Subsídios sobre práticas de monitoramento e avaliação sobre gestão governamental em Secretarias Municipais de Saúde

Abstract

What do the leaders of the Municipal Health Service (SMS) report and say about the systematic monitoring and evaluation of their own government management? The purpose of this paper is to provide input for the formulation of plausible hypotheses about such institutional processes and practices based on information produced in an exploratory study. This is a multiple case study with quantitative and qualitative analysis of answers to a semi-structured questionnaire given to government officials of a systematic sample of 577 Municipal Health Services (10.4% of the total in Brazil). They were selected and stratified by proportional distribution among states and by the population size of municipalities. In general, it shows that approximately half of the respondents use information from Health Monitoring Evaluations to orient decision-making, planning and other management approaches. This proportion tends to decrease in cities with smaller populations. There are specific and significant gaps in financial, personnel and crisis management. The evidence from the hypotheses highlights the fact that these processes are still at an early stage.

Práticas de monitoramento na gestão municipal em saúde e sua interface com a enfermagem

“…These factors were also found in other studies (3,10,(16)(17)(18)(19) . One of the factors believed to prevent effective planning in healthcare is structural weakness, such as the fragmented planning of the actual health department, related to the planning of the local authorities according to the funding they receive and the need to prove minimal organisation to use these resources, without the co-responsibility of the government regarding planning.…”

“…The integration of the SUS is necessary for the intergovernmental decentralisation of this system. For this reason, the SUS introduced new competencies and responsibilities for the three spheres of government to ensure and safeguard the right to healthcare in the union, states, and municipalities (3) . The historical construction of guaranteed access to healthcare for the Brazilian population reveals that management of the health system depends on different actors and a range of scenarios with several work and insertion possibilities for professionals who serve as mediators between public policies and the population (4) .…”

“…The practice of monitoring healthcare is associated with the development and exercise of competences and management attributes such as directionality, command, conduct, communication, regulation, and the execution of government decisions; the formulation of policies and programmes; decision making and the planning of actions, programmes and projects; assessments of the health status of a population; guidance for process implementation, consolidation, and the reshaping of health practices; more assertive planning with respect to necessary resources; and monitoring of the implementation of actions and resource use (3)(4)(9)(10) . The challenges are the consolidation of an assessment and monitoring culture that can be perennially perpetuated inside public organisations even with the changing of teams after political turnover (4) .…”

O uso de uma avaliação por gestores da atenção primária em saúde: um estudo de caso no Sul do Brasil

“…Apesar da preocupação em utilizar informações do processo avaliativo, percebida nas entrevistas, o desenvolvimento da capacidade em monitoramento e avaliação nos municípios é restrito, com ênfase no monitoramento de informações epidemiológicas, demográficas e financeiras, e menor preocupação com aspectos da avaliação participativa, como o de despertar a reflexão crítica sobre as práticas 18 . Esse fato está refletido no contexto político-organizacional não favorável ao uso.…”

Uso da análise de clusters como ferramenta de apoio à gestão no SUS

“…Among the findings it stands out that 38% of the secretariats did not have mechanisms to monitor and evaluate how goals and resources set out in Municipal Health Plan. Moreover, about a third of these institutions did not have any professional who worked specifically in the area (Miranda;Cavalcante, 2012).…”