Alcides Silva de Miranda

Metodologia de construção de um painel de indicadores para o monitoramento e a avaliação da gestão do SUS

This study sought to develop methodology for the construction of a Panel for the Monitoring and Evaluation of Management of the Unified Health System (SUS). The participative process used in addition to the systematization conducted made it possible to identify an effective strategy for building management tools in partnership with researchers, academic institutions and managers of the SUS. The final systematization of the Panel selected indicators for the management of the SUS in terms of Demand, Inputs, Processes, Outputs and Outcomes in order to provide a simple, versatile and useful tool for evaluation at any level of management and more transparent and easier communication with all stakeholders in decision-making. Taking the management of the SUS as the scope of these processes and practices in all normative aspects enabled dialog between systemic theories and those which consider the centrality of the social actor in the decision-making process.

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

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.

Análise estratégica sobre a organização de rede assistencial especializada em região de saúde do Rio Grande do Sul

Neste artigo busca-se analisar as principais estrategias intergovernamentais e os arranjos organizacionais instituidos para o incremento da acessibilidade a servicos assistenciais especializados, localizados em regiao de saude do Rio Grande do Sul. Trata-se de investigacao de natureza exploratoria e carater descritivo, com analise estrategica de abordagem qualitativa, a partir de documentos e entrevistas realizadas com dirigentes governamentais. A analise evidenciou tensoes e disposicoes politicas distintas, com preponderância de estrategias cooperativas, embora tenham sido utilizados meios estrategicos diversos, em razao da assimetria no controle de recursos e de margens de autonomia organizacional.

Discursos prácticos sobre hechos, procesos decisorios y consecuencias de las Conferencias Municipales de Salud en Brasil

Que significados podem ser evidenciados em discursos de participantes de Conferencias Municipais de Saude acerca de tais eventos, seus processos decisorios e decorrencias? Para analisar tais discursos praticos, referidos a eventos ocorridos em seis municipios do Ceara em 2007, realizou-se estudo de casos multiplos, a partir de analise documental, entrevistas e grupos focais, com analise hermeneutica e dialetica. Sobre as ocorrencias dos eventos, evidenciam-se as oportunidades de expressao e mobilizacao de alguns grupos de interesses por demandas especificas, em cenarios de interlocucao competitiva e busca de mediacoes politicas visando eficacia simbolica eventual. Dentre as decorrencias a partir das decisoes deliberadas, destacam-se discursos sobre a negligencia de governos municipais na incorporacao dessas demandas em suas agendas politicas e na implantacao de estrategias institucionais correspondentes. Como, tambem, a ausencia de monitoramento a fim por parte dos respectivos Conselhos Municipais de Saude.

Discursos práticos sobre ocorrências, processos decisórios e decorrências de Conferências Municipais de Saúde

Que significados podem ser evidenciados em discursos de participantes de Conferencias Municipais de Saude acerca de tais eventos, seus processos decisorios e decorrencias? Para analisar tais discursos praticos, referidos a eventos ocorridos em seis municipios do Ceara em 2007, realizou-se estudo de casos multiplos, a partir de analise documental, entrevistas e grupos focais, com analise hermeneutica e dialetica. Sobre as ocorrencias dos eventos, evidenciam-se as oportunidades de expressao e mobilizacao de alguns grupos de interesses por demandas especificas, em cenarios de interlocucao competitiva e busca de mediacoes politicas visando eficacia simbolica eventual. Dentre as decorrencias a partir das decisoes deliberadas, destacam-se discursos sobre a negligencia de governos municipais na incorporacao dessas demandas em suas agendas politicas e na implantacao de estrategias institucionais correspondentes. Como, tambem, a ausencia de monitoramento a fim por parte dos respectivos Conselhos Municipais de Saude.

Practical discourses about events, decisions processes and effects of Health municipal conferences in Brazil

Que significados podem ser evidenciados em discursos de participantes de Conferencias Municipais de Saude acerca de tais eventos, seus processos decisorios e decorrencias? Para analisar tais discursos praticos, referidos a eventos ocorridos em seis municipios do Ceara em 2007, realizou-se estudo de casos multiplos, a partir de analise documental, entrevistas e grupos focais, com analise hermeneutica e dialetica. Sobre as ocorrencias dos eventos, evidenciam-se as oportunidades de expressao e mobilizacao de alguns grupos de interesses por demandas especificas, em cenarios de interlocucao competitiva e busca de mediacoes politicas visando eficacia simbolica eventual. Dentre as decorrencias a partir das decisoes deliberadas, destacam-se discursos sobre a negligencia de governos municipais na incorporacao dessas demandas em suas agendas politicas e na implantacao de estrategias institucionais correspondentes. Como, tambem, a ausencia de monitoramento a fim por parte dos respectivos Conselhos Municipais de Saude.

Análise comparativa sobre a implantação do Programa Mais Médicos em agregados de municípios do Rio Grande do Sul, Brasil

The Mais Medicos (More Doctors) Program has led to an increase in the number of doctors and medical treatment in primary health care services across Brazil. This article presents the results of a case-control study of groups of municipalities based on secondary data sources. It aims to explore and discuss a set of indicators of primary health care service delivery. An improvement in performance against structural indicators was observed in municipalities where the program was implemented. With respect to the outcome indicators, a slight improvement in service delivery was observed in municipalities where the program was implemented. However, no difference was observed in impacts between the case and control municipalities. These results may have been influenced by the fact that the program has only been underway for a limited time, by underreporting of doctors by the National Health Facilities Register (CNES, acronym in Portuguese), and the predominantly substitutive nature of the allocation of medical professionals under the program in the selected municipalities.The Mais Médicos (More Doctors) Program has led to an increase in the number of doctors and medical treatment in primary health care services across Brazil. This article presents the results of a case-control study of groups of municipalities based on secondary data sources. It aims to explore and discuss a set of indicators of primary health care service delivery. An improvement in performance against structural indicators was observed in municipalities where the program was implemented. With respect to the outcome indicators, a slight improvement in service delivery was observed in municipalities where the program was implemented. However, no difference was observed in impacts between the case and control municipalities. These results may have been influenced by the fact that the program has only been underway for a limited time, by underreporting of doctors by the National Health Facilities Register (CNES, acronym in Portuguese), and the predominantly substitutive nature of the allocation of medical professionals under the program in the selected municipalities.