By Dr. Marcos Kisil, W. K. Kellogg Foundation Program Director and Coordinator for Latin American and the Carebbean
Nowadays, in almost every Latin-American country, including Brazil, you will find health policies committed somehow to the range of coverage of health services to all the population.
In the last few years, specially during the last decades, health services of Latin-American countries, including Brazil, have been going through important changes. They result fundamentally from social pressures demanding a larger supply of preventive and curative services in terms of quality and quantity. Consequently, governments of each of these countries have adopted new health policies that try to answer these social pressures, and they have been showing a larger concern about the health sector in its natural, organizational, human or financial aspects required.
Nowadays, in almost every Latin-American country, including Brazil, you will find health policies committed somehow to the range of coverage of health services to all the population. These policies manifest themselves through the adoption of a primary care strategy, with the consequent organization of services by care levels; a larger decentralization of the decision-making process (regionalization of services); new devices to finance the sector - with an important participation of the state through general taxes or social security devices; search to train health professionals reflecting service needs, through a larger teaching/assistance articulation; and a larger concern about the participation of the user population, that is, the community, in the decision-making process, which affects the services to be delivered.
A reorganization of health care systems is required by a great part of these decisions. By facing them it seems clear how important is a network of voluntary people, groups and organizations that decide to face problems and share solutions to be applied to the oral health of the population. This is the case of CEDROS Network.
CEDROS Network must be recognized as a promising new paradigm to the social organization of a sector of knowledge and practice with serious implications in the management of the health sector.
Health management must be seen as the art of applying knowledge and skills from diverse sciences to diverse circumstances, which requires decisions that affect the management and organization of health services.
Berger and Luckmann, in dealing with the sociology of knowledge, assert that "reality is built socially and that the sociology of knowledge must analyze the process in which this fact occurs" (1). The essential terms here are "reality" and "knowledge"- they are terms not only current in every day language but they also have a long history of philosophical investigation behind them. For this purpose it is enough to define "reality" as a quality that belongs to phenomena that we recognize exist regardless our will (we can not "wish they didn't exist"), and to define "knowledge" as the certainty that the phenomena are real and have specific characteristics. The search for the certainty of the phenomena is the great object of sciences. The interest in the question of "reality" and "knowledge" justifies itself, thus, at first by the fact of its social relativity. Whatever is "real" to a certain society may not be so to another. Thus, a "sociology of knowledge" will have to deal not only with the empirical multiplicity of "knowledge" in societies, but also with the processes through which any body of "knowledge" gets to be socially established as "reality".
In our particular case, we accept that oral health services, or educational programs to train health professionals, are social realities that can and must vary among different societies. The great concern of a scientific community is to provide knowledge about these realities.
In Latin-America, including Brazil, we may say that the field of oral health was institutionalized through professionals trained in schools of dentistry and that the organization of oral health services was based in the existence of this professional, with great emphasis in curative work, and eventually, rehabilitation work. This model of services led to an organization of the sector through very solid hierarchical institutions, such as the school of dentistry itself, corporate class organizations (councils, unions, professional associations), public services of the Ministry of Health and Social Security. In the last couple of decades the little success of this strategy to most of the population with no access to these professionals led to a larger concern about massive methods of prevention and greater care to train auxiliary personnel and self-care to the population.
Thus, now when it seems necessary a new organization of the oral health sector, the shape of the organization of CEDROS Network achieves a paradigmatic character. As a network it is a voluntary, horizontal structure, that is, its members are only those who want and wish to participate, in equal conditions with the other members. It is a complementary structure to the structure of the existing organizations, therefore it can facilitate the collaborating struggles among institutions. The network is agile because beforehand it is an effective communication system, connecting those interested in different subjects through networks that obtain larger efficacy. This horizontal structure, which obtains national dimensions, may have vertical dimensions, such as regional or global structures. The relationship of CEDROS Network with the developing nodes of the Latin-American Association of Dental Schools is an excellent example of the potential of a regional network. The promising relation with WHO and the University of Lund to the creation of a permanent electronic forum of oral health is a great example of how to create a global network.
According to the work proposition of CEDROS Network, in the following years it is expected that it may contribute with the following:
· To introduce novelties in the teaching of oral health and, particularly dentistry, such as improvement in the teaching plans available, curriculum design, teaching methods, development of teaching material;
· To research systematically the management needs of the oral health sector and translate them to the work plans of the different organizations involved;
· To be a permanent source of technical support to the development of oral health and its services;
· To be a source of technical support and of training teachers to the development of innovative educational programs for dentistry, auxiliary personnel and the population in general;
· Being a product of an organizational arrangement that represents a fellowship of people, groups and academic and service institutions interested in the academic, professional development of the sector, it must be a permanent forum for a constructive dialog to the improvement of oral health.
(1) Bibliography: Berger, Peter I. and Luckmann, Thomas. A Construção Social da Realidade. Ed. Vozes Ltda., Petrópolis, 1973.
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