The Occupational Health and Safety Care Policy (PASS): The Case of the SIASS UNIVASF Unit

— The aim of this article was to analyze the Health and Safety at Work Policy of the Federal Public Servants (PASS), based on the case study of the SIASS Univasf Unit. The theoretical dialogues in this study were built from the concepts that make up Worker's Health. A qualitative and quantitative research was chosen as a methodological approach. In order to infer its results, we opted for the triangulation process consisting of a combination of three technical collection procedures: documentary research, in-depth particulars and online surveys.


INTRODUCTION
There is growing interest in the field of study called Public Policy (PP), aimed at analyzing the relations between governments, governments and citizens. From this perspective, the PP are nothing more than the State in action, which includes the study of institutions, rules and analytical models that govern its political cycle. Furthermore, talking about PP is talking about its social actors (SOUZA, 2012; VIANA; BAPTISTA, 2012).
From a theoretical-conceptual point of view, public policy is not limited to the field of political science, being an interdisciplinary field, object of analysis by other areas of knowledge, such as: administration, law, economics and sociology (SOUZA, 2012).
Studies aimed at economic development have opened a new course of investigation, in which social and health policy are considered within the broader framework of the relationship between the State, economic development and social protection systems, in the so-called Social Welfare State (DRAIBE, 2001;. Within the scope of Health Policies (HP), based on integrality, universality, equity and social participation, basic principles of the SUS, a new model of health care for workers emerges, supported by actions of assistance, promotion, surveillance and prevention of related diseases to work, called worker's health. A field that manifests itself at the heart of a democratic society, embodied in the achievement of rights and the free organization of workers (MARTINS et al., 2017).
Despite advances in the field of worker health in the private sector, it is observed that there remains a large gap in the health care of public servants. Only within the scope of the federal public administration is it defined the commitment to build and implement, in a shared way, a policy aimed at federal public servants governed by the movement that culminated in the creation of the Integrated Subsystem for Servant Health Care (SIASS), in 2009 (BIZARRIA et al., 2013).
According to the federal government, the PASS is configured as a transversal policy of workers' health, involving the different bodies of the federal public administration in three support axes: health care; health expertise; health promotion, prevention and monitoring. In turn, the institution of SIASS, as a structuring system, represents an advance in health care for federal employees, a way to guarantee and make the policy effective (BRASIL, 2010).
Like all social policies and programs, PASS and SIASS aim to guarantee the best living conditions for federal civil servants, making use of the management capacity of their implementing agents (public managers) to fulfill the wishes of their beneficiary agents (federal public servants).
That said, the Health and Safety at Work Policy of the Federal Public Servants in the perception of its social actors (implementing agents and beneficiaries) becomes fundamental in sustaining this work, carried out at the SIASS UNIVASF Unit. The case was chosen because of its importance for the regional development of the semi-arid Northeast, bringing together federal institutions from three states of the federation: Pernambuco, Bahia and Piauí.
From this perspective, this study proves to be extreme to expand and discuss scientific production in the field of public health policies, which play a fundamental role in the full exercise of citizenship, in the realization of different rights of collectivities and in the construction of a State with greater effectiveness in the field of worker's health, as established in the Federal Constitution of 1988 and in Law No. 8.080, of September 19, 1990, which, among others, consigns work as a determining and conditioning factor in the scope of the objectives of the SUS ( BRAZIL, 1988;.

