of Terms of Cooperation with states and municipalities that are committed to providing the infrastructure, freeing up educators and students.

The Research and Extension Project “Extension Experiences in Popular Education and Health in SUS” (VEPOP-SUS)

The academic extension has been a privileged space for the emergence of proposals for reorienting the pedagogical practices of universities. As it is an academic activity that brings together restless and purposeful students, technicians and professors, it functions as a laboratory for innovative practices. Melo Neto¹⁹19 Melo Neto JF. Extensão popular. 2ª ed. João Pessoa: UFPB; 2014. defines academic extension as a “useful social work, imbued with the intention of bringing teaching and research into mutual correlation”¹⁹19 Melo Neto JF. Extensão popular. 2ª ed. João Pessoa: UFPB; 2014. (p. 46). According to Cruz and Vasconcelos⁴4 Cruz PJSC, Vasconcelos EM. Caminhos da aprendizagem na extensão universitária: reflexões com base em experiência na Articulação Nacional de Extensão Popular (ANEPOP). São Paulo: Hucitec; 2017. and Cruz et al.²⁰20 Cruz PJSC, Prado EV, Sarmento DS, Carneiro DGB, Costa LJA, Vasconcelos EM, et al. Mapeamento de experiências de extensão popular nas universidades públicas brasileiras: um estudo descritivo em escala nacional. Rev Conexão UEPG. 2019; 15(1):7-16., the Extension oriented by the PE constitutes the Popular Extension, which seeks dialoged modes of social action with participative forms of internal organization, in which students and popular actors occupy important spaces of protagonism.

In order to support the Extension experiences guided by EPS, the PNEPS-SUS adopted the Research Project VEPOP-SUS as a strategy, through the cooperation between the Ministry of Health and Federal University of Paraíba, between the years 2013 and 2018. The VEPOP-SUS articulated extension projects across the country aiming to promote the critical reflection on the reality of the territories in which they were located. It also sought to promote the construction of paths for new health practices – whether those carried out in the popular field or those within the scope of public services.

As for the implementation, it was methodologically divided into several fronts of action, among which the following stood out: mapping of Extension experiences in EPS in the SUS in all regions of the country; support for the promotion of meetings and events in the field of health education and extension with emphasis on PE; bi-annual holding of the National Internship on Popular Extension Experiences in Communities (ENEC), aimed at raising awareness and mobilizing new subjects for the Popular Extension movement in the country; printing and distribution of PE and EPS Extension publications throughout the country, including a Popular Extension Book on Health²¹21 Prado EV, Vasconcelos EM, Tófoli AMMA, Carneiro DGB, Cruz PJSC, Sarmento DS, et al., organizadores. Caderno de extensão popular: textos de referência para a extensão universitária. João Pessoa: Editora do CCTA; 2017..

Among the results of VEPOP-SUS, the mapping identified and gave visibility to different experiences across the country so as to enable the articulation and communication between them, in addition to providing extension groups with didactic and scientific materials for study and improvement. The amount of 117 extension initiatives was identified(^g(g)The list of the mapped experiences with their respective descriptions can be found at: http://www.ccm.ufpb.br/vepopsus/wp-content/uploads/2018/04/Mapeamento-Nacional-de-Experi%C3%AAncias-em-Extens%C3%A3o-Popular-Projeto-VEPOP-SUS.pdf ), in greater number in the Northeast, Southeast, and South regions. The following states had emphasis on the number of experiences: Paraíba, Minas Gerais, São Paulo, and Rio de Janeiro.

Cruz et al.²⁰20 Cruz PJSC, Prado EV, Sarmento DS, Carneiro DGB, Costa LJA, Vasconcelos EM, et al. Mapeamento de experiências de extensão popular nas universidades públicas brasileiras: um estudo descritivo em escala nacional. Rev Conexão UEPG. 2019; 15(1):7-16. present a detailed description and analysis of this survey, according to which most of the mapped experiences (61%) tend to be continuous, being two or more years long on the date of the survey; almost all of them (89%) are held in public universities and articulate multiple social entities – unions, associations of residents, social movements, health units, hospital units, and others.

