Evaluation in health: participatory methodology and involvement of municipal managers

Abstract

OBJECTIVE To analyze scopes and limits of the use of participatory methodology of evaluation with municipal health managers and administrators.METHODS Qualitative research with health policymakers and managers of the Comissão Intergestores Regional (CIR – Regional Interagency Commission) of a health region of the state of Sao Paulo in Brazil. Representatives from seven member cities participated in seven workshops facilitated by the researchers, with the aim of assessing a specific problem of the care line, which would be used as a tracer of the system integrality. The analysis of the collected empirical material was based on the hermeneutic-dialectic methodology and aimed at the evaluation of the applied participatory methodology, according to its capacity of promoting a process of assessment capable to be used as a support for municipal management.RESULTS With the participatory approach of evaluation, we were able to promote in-depth discussions with the group, especially related to the construction of integral care and to the inclusion of the user’s perspective in decision-making, linked to the search for solution to concrete problems of managers. By joint exploration, the possibility of using data from electronic information systems was opened, as well as information coming directly from the users of the services, to enhance discussions and negotiations between partners. The participants were disbelievers of the replication potential of this type of evaluation without the direct monitoring of the academy, given the difficulty of organizing the process in everyday life, already taken by emergency and political issues.CONCLUSIONS Evaluations of programs and services carried out within the Regional Interagency Commission, starting from the local interest and facilitating the involvement of its members by the use of participatory methodologies, can contribute to the construction of integral care. To the extent that the act of evaluating stay invested with greater significance to the local actors, its involvement with the evaluations at the federal level can also be stimulated.

Multiple Sclerosis Manifested by Paralysis of Cranial VI Pair with Diplopia

“…Ocular findings in MS include optic neuritis, retinitis, peripheral vasculitis, ocular motility abnormalities that present with diplopia or nystagmus, and pars planitis [1,12,17,20,21]. All of them must be recognized by the ophthalmologist, although optic neuritis, due to its high frequency and established correlation with MS, is the most important ocular change in the follow-up of these patients [14,19,[20][21][22][23].…”

“…Ocular findings in MS are frequent and are often the first clinical manifestation of the diseas [19,[21][22][23]. Although optic neuritis was the most commonly observed alteration, the possibility that other ocular alterations precede or accompany the disease should be highlighted.…”

Evaluation of the satisfaction of users of a service specialized in diabetes mellitus

“…In recent years, the evaluation of health services proved itself to be an important instrument for planning and managing health systems and services, not only to evaluate the effectiveness of interventions and the efficient use of the available resources, but also to satisfy all of the system's user population (1) .…”

Meta-evaluation of a participatory process in the strengthening of municipal management

“…In Brazil, participative approaches for evaluation in the health sector are starting to gain space in the literature, referenced by experiences with the inclusion of stakeholder groups in the evaluation processes 1 , 6 , with the insertion of the participatory evaluation in the fabric of wider social intervention processes 3 , and with considering the criterion “participation” in meta-evaluations 14 . We deem it fundamental to continue this journey in the search for an approximation of theory and practice, and to deepen the meaning of opting for participation.…”