Quem participa em quê?: experiências de construção compartilhada no âmbito da cooperação Brasil - Canadá para o aperfeiçoamento da gestão na Atenção Primária à Saúde

Abstract

O artigo analisa processos e resultados da construção compartilhada de conhecimento e intervenção no Projeto de Aperfeiçoamento da Gestão da Atenção Primária (AGAP) desenvolvido no âmbito da cooperação Brasil e Canadá em quatro Estados da região Nordeste do País, utilizando metodologia de avaliação com enfoque nos alcances e aprendizagens, que tem como pressuposto a cooperação e participação das partes, preconiza a triangulação mediante a combinação de abordagens e de técnicas qualitativa e quantitativa caracterizada como multimétodos, a partir da identificação dos momentos que significaram encontros de compartilhamento, elementos que dificultaram ou facilitaram este processo e das lições apreendidas. A pesquisa avaliativa compreendeu análise documental, observação de encontros presenciais, oficina com o Comitê Gestor de Avaliação para apresentação e pactuação da proposta, oficinas de avaliação com os projetos locais, observação de unidades de saúde nos municípios, entrevistas semiestruturadas com sujeitos estratégicos dos níveis locais, regionais, nacional e internacional. Os resultados demonstraram que a relação de cooperação Brasil/Canadá é promissora, entretanto precisa ser construída de forma mais cooperada e dialogada em que os objetos da cooperação sejam construídos de forma compartilhada.

Gestão na atenção primária: implicações nas cargas de trabalho de gestores

“…The set of these challenges and difficulties, with their indication of their greater or lesser presence in the studied literature, is presented in Figure 2. Among the main challenges or difficulties mentioned by the authors who studied PHC management stands out the difficulties involved in a new care model, which is complex, aims to meet people's health needs, goes beyond the model of individual and curative care, and involves multi-professional teams oriented to perform an interdisciplinary work (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) . As illustrated in the following sections:…”

“…Several aspects of management mentioned in the texts as challenges or difficulties, visible in group 1 of Figure 2, are related to the characteristics of the PHC model itself, highlighting aspects of this new model that constitutes a challenge for management. Among them were the difficulties of effectiveness of the comprehensive care, including the deficits in the functioning of the care network (18)(19)26,31,(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46) and the challenges of deploying and working intersectorality (18)(19)23,25,28,31,(47)(48)(49)(50)(51)(52)(53) . It was identified difficulties related to the effectiveness of the Healthcare Councils in relation to the articulation with the population for sharing and approval management instruments of the Unified Health System, in the Brazilian case (19,54) .…”

“…It was identified difficulties related to the effectiveness of the Healthcare Councils in relation to the articulation with the population for sharing and approval management instruments of the Unified Health System, in the Brazilian case (19,54) . It was also found lack of knowledge by the managers related to the territory under their liability (18,51,55) and about the aspects that involve the management of PHC (17,21,28,40) .…”

“…The second challenge/difficulty that appeared most in the texts and that can contribute to increase the workloads of the managers is the turnover of professionals working in PHC (19)(20)22,28,(30)(31)(32)(35)(36)42,(45)(46)56,59) , in particular medical professionals, which difficult the establishment of bond with colleagues, managers and users, illustrated below.…”

“…Group 3 describes aspects related to labor instruments, understood in a broad sense including: deficits in the physical area, equipment, materials and information systems (18,24,27,38,41-42,44-46-50,54,57,61-62,64-66) , problems in the geographical location of local health units (65,71) , with emphasis on the deficits in financing and also on efficiency in the application of resources (18)(19)24,(27)(28)30,(35)(36)40,50,65,(71)(72)(73) . Rev Gaúcha Enferm.…”