Based on this mapping, the VEPOP-SUS Network was created, consisting of a discussion via e-mail and social networks, bringing together students, professors, technicians, and activists of social movements. Through this network, it was possible to promote a permanent communication between protagonists of the extension actions, facilitating the mobilization of national events, in addition to articulating their insertion in the national EPS collectives and in the internships of Extension experiences promoted by ENEC.

In order to promote the meeting of these Extension groups spread across the country, the VEPOP-SUS promoted or supported, between 2014 and 2016, a total of five national events and one at the state level. There were 530 people enrolled, and 180 experiences were involved(^h(h)The list of the nationally involved experiences and the Project Final Report can be found at: http://www.ccm.ufpb.br/vepopsus/wp-content/uploads/2019/03/RELAT%C3%93RIO-GERAL-FINAL-PROJETO-VEPOP-SUS-TC-383-2013-UFPB.pdf ). Among the events held, the following ones can be highlighted: National Seminar on Popular Education in Health Education (2014); IV National Exhibition of Experiences and Reflections on Popular Extension (2015), and the 3^rd National Seminar on Research on Popular Extension (2016).

In parallel to these events, the VEPOP-SUS supported the realization of ENECs, which have as common thread the insertion and coexistence, for 15 days, of health students from social work contexts in communities in situations of vulnerability. A diagnosis with residents was made, and a report was elaborated with critics and suggestions that were later worked on by extension students responsible for the continuous work in these communities. Along with this insertion, the internship developed a training on PE and its theoretical and methodological assumptions, including the construction of knowledge about participatory perspectives on social research.

By virtue of ENEC, students from 11 Brazilian states and 2 countries (Haiti and Benin) came to Paraíba to experience the reality of different communities, critically observing all aspects that influence their political, social and economic organization. Communities located in Zona da Mata and in the state interior were involved. In total, there were 11 editions of the internship, covering about a hundred students from public and private universities.

Simultaneously to the events with experience meetings and internships, the VEPOP-SUS organized the printing and distribution of publications on Extension, EP and EPS, aiming to contribute with the pedagogical subsidy of students’ education inserted in extension experiences. Among the publications, the book²¹21 Prado EV, Vasconcelos EM, Tófoli AMMA, Carneiro DGB, Cruz PJSC, Sarmento DS, et al., organizadores. Caderno de extensão popular: textos de referência para a extensão universitária. João Pessoa: Editora do CCTA; 2017. “Popular Extension Book: reference texts for Academic Extension”. There were 36 works(ⁱ(i)The publications supported by the VEPOP-SUS can be accessed free of charge at: http://www.ccm.ufpb.br/vepopsus/home/todos-os-projetos/vepop-sus/biblioteca-vepop/) distributed free of charge, either by making them available on the Internet, by assigning printed copies at national events, or by sending them by mail to students from different higher education institutions.

Considering the various fronts supported by the Project VEPOP-SUS, it is believed that PNEPS-SUS was able to fulfill the role of explaining how diverse and rich the Brazilian movement of extension on Popular Education is.

The Historical and Political Education Course for Students of the Health Care Area (FHP)

Within the sphere of PNEP-SUS, the The Rio de Janeiro State University (UERJ), in partnership with other higher education institutions, proposed the realization of the FHP Course. It was made from dialogues and reflections on the importance of political education spaces for undergraduates, considering that the courses are being increasingly filled by diverse academic activities of technical nature – though not very reflective –, and that not all curricula have “green areas” with political debate and collective reflection.

The first design of the course was presented as part of an agreement between the UERJ and the Ministry of Health in 2002, already indicating the partnership with some higher education institutions (HEI) in the state of Rio de Janeiro and with the Sergio Arouca National School of Public Health of the Osvaldo Cruz Foundation. In the course of the planning, other HEIs joined the project.

