This inquiry concerns the daily activities of a public health program for “persons in a street situation” in São Paulo, and describes the various places, moments, competences and technologies they involve. Since 2013, Brazil has put in place mobile teams of Consultorio na Rua to care for the health of the homeless. Patrolling the streets of their local area, each of these teams is responsible for meeting the “persons in a street situation” and doing the work of health monitoring and assistance. Two non-governmental organizations were in charge of placing and dealing with 20-odd teams of Consultorio. This research focuses on the daily activities of one of these organizations, with the aim of understanding how a municipal health program for “persons in a street situation” is created and maintained in this specific institutional context of “partnership” with a non-governmental actor.
The context of this research is the sociology of public problems. It examines the evolution in how the public authorities of São Paulo and Brazil have viewed and dealt with the issue of “persons in a street situation” and shows the amalgam made during the 2000s between the latter and the fight against crack. This sociology of public problems thus translates into a sociology of public action. The gradual recast of issues of street persons and the fight against crack is approached from the specific angle of the institutional configurations it contributes to engendering, studying the government instruments that have disappeared and those that have appeared between the beginning of the 2000s and today.
The comparative aspect – thanks to a first Master inquiry led in a mechanism previous to the Consultorio na Rua teams – as well as the ethnographic orientation of these two inquiries, by focusing on the actual day-to-day practices of these mechanisms on the ground, nonetheless bring to light the permanent aspects of the two public policies. In combination with the ethnography of the evolution of healthcare teams over several years, observation periods in various divisions of the São Paulo healthcare administrations aid in sketching out a sociology of institutional change, by indicating on one hand what is permanent in practices, beyond the evolution of government instruments, and on the other hand, changes, or adaptations of practices on the field not sanctioned by legal evolutions.
The main theme of the inquiry is ethnographic, and aims to observe and describe the activities of the organization in their different décors.
- Observation, over several months, of the program’s administrative team;
- Observation of meetings at the municipal health secretariat for the evaluation and definition of the organization’s activities;
- Observation of two mobile health teams, during four to five months each, so as to be able to describe in detail their activities.
A second theme examines recent changes in how these persons are cared for, seeking in particular to show how the growing importance of the crack problem in recent public debate has had an impact on how to consider and take care of “persons in a street situation”.
The Social Center Nossa Senhora de Bom Parto, or “BomPar”
This NGO, signatory of a “partnership” (parceria) with the São Paulo Municipal Secretariat of Health, is at the heart of the inquiry, and in a rationale of “terciarisation” (tercerizaçao) is in charge of public services, implementing half of the city’s 16 Consultorio na Rua teams.
Founded in 1946 by Dom Luciano Mendes, clergyman of the parish of Nossa Senhora do Bom Parto, in the workers neighborhood of Tatuapé, the Social Center’s aim was to propose training for neighborhood women. Over time, the organization increased in size and broke away from the parish to become an independent entity and is today a major actor in the sector of “terciarized” assistance in São Paulo. The “BomPar” is also a pioneering figure of aid to “persons in a street situation”. In 1989, it founded what would become the city’s first non-asylum housing structure. During the 1990s, it participated in mobilizations demanding of the public authorities to improve care conditions for these persons. Ten years later, it was chosen by the Town Hall to think out and install the first public health mechanism specifically designed for the street in Brazil. Founded in 2004, the Program A Gente na Rua, put in place the first Street Family Health Teams (ESF-R) in the country. In 2013, these became the teams of the Consultorio na Rua, meant to be more capable of dealing with the issues of addiction and mental health affecting the “street population” more and more.