Resumo Este artigo analisa a construção e desenvolvimento da Política Nacional de Práticas Integrativas e Complementares (PNPIC) no SUS e seus antecedentes. O estudo envolveu revisão de literatura, análise documental e entrevistas com atores-chave no processo de construção e implementação da política. Apoiou-se no modelo de múltiplos fluxos proposto por Kingdon no que tange à formulação da agenda política. Os resultados apontam momentos importantes na trajetória da política: influência de parâmetros internacionais; papel das conferências nacionais de saúde na construção da demanda social; experiências iniciais de oferta na rede pública; protagonismo no âmbito do ensino e pesquisa; entrada na agenda política; condução federal e desafios para a institucionalização. A formulação da PNPIC ocorre pela pressão de atores estratégicos que empreenderam ações em condições institucionais favoráveis no âmbito do Ministério da Saúde após mudança política na esfera do Governo Federal em 2003, criando uma janela de oportunidade política. Tal processo foi marcado por resistências oriundas da racionalidade biomédica e disputas de interesses. Apesar do avanço relativo à disseminação e visibilidade da oferta de serviços, as ações no âmbito da condução federal não foram acompanhadas por mudanças significativas na formação dos profissionais e nas práticas hegemônicas de saúde.

Issue National guidelines for Heat-Health Action Plans (HHAP) in Portugal exist since 2004. These guidelines are further developed and implemented at Local Public Health Units (LPHU) together with local partners. Tabletop exercises are a useful tool to improve preparedness. Despite the long experience with HHAP there has not been any tabletop exercise in Amadora. Description Amadora’s LPHU organized a tabletop exercise with local partners to improve HHAP preparedness (12th July 2018). It included: LPHU, city hall, civil protection services, local social services, primary healthcare services, local public hospital, and firefighters. The exercise hypothesized a scenario of an unprecedented increase of temperature for an extended period of time, activating the highest level of warning (red) and action in the HHAP. Results During the exercise several issues were identified. Some partners were not clear about the pathway established for red warnings and partners were not aware of relevant HHAP activities. Also, from the 8 sites listed as climate shelters, only 2 were deemed as adequate for using in this scenario, even though they have been listed for several HHAP. Due to the exercise, it was possible to conduct an inspection of said shelters, which hadn’t took place yet due to the lack of resources. It was possible to find out that only one shelter was fit for purpose. Additional private facilities were identified as desirable shelter locations during the exercise. A few weeks later, a red warning was issued and clarification arising from the tabletop exercise was useful to properly implement measures. Lessons Despite the perceived frequent and good communication among partners of the HHAP, several issues - mainly regarding the adequacy of shelters - were identified with a tabletop exercise. It also improved preparedness for the following HHAP warning. As such, tabletop exercises should be promoted within HHAP. Key messages Despite developing heat-health action plans for several years, with the involvement of community partners, unidentified constraints existed in Amadora, Portugal. Tabletop exercises should be used more frequently, as we were able to identify and solve constraints within our heat-health action plan using one.

No abstract