Extended workshops with the participation of professors, students and people from popular movements produced the Pedagogical Political Project, which consisted of the guidelines for the preparation of didactic-pedagogical material and for the Virtual Learning Environment (VLE). The whole process was based on a concept of shared construction of knowledge, as substantiated by Carvalho, Acioli and Stotz²²22 Carvalho MAP, Acioli S, Stotz EN. O processo de construção compartilhada do conhecimento: uma experiência de investigação científica do ponto de vista popular. In: Vasconcelos EM, organizador. A saúde nas palavras e nos gestos: reflexões da rede de educação popular e saúde. São Paulo: Hucitec; 2001. p. 101-14..

The first edition of the FHP Course was held in 2014, from September to November, and offered a total of 1,274 vacancies distributed among 23 HEIs in 13 states plus the Federal District. The vacancies were distributed, primarily, to university students in the health area, registered at the HEI in which they enrolled, remaining 274 additional vacancies for other profiles, such as: participants in university extension projects, graduate students, health professionals, students in technical courses, and participants in social and workers movements.

The course received a total of 2,471 registered applicants. Of the 1,274 expected students, 990 enrolled, being distributed in 59 classes in the 23 HEIs. A total of 106 professors/mediators participated, including the general coordination, certifying 251 graduates (25% of the total enrolled).

The general objective of the FHP Course was to “begin the study of the society in which we live so as to raise the student’s and professional’s awareness and understanding of the context of policies and the defense of social rights and SUS”³3 David HMSL, Pina JA, Stotz EN, Lima Júnior IA, Vasconcellos LAV, Mattos LV, et al. Curso para a formação histórico-política na graduação em saúde: análise de uma construção partilhada. Trab Educ Saúde [Internet]. 2018 [citado 17 Jul 2020]; 16(3):997-1015. Disponível em: https://www.scielo.br/pdf/tes/v16n3/1678-1007-tes-1981-7746-sol00141.pdf
https://www.scielo.br/pdf/tes/v16n3/1678... . The specific objectives referred to the modular organization of the course: three main modules, interspersed with on-site moments, in addition to classes and discussion forums on the VLE, according to the study program presented in Frame 1, which shows the modules, their goals and planned on-site moments.

It started from the practical experience of students at the university, problematizing and interpreting it, seeking to explain the motivations and desires concerning the university education. It also discussed the role of education in the current scenario, taking into account the contradictions that move society. The setting-up of the course considered three major generative themes – education, work, and health –, which expressed the apprehension and problematization of students’ insertion to the study of Brazilian society³3 David HMSL, Pina JA, Stotz EN, Lima Júnior IA, Vasconcellos LAV, Mattos LV, et al. Curso para a formação histórico-política na graduação em saúde: análise de uma construção partilhada. Trab Educ Saúde [Internet]. 2018 [citado 17 Jul 2020]; 16(3):997-1015. Disponível em: https://www.scielo.br/pdf/tes/v16n3/1678-1007-tes-1981-7746-sol00141.pdf
https://www.scielo.br/pdf/tes/v16n3/1678... .

What was sought in this pedagogical process – characterized by the practice-theory-practice dialectic – was to encourage the autonomy of thought and critical reflection – both individual and collective – on the context and processes of life in society¹1 Freire P. Pedagogia do oprimido. 17a ed. Rio de Janeiro: Paz e Terra; 1987..

In addition to the VLE, students and tutors of the course produced a page on Facebook(^j(j)This page can be accessed at https://www.facebook.com/fhpeus/ ) which, during the course, was very active and constituted a freer space of expression, where students could publish photos, poems, videos, and texts about the themes involved.

The course results allowed for a positive evaluation, even considering the high levels of evasion, which are common in distance processes and become aggravated by operational and schedule difficulties in the face of national events, such as the 2014 FIFA World Cup, and other limitations present in the context of Brazilian social system.

