The oral health policy in a municipality of Bahia: the agents of state bureaucracy

ABSTRACT This study aimed to characterize Oral Health Coordinators (OHC) involved in the implantation of the Brazilian Oral Health Policy (BOHP) in a municipality of Bahia, exemplary case, between 1997-2015. A qualitative approach case study was carried out, based on the Bourdieu theoretical, through in-depth interviews with six OHC, with an average of 45 years of age. Their professional trajectories were analyzed from the following categories: social origin, professional training, professional trajectory and insertion, and trajectory in the bureaucratic field. The majority of them graduated from public institutions and presented an upward trajectory in the bureaucratic field. The insertion in management was influenced by dispositions, network relations, and professional performance in Family Health Strategy (FHS). Professional qualification seems to be a differentiating aspect. Post-graduation in public health represented a greater possibility of insertion in the FHS. The management team maintained clinical practice. The support of municipal management and health was highlighted by almost all interviewees. The BOHP contributed to the expansion of the oral health network, however, the main propositions were implanted previously. The importance of management in the BOHP implementation is evident and it is recommended to carry out similar analysis of other cases to identify regularities that contribute to the explanation of the different degrees of BOHP implementation.

摘要 本研究旨在刻画1997年至2015年间，巴伊亚州某典型试点市镇中参与巴西口腔健康政策（Brazilian Oral Health Policy，BOHP）推行工作的口腔健康协调员（Oral Health Coordinators，OHC）的特征。本研究采用基于布迪厄理论框架的质性案例研究方法，对6名平均年龄为45岁的口腔健康协调员开展深度访谈，并从社会出身、职业培训、职业轨迹与从业融入情况、科层场域内的职业发展轨迹四类维度对其职业轨迹展开分析。研究对象大多毕业于公立院校，且在科层场域内呈现职业晋升的发展轨迹。其管理岗位的入职受到惯习、人际网络关系以及家庭健康策略（Family Health Strategy，FHS）履职表现的影响。职业资质水平似乎是区分个体职业发展差异的关键因素，修读公共卫生专业研究生课程，则为其入职家庭健康策略岗位提供了更大机遇。受访的口腔健康协调员均在担任管理职务的同时保留了临床执业工作。几乎所有受访者都着重提及了市级管理部门与卫生主管机构提供的支持。巴西口腔健康政策推动了口腔健康服务网络的扩容，但该政策的核心主张早在政策正式推行前就已得以落地。本研究证实了管理工作在巴西口腔健康政策实施过程中的重要性，并建议针对其他实施案例开展同类分析，以提炼可用于解释不同地区巴西口腔健康政策实施程度差异的共性规律。