Deficiência e saúde pública: estudo de rotas (in)acessíveis na perspectiva da pessoa com deficiência no alcance ao atendimento de saúde pública na cidade de Maceió

Abstract

With the new wording introduced in 2015 by the Brazilian Law for the Inclusion of Persons with Disabilities (Law 13.146/2015) to paragraph 3 of Article 41 of the City Statute (Law 10.257/2001), it was determined that from 2016 onwards, Brazilian municipalities with a Master Plan were required to develop their accessible route plans, ensuring accessibility for persons with disabilities to all existing routes and streets, in an integrated manner with public passenger transport systems. However, this legal determination was not fulfilled in the city of Maceió/AL, where the “urban accessibility in terms of route” continued to be overlooked, and urban interventions instead focused on isolated aspects and/or locations, resulting in “accessibility islands” in a city that remains predominantly inaccessible to those without full physical abilities. In this context, a significant portion of persons with disabilities residing in and/or commuting within Maceió/AL need to undergo physical therapy and medical treatments in the public health system of this capital, facing multiple accessibility barriers in their urban commutes to public health service locations. The advent of Covid-19 further highlighted this issue, as UN data (2020) indicated an increase in inaccessibility to the medical and physiotherapeutic treatments that these individuals were already receiving before the pandemic. This doctoral thesis aimed to develop guidelines for the design and implementation of an effective accessible routes plan, focusing on commutes to public health service locations in Maceió/AL, from the privileged perspective of three groups of persons with disabilities (Physical Disability, Visual Disability, and Hearing Disability/Deaf) in this city. This research is applied in nature and approached the problem qualitatively, characterized as exploratory-descriptive in relation to its objectives. The technical procedures were divided into three major execution stages: Stage 1: Conducting a Bibliographical Survey on authors such as Garcia (2012), Lippo (2012), Mace (1991), Morano and Santiago (2019), Gehl (2015), Virtuoso (2016), Verde et al. (2020), Cooper (2004), Norman (2013), Pruitt and Adlin (2006), Pazmino (2015), Sommer and Sommer (1997), and Rheingantz et al. (2009), Documental Research on the main institutional, normative, and legal advancements of accessibility in the Brazilian context, and a Systematic Literature Review using the Cochrane Collaboration Method (2021); Stage 2: Field Study A, involving the creation of 07 (seven) personas through the methodological tool titled "Persona Lifecycle" proposed by Pruitt and Adlin (2006); Stage 3: Field Study B, conducting “persona-scenario analyses” according to the propositions of Cooper (2004) and Pazmino (2015) of the created personas, and the subsequent creation of "person/individualcentered behavioral maps," according to the propositions of Sommer and Sommer (1997), Pinheiro and Günter (2008), and Rheingantz et al. (2009), where data analysis was conducted using the Inductive Method. The results demonstrated that the 07 (seven) created personas, the persona-scenario analyses conducted, and the person/individual-centered behavioral maps developed in this study represented accurately with precision and theoretical-methodological rigor the subjectivities, specificities, difficulties, challenges, and needs inherent to “urban accessibility in terms of route” of the 30 (thirty) real persons with disabilities researched, distributed in Group 01 – Physical Disability (10 subjects), Group 02 – Visual Disability (10 subjects), and Group 03 – Hearing Disability/Deaf (10 subjects), regarding their actual usual commutes to public health service locations in the city of Maceió/AL. This, combined with the recognition of my "place of speech" as a researcher/observer who is a person with a physical disability, through the use of the "experiential approach" proposed by Rheingantz et al. (2009), provided importante guidelines for the design and implementation of an effective accessible routes plan aimed at facilitating access to public health service locations in this capital.