Integrative and complementary practices in health (ICPS)
Fátima Helena do Espírito Santo¹
1 Federal Fluminense University
Integrative and Complementary Practices (ICPS) emerge in the current health system context as an alternative to promote comprehensive care centered on the demands of the person, through less invasive and costly approaches that favor the development of their potential to face situations related to the process of living and being healthy which involves, in addition to the environment, a continuous interaction between mind and body.
Based on a comprehensive and dynamic approach to the health-disease process, ICPs promote natural mechanisms for the prevention of health problems and health recovery based on a therapeutic project that values bonding, welcoming, touch and active listening as essential elements to provide comfort and safety in the perspective of balance aiming at the prevention, promotion and maintenance of people's health in different environments.
It is important to mention that ICPs can be used both individually and in groups, but the choice of the adopted practice must be preceded by a previous assessment of the expected benefits taking the preferences, characteristics, cultural values and individual needs and/or groups as a reference, as well as the professional's experience and knowledge in this area.
In Brazil, the term Integrative and Complementary Health Practices (ICPs), corresponds to the denomination of the World Health Organization (WHO) of "traditional and complementary medicine", where "traditional medicine" refers to the sum of knowledge, skills and practices based on theories, beliefs and cultural experiences used for health maintenance, prevention, diagnosis and treatment of physical and mental illnesses. And "complementary medicine" is a broad set of health care practices, different from conventional ones, which are not fully integrated into the dominant health system. (1)
ICPs were institutionalized in the Unified Health System (SUS) with the National Policy on Integrative and Complementary Practices (NPICP), approved by Ordinance GM/MS No. 971, on May 3, 2006. This policy covers the responsibilities and institutional guidelines for the offer of: homeopathy, traditional Chinese medicine/acupuncture, medicinal plants and herbal medicine. It also creates an observatory of anthroposophical medicine and social thermalism/crenotherapy. Its main objective is to incorporate and implement these practices within the scope of SUS, for the prevention of injuries, health promotion and recovery, with an emphasis on primary care, focused on continuous, humanized and comprehensive health care. (2)
The construction of this policy followed the guidelines and recommendations of several national health conferences and the WHO, which encourages and strengthens the insertion, recognition and regulation of these practices, products and their practitioners in national health systems. These guidelines were recently updated with the document "WHO Traditional Medicines Strategy for 2014-2023".(1)
In March 2017, NPICP was expanded with 14 other practices: art therapy, ayurveda, biodance, circular dance, meditation, music therapy, naturopathy, osteopathy, chiropractic, reflexotherapy, reiki, shantala, integrative community therapy and yoga, totaling 19 practices (3) In 2018, the following practices were included: aromatherapy, apitherapy, bioenergetics, family constellation, chromotherapy, geotherapy, hypnotherapy, laying on of hands, anthroposophical medicine/anthroposophy applied to health, ozone therapy, flower therapy and social thermalism/crenotherapy. (4)
Thus, there is an increasing advance in the legitimization of these practices in Brazil, offering other therapeutic possibilities for people and perspectives of greater comprehensiveness and resolution in health care in the context of SUS, whose main point of entry is Primary Health Care.
Thus, it is worth mentioning that the National Policy of Integrative and Complementary Practices is transversal in its actions in SUS and converges with other national public policies such as: Humanization, Primary Care, Health Promotion, Permanent Education, Pharmaceutical Assistance, Medicinal Plants and Herbal Medicines, Traditional Peoples and Communities, among others, whose actions resulting from this interaction are fundamental for improving the health care of the population. (5)
In the field of health professions, ICPs are linked to nursing care by approaching and understanding the human being, valuing their life trajectory, their individual characteristics and ways of dealing with health and illness, through welcoming and active listening that favors the expression of ideas, knowledge and experiences and the creation of a therapeutic bond.
