Critical realism and social inequalities: Considerations from an evaluative research

Abstract

Based on different theoretical references (public health, program evaluation, and critical realism), the paper analyzes whether conditional cash transfers contribute to the reduction of monetary poverty and improved health care. It employs evaluative research material, consisting of a case study on the health conditionalities of the “Bolsa Família” Program (PBF) and its implementation by the Family Health Strategy in a primary care service (PHC service) located in a slum area in Rio de Janeiro. Experiences and perceptions of managers, health professionals, and beneficiary families were prioritized to understand the dynamics of the program. A predominant perception is that the PBF “benefits those who need it, but also those who do not need it”. On the one hand, health care is recognized as limited, since households are vulnerable and with health problems resulting from this condition. On the other hand, having access to the Clinic is a crucial resource since the benefit is seen as of little value, which reinforces the idea of “aid”. It concludes that the three domains of stratified reality contribute to understanding the scope of programs that address the imbrication of biological and social aspects in contexts marked by inequality and poverty.