A continuidade das redes de instituições estruturantes de saúde durante a inércia da Unasul: a ação das comunidades epistêmicas na RINS, RESP e RETS

Abstract

This research asks how and why the Network of National Health Institutes (RINS), the Network of Public Health Schools (RESP) and the Network of Technical Health Schools (RETS) of the Union of South American Nations (UNASUR) were maintained and expanded during the context of inertia of this regional institution and became Latin and Ibero-American networks and action plan: Rede IANPHI LatAm, RESP-AL, RETS-AL and RIETS. The hypothesis for this is based on Peter Haas's expectations about the sustainability that epistemic communities confer on their common policy enterprise. In this sense, the hypothesis addressed is that the condition of networks participants as members of an epistemic community born in Brazil, which was a leader in the health sector in Latin America, motivated the maintenance and expansion. To verify this hypothesis, this research has a hypothetical-deductive method of approach and is carried out through a historical case study, whose evidence was collected through bibliographical and documental review and semi-structured interviews, and processed through process-tracing. As a result, the process of maintaining and expanding the networks is better defined as re-signification, since the format of networks of health structuring institutions continued, but the new networks have different characteristics from the Unasur networks, mainly the criteria of membership, geopolitical alignment, agenda setting, and financial resources. The existence of an epistemic community that extends between representatives of Brazilian institutions in the three Unasur networks and in the re-signified networks and plan was confirmed. The community, however, is better defined as being linked to Fiocruz, rather than to Brazil in general. The main political common policy enterprise of the community is the structuring cooperation in health (CES). CES is understood both as a model of cooperation and as a public health vision. As a public health vision, it descends from the evolution of other enterprises defended by previous generations of this community over time and at regional and national levels (preventive medicine, social medicine and collective health). Most of the networks were re-signified due to institutional choices made by different units at Fiocruz and personal choices arising from the engagement of epistemic community members with the work in the networks. The Rede IANPHI LatAm, in turn, emerged from the construction of regional networks by IANPHI, still in the beginning of the context of inertia of Unasur, being favored by previous relations in RINS. In addition, the experience of the epistemic community of CES in the networks could provide some lessons about the characteristics of post-hegemonic regionalism, the approach of epistemic communities and the study of the realization of the human right to health in Latin America and the Third World.