The document discusses an evaluation of the challenges facing the implementation of the Programa de Saúde na Escola (PSE) health program in schools in Camaçari, Brazil. The PSE was established in 2007 to integrate public health and education systems and address student health issues. While launched in Camaçari in 2013, implementation challenges include limited PSF health care worker capacity, staff discontinuity, difficulties with specialist referrals, and underdeveloped coordination groups dominated by health sectors. The study aims to understand these challenges through qualitative interviews with PSE administrators, health workers, school staff, parents and students. Initial findings indicate the program is still young with much to develop, including stronger collaboration between education and health teams,

1. An Evaluation of the Challenges of
the Implementation of Programa de
Saúde na Escola (PSE) in Camaçari
By Daniel Wilhite

2. PSE History + Background
 Established by Ministry of Education in 2007
 Mission: “contribute to the integral education of students
through health promotion, illness and disease
prevention, and health care, aimed at addressing the
vulnerabilities that compromise the full development of
children, adolescents, and young people….”
 Integrates public education and health systems
 Pesquisa Nacional de Saúde do Escolar (PeNSE) data
demonstrates need
 Started in Camaçari in 2013 (2 yrs. old)
 PSF + PSE partnerships

3. Implementation
Challenges
 PSF capacity
 Can only serve up to 1,000 students
 Many serving fewer than allotment
 Staff discontinuity
 Medical professionals – 7 y contracts
 Administration shifts every 4 yrs.
 PSF connectivity
 Difficulty in successful specialist referrals
 Grupos Intersetoriais de Trabalho (GTIs)
 Team made up of Sec. Health, Sec. Education, local cultural, leisure, sport, transport,
urban planning, NGOs, civil society entities
 Reality: dominated by health sector
 Ethical concerns
 Disclosure
 Parent tension

4. Study Aims
This research seeks to verify the extent to which these
previously identified programmatic challenges are
relevant to the experience of PSE in Camaçari, Brazil.
The study, through qualitative methods, hopes to
capture the state of PSE at a local municipal level and
the primary concerns of all parties involved in its
operation.

5. Study Hypotheses
1. There are not enough PSF health care worker teams to
implement PSE at all public schools in Camaçari.
2. There are issues of programmatic continuity within PSE
teams.
3. There are problems of connectivity to specialized care
within the PSE system.
4. The Grupos Intersetoriais de Trabalho (GTIs) are
underdeveloped and dominated by the health sector.
5. There are ethical concerns of parents about PSE medical
care within public schools.

6. Data Analytic Sample +
Analysis
 Interviewees:
 PSE administrators
 PSF health care workers in a unit officially affiliated
with PSE
 Public school administrators, teachers, parents, and
students of schools affiliated with PSE
 Interview questions
 Analysis plan

7. Fieldwork
 Interviews with administrators in Camaçari: Paula
(Sec. of Health/DAB), Marieni (Sec. of Ed.), Lidiane,
Ana
 Interviews with health professionals and principal
in Fonte das Aguas
 PSE school visit in Fonte das Aguas
 PSE administrator meeting observation

8. School Visit

9. Arembepe, Fonte das Aguas,
Camaçari

10. Initial Findings
 PSE Administrators:
 It’s a very young, new program – “a lot needs to be figured out”
 Lack of established GTIs, mostly run out of Sec. of Health -> lack of teamwork between educators and
medical teams
 Some PSF units are much more proactive than others
 Lots of discontinuity among medical teams, admins
 Hasn’t reached all schools, BUT has definitely expanded
 More conservative parents are resistant to sex ed (ex. pamphlets)
 Health Professionals
 Some schools are more cooperative/welcoming than others
 Its sometimes hard to schedule and get to schools (transport)
 Root many problems in habits of parents
 Frustrated with specialist referral difficulties
 Schools
 Love working with PSF team who they know them well
 Easy way to fast-track students to get appointments and parents are usually welcoming of this
 Teachers remain in classrooms and monitor children during information sessions, but don’t actively lead
 Learned of other teachers who attend workshops to teach about health education
 Can be a bit disruptive to normal routine

11. Moving Forward
 More interviews with principals, teachers, parents,
and students
 More observation of PSF work during PSE visits
 Interview scripts + coding
 Final analysis