The expectations on education processes like this lies precisely in the possibility of starting new paths of thought and exchange, in addition to bringing diverse and solidary perspective of world and society. It is an expectation for the future and for the ability of young people to independently lead their lives and to weave new sociability, respectful of each other and of the planet, so that everyone can, in their own time and according to their existence, fulfill the universal vocation that we have to, according to Paulo Freire¹1 Freire P. Pedagogia do oprimido. 17a ed. Rio de Janeiro: Paz e Terra; 1987. “be more”.

The course material remained available for the formation of new classes and been used in the Nursing Residency courses at UERJ. The contents are intended to be updated in order to account the most recent political situations and to continue offering the course according to the interest of students.

Approximations, complementarities and differences between the experiences

During the development process of these three experiences, several opportunities for approximation between them were verified, especially from the perspective of the specific dynamics of each territory. As an example, we mention contexts in which the FHP Course and the EDPOPSUS collaborated in the education of protagonists in territories where Popular Extension projects were developed, converging to the densification of the training of health agents and popular leaders, in addition to the training of health students. This qualified the action possibilities of the projects monitored by VEPOP-SUS, both by the national mapping, by the communications of its virtual network, and by the access to literature works in the field of PE.

Many graduates of extension projects guided by the PE started to act in the EDPOPSUS and FHP as educators and facilitators of education processes. It should also be noted that VEPOP-SUS subsidized the publication of a work that included didactic and pedagogical texts used in EDPOPSUS⁵5 Bornstein VJ, Alencar A, Leandro BBS, Matielo E, Nespoli G, Goldschimdt IL, et al., organizadores. Formação em educação popular para trabalhadores da saúde. Rio de Janeiro: EPSJV; 2017., also contributing to its wide distribution across the country.

The strategies offered by the FHP Course contributed for students linked to many of the extension projects of VEPOP-SUS to have a densification in their critical and reflective formation in the historical and political sense. This expanded the student formation, considering the few spaces reserved in the curricula so that the extensionists action undertakes education processes with this dimension.

Likewise, the EDPOPSUS supported the expansion of the protagonism and critical and citizen perception of actors in each territory where the extension projects were active.

The popular extension, through the support of VEPOP-SUS, constituted a strategy of continuity for the education processes after the end of the classes of such courses, since its participants found in the extension a possibility to continue developing the PE actions in their respective contexts and territories.

The overload of activities that permeated these various projects hindered a greater process of interaction and shared construction between their respective coordination. In addition, the Brazilian political and social context of the 2010s – with attacks on democracy and profound processes of ruptures with social and public policies – constituted a hindrance to more collaborative and organic action among several projects at the national level, which could have enhanced the aforementioned approaches and complementarities.

Publications from other experiences reveal that another important limit in the initiatives was the need for greater dialogue with education processes promoted in other countries, especially in contexts that were fundamental in the construction of the theoretical and methodological conception of PE in Latin America. Regarding Popular Extension, it is still necessary to expand the dialogue with practices and reflections produced in the context of Argentina and Uruguay under the aegis of the concept of Critical Extention²³23 Medina JM, Tommasino H. Extensión crítica: construcción de una universidad en contexto: sistematización de experiencias de gestión y territorio de la Universidad Nacional de Rosario. Rosario: UNR Editora; 2018..

