Apoio institucional em saúde: desafios para democratização na atenção básica

Abstract

It was aimed to analyze one of dimensions of the Basic Attention offered by in primary care team by the municipal administrations of Brazilian cities that have joined Access Improvement Programme and Quality of Primary Care (PMAQ-AB in portuguese). Owned descriptive exploratory, by qualitative and quantitative approaches to data analysis. Data collection took place between February-October 2014 by two sample groups, the first one consisting of respondents of module II corresponding to 2941 teams of 23 capitals that have joined the program and the second one by 22 managers of Primary Care Brazilian cities that responded to the module IV (on line). In quantitative phase variables were analyzed using descriptive statistics, using IBM SPSS Statistics Software 20 and organized and grouped results in three dimensions: characteristics of Institutional Support; Institutional Sketchpad the work process and support teams to manage and plan work processes. In qualitative phase, it was analyzed general guidelines for the Institutional Support in the municipal, as described by the municipal manager in online form. For organization and categorization of qualitative data was used Atlas ti.7.1, and as a method of interpretation, content analysis. From the conception of support as a democratizing tool, it was proceeded to approach concepts Support Paideia (Campos), power relations (Foucault) and institutional analysis (Lourau). It was defined following categories of analysis: Category 1 - Dimension administration and planning work processes by subcategories: Support for organization of work process of teams; Support planning, monitoring and evaluation; Support the actions of teams; Support for the strengthening of health care networks and intersectoral actions and organizational and administrative structure of support in the city. Category 2 - Dimension Policy by following subcategories: Support for participative process management and stimulation of social control; Support the building of democratic relations, cooperatives and dialogical; Support for actions related to PMAQ; description of Institutional Support using the same wording of official documents of health ministry. Category 3 - Pedagogical dimension formed by Subcategory: formation and training of professionals and managers. It was observed that Institutional Support is a reality in context of Primary Care in Brazil, but it was found that in both actions supported as the guidelines proposed by managements is evident in a normalizing and trace this process. There was a positive evaluation by teams Sketchpad Institutional, although these professionals find themselves overwhelmed when exercising that function by excessive number of teams under their responsibility, demonstrating the need for a design that takes into account how to operate the Support function. In Brazilian cities were observed weaknesses in a position to manage the processes for institutionalization of support, the conclusion was that managements and management teams in Primary Care need to be supported in conducting this process. It is proposed thus deepening the theme and when other PMAQ-AB cycles tooccur be made adequacy of instruments used in external evaluation concerning the importance Institutional Support in order to advance the appreciation of uniqueness of support, especially regard to co-management as a collective and democratic process.