II. WORKER'S HEALTH
The field of workers' health, as a public policy, was built on the different combinations of strength between capital, labor and the State. From the practices aimed at health-work relations, a transition process between the three models can be observed: occupational medicine, occupational health and worker health. Models that are present and alternate in hegemonic terms due to prevailing labor relations, the level of organization of workers and institutional policies (RAMMINGER; NARDI, 2007; ANDRADE, 2009).
Occupational medicine, as a medical specialty, emerged in the 19th century, in England, with the Factories Act, being the first legislation to be included in the field of worker protection. Thus, the presence of a doctor inside the factories represented both an investigation of the causes that led to illness, and a way of recovering the worker's health, which is fundamental for the emerging production and industrialization line. Centered on the figure of the physician, in the context of work, reflecting a propensity to isolate specific risks and act on their consequences, medicalizing their symptoms or associating them with a legally recognized disease. In the same way, the diagnosis of disease in the selection phase works as a way to prevent the contracting of an agreement, whose health is compromised (MINAYO-GOMEZ; THEDIM-COSTA, In addition to occupational medicine practices, the occupational health model emerges as a more extensive proposal. Despite this reduction and expansion, in practical terms, there are limitations related to the field of occupational medicine, as protective measures end up restricted to specific measures on the most evident risks. The use of individual protection equipment is emphasized, to the detriment of other collective protection instruments. Safety standards are established as a form of symbolic prevention, charging subordinate workers with the burden of accidents and illnesses, resulting in a double penalty (MACHADO; MINAYO-GOMES, 1995).
In this perspective, workers' health arises from the need for the State to intervene more importantly in the relations of the production process, in order to promote more dignified working conditions for workers. In a context of critical reflection, it goes beyond the conceptions and practices of the models in force until then, related to occupational medicine and occupational health, creating a way to deal with the work-health relationship in work environments and to introduce care practices to workers' health. It should be noted that the field of workers' health is under permanent construction, guided by the assumptions of collective health, in terms of the hegemonic conceptions of occupational medicine and occupational health In this context, a Policy for Health and Safety at Work for the Federal Public Servants was born, an initiative, for a time, by the Ministry of Planning, Budget and Management (MPOG), aimed at providing health care to the civil servant based on the health relationship. -work, whose "government emphasis has always been on training and compensating public servants, without prioritizing the relationship between health and work" (RAMMINGER, NARDI, 2007, p. 217).

III. THE PASS AND THE SIASS
The federal government, with the objective of minimizing the effective costs of the lack of a policy aimed at the health of the civil servant, through the Ministry of Planning, made efforts to institutionally respond to the gaps left in the health care of public servants, establishing the initial milestones for the construction of a health care policy for federal public servants, fulfilling the aspirations of For the federal government, the institution of SIASS represents an innovation in health care for federal public servants, a way to ensure sustainability and give effectiveness as PASS actions. As a structuring system, it enabled the articulation between the different bodies of the direct federal, autarchic and foundational public administration to standardize procedures and collectively create norms, actions, training projects and communication channels (BRASIL, 2010). Given the above, a triad formed by the axes that support the policy must be based on interdisciplinary actions that modify work environments and processes, allowing its social actors (implementing agents and beneficiaries) to become active and central subjects in the its planning and execution (MARTINS, 2017).

IV. METHODOLOGICAL PROCEDURES
This research stands out as descriptive and exploratory, proposing to know the perceptions of social actors about the PASS in the SIASS UNIVASF Unit and the way in which it is being implemented in federal institutions.
Taking a stand on philosophical, ontological and epistemological conceptions, a social constructivist conception was adopted in this study, which aims to trust the participants' perception of their own reality (CRESWELL, 2010).
To reach the proposed research proposal, qualitative and quantitative approaches are used, understanding that together these approaches are greater than one or the other in isolation. In this sense, the mixed method and the sequential exploratory strategy based on Creswell (2010) were adopted, a procedure determined to be more appropriate to the interdisciplinary nature of this study.
Regarding the sequential exploratory strategy, a qualitative phase was carried out before, aimed at the managers of the institutions and, later, a quantitative phase involving the institutions' federal civil servants, with greater weight being given to the qualitative phase.
The research strategy adopted was the incorporated single case study based on Yin (2015) and included 10 (ten) units of analysis and multiple sources of evidence, through a triangulation process, which forms the development of convergent lines of investigation, consisting of a combination of three technical collection procedures: documentary, private, in-depth individual research and an online survey.
As for the analysis of the results obtained, qualitative data were found in the content analysis based on Bardin (2016) with the support of the Atlas.ti 8 software and quantitative data in the univariate descriptive statistics with the aid of Microsoft Excel®.
Regarding the time frame, a cross-sectional study was carried out during a six-month period, between March and August 2019, at the SIASS UNIVASF Unit.
The scientific research is based on the perception of the social actors of the PASS that make up a SIASS UNIVASF Unit, that is, the implementing agents (federal public managers) and beneficiaries (federal public servants) of the institutions participating in the ACT 2018.
A manager from each participating institution of the ACT celebrated with a SIASS UNIVASF Unit was selected to respond to the individual in depth. The corpus of this research was composed altogether by 10 (ten) individual in depth, and of the 10 managers interviewed, only 01 did not have higher education. In addition, the time in the exercise of the function varies between 08 months and 10 years, depending on the manager.
An online survey aimed at federal public servants participating in the ACT of the SIASS UNIVASF Unit was carried out through Google Forms and concluded with a total of 672 respondents, corresponding to 22.4% of the universe.
It is evident that the institutions with the highest number of respondents were the Federal Institute of Sertão Pernambucano (IF SERTÃO)  The SIASS UNIVASF Unit has a multidisciplinary team formed by 17 (seventeen) professionals from different areas of activity, including physicians, nurses, psychologists, nutritionists, occupational safety technicians, completing care actions, injuries and health promotion of federal public servants under their responsibility.
Regarding its physical structure, it has its own headquarters, inaugurated with investments from the Ministry of Planning on April 25, 2015, including facilities that are modern and comfortable, with a wellness room, a social room, three rooms for multidisciplinary care , an auditorium with 40 seats, in addition to administrative rooms, to better serve the federal public servant.

