“…The dimension of implementing the proposal in terms of changing the pattern of provision and expanding access is evidenced by the large number of units established, with substantial increases in basic consultations recorded in the information system (Tanaka;Drumond Jr., 2010). Such relevance could justify the choice of this object of analysis through the need to understand the impacts of this large-scale policy on the organization of primary health care and its impact on other levels of the system.…”
Section: Results: Using Clusters To Evaluate Ama Servicesmentioning
confidence: 99%
“…The incorporation of evaluation into decisionmaking in managing health services has been recommended as one of the main instruments for improving quality, resolution and responsive capacity to the health needs of the population (Tanaka;. In this sense, for Felisberto et al (2010), disseminating and incorporating an evaluative culture into everyday practice of three SUS management levels would qualify the decision-making of the actors involved.…”
The institutionalization of health services evaluation tools is a strategic challenge for the development of the Brazilian National Health System (SUS). The aim of the study was to explore the potential of cluster analysis as a technical tool to support the SUS management. Steps for constructing clusters applied to a concrete reality are presented and discussed, by analyzing a type of health care emergency services (AMA), in São Paulo city. The strategy was based on using secondary data to construct homogeneous groups, which allows multivariate analysis, enhancing the interpretation of the relationship between these data. The study findings indicate that this technique has the potential to be used by institutional actors in the SUS management to evaluate and to monitor health services in big cities or health regions.
“…The dimension of implementing the proposal in terms of changing the pattern of provision and expanding access is evidenced by the large number of units established, with substantial increases in basic consultations recorded in the information system (Tanaka;Drumond Jr., 2010). Such relevance could justify the choice of this object of analysis through the need to understand the impacts of this large-scale policy on the organization of primary health care and its impact on other levels of the system.…”
Section: Results: Using Clusters To Evaluate Ama Servicesmentioning
confidence: 99%
“…The incorporation of evaluation into decisionmaking in managing health services has been recommended as one of the main instruments for improving quality, resolution and responsive capacity to the health needs of the population (Tanaka;. In this sense, for Felisberto et al (2010), disseminating and incorporating an evaluative culture into everyday practice of three SUS management levels would qualify the decision-making of the actors involved.…”
The institutionalization of health services evaluation tools is a strategic challenge for the development of the Brazilian National Health System (SUS). The aim of the study was to explore the potential of cluster analysis as a technical tool to support the SUS management. Steps for constructing clusters applied to a concrete reality are presented and discussed, by analyzing a type of health care emergency services (AMA), in São Paulo city. The strategy was based on using secondary data to construct homogeneous groups, which allows multivariate analysis, enhancing the interpretation of the relationship between these data. The study findings indicate that this technique has the potential to be used by institutional actors in the SUS management to evaluate and to monitor health services in big cities or health regions.
“…12 Relating evaluation to everyday life binds the possibility of institutionalizing evaluation to the interests that people might have in "evaluating their own practice" and in "transforming their work". 13 This idea is supported by the premise that there is a decision-making level in which social actors interfere, mobilizing resources in order to solve the problems posed by the present reality. This level does not necessarily belong to the same sphere as that of the evaluator.…”
Section: Primary Health Care (Phc) In Brazil Viewsmentioning
This paper presents the findings of a qualitative research which analyses the characteristics of the evaluation process of community health agents' work. The research was undertaken in three different municipalities. Community health agents, their supervisors, and Primary Health Care managers took part in the investigation, which consisted of semi-structured interviews and focus groups. The discussion was organized according to content analysis, and based on the concept of health work process. Four categories of analysis were proposed: work load minimization, productivism, disease control and supervision. These categories show the predominance of evaluation practices that emphasize quantitative results, particularly those related to coverage targets and to the performance of activities structured by the biomedical approach. Conclusions point to the importance of considering the limitations of the kind of evaluation practices used in Primary Health Care, and to the need for elaborating theoretical and methodological frameworks for evaluation that will effectively contribute to improve the health agents' work.
DESCRIPTORS:Community health workers. Health evaluation. Family health. Health education.
AVALIAÇÃO EM SAÚDE E REPERCUSSÕES NO TRABALHO DO AGENTE COMUNITÁRIO DE SAÚDERESUMO: Este artigo apresenta resultados de uma pesquisa qualitativa que analisa as características do processo de avaliação relacionado ao trabalho do agente comunitário de saúde. A investigação foi desenvolvida em três municípios, tendo nela participado agentes de saúde, seus supervisores e gestores da Atenção Primária com os quais foram realizadas entrevistas semiestruturadas e grupos focais. A discussão foi organizada com base na análise de conteúdo e apoiada na noção de processo de trabalho em saúde. Foram compostas quatro categorias: minimização da carga de trabalho, produtivismo, controle de agravos e supervisão. Estas apontam o predomínio de práticas de avaliação, que enfatizam o alcance de resultados quantitativos, sobretudo relativos às metas de cobertura e à realização de atividades com enfoque biomédico. As conclusões sinalizam a importância de pensar as limitações deste tipo de práticas avaliativas difundidas na Atenção Primária e de elaborar proposições teórico-metodológicas que contribuam para o componente educativo do trabalho do agente comunitário.
DESCRITORES:Agente comunitário de saúde. Avaliação em saúde. Saúde da família. Educação em saúde.
LA EVALUACIÓN EN SALUD Y SUS REPERCUSIONES EN EL TRABAJO DEL AGENTE COMUNITARIO DE SALUD RESUMEN:Este artículo presenta resultados de una investigación cualitativa que analiza las características del proceso de evaluación relacionado al trabajo del 'Agente Comunitario en Salud'. La investigación fue desarrollada en tres municipios, teniendo como sujetos: agentes de salud, sus supervisores y gestores de Atención Primaria. Fueron realizadas entrevistas semi-estructuradas y grupos focales. La discusión fue organizada teniendo como base el análisis de contenido, apoyada en la noción...
“…Exceto por questões levantadas por um dos debatedores (TANAKA, 2006), o conceito de "institucionalização" utilizado pelo autor não foi problematizado pelos demais debatedores. As reflexões do autor e dos demais debatedores centram-se na face "operacional" da proposta, o que poderíamos designar como uma "postura pragmática" no debate sobre avaliação.…”
Section: O Discurso Da Institucionalização Deunclassified
O objetivo deste artigo é promover uma reflexão sobre o discurso da institucionalização de práticas de saúde, notadamente da avaliação, e em que medida ela pode levar à mudança pretendida, ou, por outro lado, reafirmar conceitos enraizados e reproduzir práticas. Para isto, se buscou auxílio nos teóricos do campo das ciências humanas, principalmente aqueles que têm refletido sobre as instituições sociais. Os referenciais teóricos utilizados são de autores da sociologia positivista, da fenomenologia sociológica e do movimento institucionalista francês. Com eles, busca-se compreender a noção de instituição presente nessas escolas e seu reflexo na concepção de institucionalização. À luz do referencial no qual se apóiam, os autores sugerem alguns cuidados na condução prática das ações que apóiam o movimento da institucionalização da avaliação em saúde.
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