Thus, in the expectation of new directions in people's health care, it is suggested that nurses and other health professionals seek to broaden their view beyond the technicist view focused on the individual's disease with practices that favor balance and well-being aiming to contribute in a more humane way to improving the quality of life of the people under their care. And, in this sense, the transition to a new model needs to occur slowly and carefully, in view of the enormous symbolic power of conventional medicine centered on the biomedical model in our Western culture in order to enable more integrated and integrative care in services through care actions centered on the healthy core of the person to stimulate their potential for healing and balance.
However, during the expansion of the ICPs, there is already a growing movement of several professionals and researchers working in this field, with the formation of research groups, networks of professionals in different areas of the country and the organization of events such as the National Congress of Integrative and Complementary Practices (CONGREPICs), with the purpose of sharing experiences and knowledge in the face of new perspectives in health care.
Among the advances allied to this movement, the Brazilian Academic Consortium for Integrative Health (CABSIn) was launched in 2018 during the 1st International Congress of Integrative and Complementary Practices in Public Health, in Rio de Janeiro. It is a collaborative network of researchers, universities and research institutions from all over Brazil that integrates conventional medicine and complementary approaches based on scientific evidence and collaboration of the Latin American and Caribbean Center on Health Sciences Information (BIREME / PAHO / WHO).
The Virtual Health Library in Traditional, Complementary and Integrative Medicines (VHL MTCI) is a thematic VHL, specialized in the area of MTCI that aims to promote the dissemination, exchange of knowledge and experiences among researchers, managers, professionals and students interested in MTCI.
In recent decades, we have seen significant advances in the ICPs, however, we face some challenges regarding their consolidation in our country such as: disseminating and expanding the supply of these practices to the population in the health network, training and qualification of human resources in this specialized area, investments in infrastructure and financial resources to maintain these practices in services, as well as incentives for research aimed at expanding knowledge and gaining more scientific evidence on the effectiveness of using ICPs in health care.
References
1. Organización Mundial de la Salud. Estrategia de la OMS sobre Medicina Tradicional 2014-2023 [Internet]. Organización Mundial de la Salud; 2013 [cited 2018 maio 28].Available from: https://pesquisa.bvsalud.org/ripsa/resource/pt/who-95008
2. Brasil. Ministério da Saúde. Portaria nº 971, de 03 de maio de 2006. Aprova a Política Nacional de Práticas Integrativas e Complementares (PNPIC) no Sistema Único de Saúde. Diário Oficial da União [Internet]. Brasília; 03 maio 2006 [cited 2020 maio 12].Available from: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2006/prt0971_03_05_2006.html
3. Brasil. Ministério da Saúde. Portaria nº 849, de 27 de março de 2017. Inclui a Arteterapia, Ayurveda, Biodança, Dança Circular, Meditação, Musicoterapia, Naturopatia, Osteopatia, Quiropraxia, Reflexoterapia, Reiki, Shantala, Terapia Comunitária Integrativa e Yoga à Política Nacional de Práticas Integrativas e Complementares. Diário Oficial da União [Internet]. Brasília; 27 mar 2011 [cited 2020 maio 12]. Available from: http://189.28.128.100/dab/docs/portaldab/documentos/prt_849_27_3_2017.pdf
4. Brasil. Ministério da Saúde. Portaria n° 702, de 21 de março de 2018. Altera a Portaria de Consolidação nº 2/GM/MS, de 28 de setembro de 2017, para incluir novas práticas na Política Nacional de Práticas Integrativas e Complementares - PNPIC. Diário Oficial da União [Internet]. Brasília; 21 mar 2018 [cited 2020 maio 12]. Available from: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2018/prt0702_22_03_2018.htm
5. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Práticas Integrativas e Complementares. Plantas medicinais e Fitoterapia na Atenção Básica. Normas e Manuais Técnicos Cadernos de Atenção Básica [Internet]. Brasília: Ministério da Saúde. 2012 [cited 2020 maio 12]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/praticas_integrativas_complementares_plantas_medicinais_cab31.pdf