VI. THE IMPLEMENTATION OF THE PASS IN THE SIASS UNIVASF UNIT
The documentary research consisted of verifying, at the local level, the implementation of PASS actions in the participating institutions, through the fulfillment of the signed ACTs and respective work plans, whose supervision and monitoring of actions are the responsibility of an interinstitutional committee by a representative of each participating institution.
It was found that between 2010 and 2018, a total of 8,633 (eight thousand, six hundred and thirty-three) consultations were carried out for civil servants, dependents and visitors in transit in the expert sector of the SIASS UNIVASF Unit.
Based on the basic numbers, it is possible to observe that most demands for official expertise in health come from institutions, to demonstrate the scope of the technical cooperation agreement signed and the full functioning of this axis of the policy.
Based on the accounts of the managers in the depth of people, it was identified that only 02 (two) institutions implemented actions in the three axes of the policy, which indicated the low level of involvement of the implementing agents with the celebrated ACT. It was also evidenced that for the vast majority, the agreement is limited only to material exchanges and existing human resources as a result of the medical expertise carried out by the SIASS UNIVASF Unit.
From the point of view of the beneficiary agents, it was verified, from the online survey, that there is a significant level of ignorance about the PASS in the participating institutions, revealing that although the SIASS Unit is recognized for the importance of its actions for the public servant federal government, is not perceived by its beneficiaries as the executing agency of a public health care policy.
Based on the triangulation of the results obtained through documentary research, in-depth individual needs and the online research carried out, it can be attested that, in addition to representing most of the demand, the official expertise in health is the only axis carried out by the Reference Unit base for the 10 (ten) participating institutions of the celebrated ACT.
It is also noted that the responsibility for implementing the health promotion and surveillance axes in the SIASS UNIVASF Unit was expressly transferred to the participating institutions, through the work plan drawn up from the celebrated ACT. However, the civic commitment assumed by the institutions themselves is not being fulfilled in its entirety and neither is it supervised by the interinstitutional commission translated to this manufacturer, contrary to the legal precepts contained in Decree No. 6.833 / 2009 that instituted the SIASS in national terms.
It was also evidenced that the PASS is not perceived by managers and federal public servants as a public policy for the health of the public servant. Therefore, it is perceived by its social actors (implementing agents and beneficiaries) as a mere partnership to carry out expertise in health, which reflects a fragmented view of the policy, which should invoke health in its unrestricted and integral sense, embodied in interdisciplinary actions in its three support axes: promotion, health surveillance and official expertise, respectively in that order (MARTINS, 2017).
From this perspective, it is possible to infer an inversion in the general scope of the policy, idealized and conceived within a worker's health model, benchmarks are prevention, promotion and health surveillance, contrary to the conceptions and practices restricted to operations performed after the illness of the civil servant, which refer to the retrograde models of occupational medicine and occupational health (MINAYO-GOMEZ et al 2018).

VII. CONCLUSIONS
Without intending to exhaust all theories on the subject, the result presented shows a clear gap between the central objective of PASS -preventing illness and promoting the health and safety of the server's work -and the way it is being implemented and perceived by its social actors in the participating institutions in the SIASS UNIVASF Unit. In practice, only the official health expertise axis was fully implemented.
In view of the factual situation, as Martins (2017) points out, promoting health surveillance and promotion actions