It can also be pointed out as promising the future approximation of these experiences with perspectives of research and knowledge production articulated with the dimension of community action and popular protagonism developed in countries like Colombia, Costa Rica and Mexico. Also with Europeans productions, through proposals such as research-action and participatory investigation-action²⁴24 Fals Borda O. Aspectos teóricos da pesquisa participante: considerações sobre o significado e o papel da ciência na participação popular. In: Brandão CR, organizador. Pesquisa participante. 5a ed. São Paulo: Brasiliense; 1985. p. 42-62., community-based participatory research²⁵25 Wallerstein N, Duran B, Oetzel JG, Minkler M. Communitary Based Participatory Research for Health: advancing social and health equity. 3th ed. New Mexico: Jossey-Bass; 2017., originally called Community-Based Participatory Research (CBPR), integral and systemic research-action²⁶26 Morin A. Pesquisa-ação integral e sistêmica: uma antropopedagogia renovada. Rio de Janeiro: DP&A; 2004., and others. In turn, it is possible to expand the pedagogical perspectives in PE developed in the context of PNEPS-SUS, with the articulation of the historical and political formation of PE with the perspective of the decoloniality of knowledge²⁷27 Fleuri RM. Educação Intercultural: decolonializar o poder e o saber, o ser e o viver. Visao Glob. 2012; 15(1-2):7-22., and increasing education towards interculturality²⁸28 Walsh C. Interculturalidad y (de)colonialidad: perspectivas críticas y políticas. Visao Glob. 2012; 15(1-2):61-74..

Despite these challenges, the analysis of the experiences studied and their bibliographic productions shows that each project presented a unique and creative contribution to reinforce the theoretical and methodological perspective of PE as a reference in health education.

In the FHP course, the centrality of historical, social and political dimension for the education of health social actors was highlighted. As for the EDPOPSUS, the importance of social articulation and critical formation of protagonists emerged in an inseparable way from their action and from their experience with the territories and territorialized social groups, especially with health agents and popular leaders. In VEPOP-SUS, in turn, it became evident the need for densification of PE insertion in the context of university extension and the expansion of pedagogical spaces for students to approach the popular context.

Thus, the three experiences converge to explain the theoretical and methodological power of PE in unveiling training processes in health that mobilize collective action and the organization capacity of individuals in the face of the challenges in the current Brazilian context¹²12 Lima LO, Silva MRF, Cruz PJSC, Pekelman R, Pulga VL, Dantas VLA. Perspectivas da Educação Popular em Saúde e de seu Grupo Temático na Associação Brasileira de Saúde Coletiva (ABRASCO). Cienc Saude Colet [Internet]. 2020 [citado 16 Jul 2020]; 25(7):2737-42. Disponível em: https://www.scielo.br/pdf/csc/v25n7/1413-8123-csc-25-07-2737.pdf
https://www.scielo.br/pdf/csc/v25n7/1413... . They have as a characteristic a dialogical and participatory approach that lead towards a humanizing and emancipatory horizon, based on Freire’s pedagogical proposal¹1 Freire P. Pedagogia do oprimido. 17a ed. Rio de Janeiro: Paz e Terra; 1987..

Final considerations

By analysing the three formative experiences of PNEP-SUS presented in this article, we were able to indicate how the PE – with its history of knowledge, experiences, and reflections – shows itself as powerful and fruitful path for the constitution of new significances for professional education within the scope of SUS. In our view, this path has five remarkable dimensions:

1) Methodology with actions and knowledge committed to the popular classes, having, therefore, an emancipatory political intentionality, including the defense and improvement of SUS in its various spaces.

2) Outline of principles and attitudes – in care, management, training and social participation in health – consistent with the perspective of good living, quality of life and human emancipation.

3) Respect for popular knowledge and practices towards health promotion with popular participation and dialogicity.

4) Understanding that educational experiences can constitute spaces to feed new movements and new practices, especially in territorialized initiatives with a critical conception of health and its social determinations.

The experiences analyzed point out for the EPS practices and movements to prioritize the development of educational processes in a systematic and territorialized way. In the debate on education at SUS, these experiences recommend that, increasingly, priority be given to learning processes with students’ experiences in communities, popular movements and/or institutional spaces. Through these experiences, pedagogical conditions can be created so that students are able to reflect on the challenges of the current world, as well as on the ways of feeling, thinking and acting of the popular classes in the face of these challenges.

It is crucial that new studies explain ways to build education experiences in EPS, as well as critical analyzes about the limits and challenges in these processes. This should be a way to increase the socialization of approaches and methodologies diversity, allowing more actors to take part in these processes and expanding the possibilities of qualification and expansion of these pedagogical activities in SUS spaces.

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