RELAÇÕES DE PODER NO PROCESSO DE TRABALHO DAS AÇÕES DE CONTROLE DA DENGUE / RELATIONS OF POWER IN THE WORKING PROCESS OF DENGUE CONTROL ACTIVITIES

Introducao : O agente transmissor da dengue possui grande forca de transmissao, tornando-a um problema de saude recorrente. Campanhas preventivas sao constantemente realizadas por agentes de endemia no intuito de controlar a ocorrencia da doenca. O exercicio do poder no programa de controle da dengue tem sido avaliado como hierarquizado e autoritario, o que dificulta o controle da epidemia. Objetivos : analisar as relacoes de poder estabelecidas entre gestores, agentes de endemias e comunidade no processo de trabalho das acoes de controle da dengue, em bairro endemico no municipio de Sao Luis (MA). Metodos : Foi utilizada pesquisa qualitativa, por meio de entrevista semiestruturada utilizando analise de conteudo, com gestores, agentes de endemias e pessoas da comunidade. Resultados : O processo de trabalho e marcado pela hierarquia, obediencia e separacao entre o pensar e o fazer. Os agentes desenvolvem suas acoes sem espaco para solucoes criativas diante das dificuldades do campo. A organizacao hierarquizada torna os agentes passivos e compromete o trabalho. Os moradores se dizem colaborativos, em contradicao com a percepcao dos agentes. Conclusao : Apesar da proposta de descentralizacao, as acoes de controle da dengue ainda se mantem subordinadas a forte hierarquia. O agente tem sua autonomia diminuida, convivendo com a tensao gerada pelo cumprimento das metas ordenadas por seus superiores e o exercicio de poder da comunidade, que reage ao cumprimento de determinacoes autoritarias. O nao exercicio do dialogo impede negociacoes que facilitem a incorporacao do saber cientifico pela comunidade e sua adesao as propostas de controle da epidemia. Palavras-chave : Dengue. Servicos de saude comunitaria. Poder. Abstract Introduction : The causative agent of dengue has great strength of transmission what makes it a persistent health problem. Agents of endemic diseases constantly perform preventive campaigns in order to control endemic disease occurrence. The exercise of power in the dengue control program has been reported as hierarchical and authoritarian in that in turn, makes difficult to control the epidemic. Objectives : To analyze the relations of power established between managers, agents of endemic diseases and the community in the working process for control of dengue in an endemic area in Sao Luis, Maranhao, Brazil. Methods : We used a qualitative research method by semi-structured interviews using the content analysis that was performed with managers, agents of endemic diseases and individuals in the community. Results : The working process is marked by the hierarchy, obedience and separation of thinking from doing. The agents develop their activities without chances for creative solutions before the difficulties faced in the field. The rigid hierarchical organization makes the agents work passively what in turn undertakes the work. Residents say they are collaborative, which contradicts the perception of agents. Conclusion : Despite the proposal of decentralization, actions to control dengue remain subject to strong hierarchy. Agents have very limited autonomy and have to deal with the tension generated by the achievement of targets ordered by their superiors and the power exercise of the community which reacts to the authoritarian determinations. The lack of dialogue makes incorporation of scientific knowledge by the community difficult and impairs its adherence to the proposed epidemic control actions. Keywords : Dengue. Community health services. Power.