Analysis of partnerships for actions intra-sectoral and inter-sectors for health in areas of high socio-environmental vulnerability in the city of São Paulo/Brazil: a mixed method study

Abstract

Context: Since poverty areas are socioeconomic complex and limiting environments, there is a need to develop intra-sectoral and inter-sectoral actions in the health territory in order to achieve the economic and social well-being of people and society. This research aims to understand the relationship between inter-sectorial and inter-sectoral actions for health and socio-environmental groupings of the most vulnerable health territories in the city of São Paulo, identify which are the most frequent partners of these actions and how professionals experience these partnerships in their daily lives. Method: We adopted the mixed sequential and explanatory method. In the first phase, an online form was applied and identifies the Basic Health Units (BHU) that take place as intersectoral actions with more partners. In the second phase, we explored how the professionals consider the characteristics of the territory where they act to seek partnerships and how they carry out the actions. Results: Analysis of quantitative data indicated that: a) More than 98% of BHUs conduct intra- and inter-sectoral partnerships and b) there is no relationship between the indices of the most vulnerable groupings and the presence of intra- and inter-sectoral actions with statistical significance p <0.05. The content analysis of literal transcriptions pointed out that: intra- and inter-sectoral practices developed in the health territories were driven by the needs of the treatment of diseases or by the precarious conditions of life of individual or collectivities. However, in order to assist different types of violence, health professionals avoid seeking partnerships, including with the Tutelary Council and the Center for Human Rights, as they fear they will suffer reprisals by those who cause this violence. There was consistency between quantitative and qualitative data, except for partnership with education, other BHUs, environment, and the Tutelary Council. Conclusion: The construction of personalized partnerships for individual and collective health, in order to cope with social inequalities; of chronic diseases and by phases of the life cycle involved in socioeconomic fragilities that generate more poverty is part of the job from BHU’s professionals.