Desempenho gerencial em serviços públicos de saúde: estudo de caso em Mato Grosso do Sul, Brasil

Abstract

This paper presents part of a doctoral dissertation that developed a theoretical model capable of identifying managerial performance in various administrative levels of a Municipal Health Secretariat. The methodology was a case study of the Municipal Health Secretariat in Campo Grande, capital of the State of Mato Grosso do Sul, Brazil. The theoretical model was based on recent debates emphasizing the need to modernize public administration, with an emphasis on efficacy and efficiency in the organizations as a whole. Some 31 interviews were conducted with the objective of identifying the managers' performance, through questions based on their daily practices in planning, organization, direction, and control. Managers from higher hierarchical levels obtained better results, while those in basic health units generally developed activities and complied with decisions passed down by imposition, with limited capacity to plan, organize, or control activities pertaining to their management sphere. These results stem partially from the charismatic leadership and centralizing administration of the current management in the municipal health system.

A gerência da Unidade Básica de Saúde no controle da tuberculose: um campo de desafios

“…Efficacy, from the perspective of the health area, is defined as the ability of managers to achieve results in the activities of planning, organization, direction and control, without disregarding the greater purpose that is to solve the health problems of the clients (10) .…”

“…These statements lead to the idea that the subject takes the management performance from the technical-bureaucratic point of view, against the idea of the Strategic Planning (10) . This aspect has already been the analysis field of other authors (10) , showing the managers' lack of knowledge about the health problems of their territory, and requiring a greater participative involvement to rethink the production and reproduction of the management aspects (9,11) .…”

“…This aspect has already been the analysis field of other authors (10) , showing the managers' lack of knowledge about the health problems of their territory, and requiring a greater participative involvement to rethink the production and reproduction of the management aspects (9,11) .…”

“…Some authors consider that the area of planning and management in health has a potential for changes and innova-tions in the process of organization, management and evaluation, which must be frequently revisited by the manager (10) .…”

Gerência em saúde: a percepção de coordenadores da estratégia saúde da família, em Uberaba-MG

“…Da mesma forma como se buscava, em cada época, o alcance da segurança de uma produtividade satisfatória, atualmente também existe, na área da saúde, uma abordagem gerencial preconizada que busca contribuir para o desenvolvimento do cuidado integral (2) . Sabe-se que a estrutura organizacional do processo gerencial em saúde deve ser desenvolvida de forma horizontal -ou seja, não hierarquizada, com participação plena dos profissionais atuantes juntamente com a população-alvo -e descentralizada, não havendo concentração de responsabilidades (3) . Sendo assim, estabelecer-se-ia o princípio da cogestão em saúde, entendida como uma estratégia gerencial a ser desenvolvida com base na democratização e participação de todos os envolvidos no processo de trabalho, dependendo de uma construção ampliada da direção gerencial não centralizada em minorias, mas dividida entre todas as pessoas de um coletivo, as quais são corresponsáveis pelas tomadas de decisão (4) .…”