Participação popular na saúde indígena: notas a partir das conferências nacionais e dos conselheiros distritais de saúde

Abstract

Popular participation has been constant since the internationalization of human rights and redemocratization. Despite this and the engagement of indigenous fronts, there is great tension between state policies and indigenous peoples. The research problem we face is: what is the nature of popular indigenous participation, especially in District Councils and National Conferences on Indigenous Health, and what are the main aspects related to this participation for indigenous communities in Brazil, in view of need to observe the ethnic specificities of peoples to guarantee differentiated attention? We argue that the Indigenous Health Conferences and District Councils are empirical objects capable of providing evidence to understand whether there is a clear intercultural participatory dialogue and/or whether the particularities of peoples are used as excuses to limit participation. The research, of qualitative methodology and of descriptive, exploratory and ethnographic types, uses the techniques of bibliographic review, document analysis and interviews for data collection. The first chapter explores historical and legislative aspects, with emphasis on speeches and official documents related to this fundamental right. The chapter examines state formation and the violence suffered by indigenous peoples during the colonization process, resulting in the repression of their cultural expressions. The 1988 Constitution stands out as a milestone for the recognition of indigenous rights, promoting public policies that value diversity, autonomy and interculturality, as well as popular participation through social control in the management of indigenous health. The chapter ends with the study of SASISUS and SESAI, which established an organized system of health services with an emphasis on differentiated care, interculturality and medical pluralism, from health districts to district councils and national conferences. In the second chapter, we collect data to test our arguments in two stages: first, with the analysis of the reports of the National Conferences, which provided information on the motions, approvals and topics discussed, revealing contradictions between discourse and practice and bureaucratic and superficial texts, even if these events are considered of extreme importance; then, with interviews with district counselors, who highlighted categories such as management, social control, differentiated attention, interculturality, democracy and citizenship to support their demands. In the last chapter, the results of the content analysis highlighted the ambiguities of official discourses on indigenous participation, highlighting the fragility of democracy and the challenges of interculturality in social control. We also approach the influence of bureaucratic management on the neoliberal agenda of the State, in addition to discussing the reasons for participating and valuing the strength of the popular movement. We consider both the tactics of pressure and everyday transgression and the structural reforms that participation can generate in the long term, such as the new Latin American constitutionalism.