Marcelo Caldeira Pedroso

Ouvidorias públicas de saúde: estudo de caso em ouvidoria municipal de saúde

OBJETIVO : Analizar el papel de la defensoria y su contribucion para la gestion de la salud publica segun usuarios de sistema de Salud y de consejeros municipales de salud. METODOS : Investigacion cualitativa, estudio de caso, descriptivo y transversal. La unidad de analisis fue una defensoria de salud, localizada en municipio del estado de Minas Gerais, Brasil, de mayo a agosto de 2010. El estudio fue de naturaleza observacional con datos colectados en entrevistas con dos grupos de stakeholders: usuarios y consejeros de salud. Se entrevistaron 44 usuarios del Sistema Unico de Salud que registraron manifestaciones presenciales en la defensoria y todos los 20 consejeros del municipio. Las informaciones obtenidas fueron analizadas con base en tres aspectos: (1) naturaleza de las informaciones obtenidas; (2) discusion sobre subsidios para cualificar el funcionamiento de la defensoria como herramienta de gestion; (3) proposicion de acciones para el mejoramiento de la gestion democratica en el campo de la salud publica. RESULTADOS : Las demandas reportadas en la defensoria indicaron dificultad de acceso a las acciones y servicios de salud, corriendo el riesgo de ser percibidas como atajos para la obtencion de accesibilidad, desconsiderando el principio de la justicia social. La actuacion de la defensoria conto con la aprobacion de los ciudadanos. Los usuarios relataron como principales funciones de la defensoria: ayudar a solucionar problemas de salud y oir y aclarar el funcionamiento del Sistema Unico de Salud. La informacion fue enfatizada por los consejeros de salud como instrumento de poder y de acceso a los derechos de los usuarios del Sistema Unico de Salud. Destacaron que la defensoria tiene como tarea garantizar justicia en la efectividad de la politica de salud y que desempena importante papel de mediacion entre el Consejo de Salud, los ciudadanos y los gestores del sistema municipal de salud. Aunado a eso, atribuyeron a la defensoria caracter ejecutivo que usualmente ella no abriga. CONCLUSIONES : La defensoria es una importante herramienta de gestion y actua en la fiscalizacion del funcionamiento del sistema de salud. La implantacion de la defensoria es un avance en el campo de la gestion democratica. Existen desafios a ser superados para que las defensorias contribuyan en la ejecucion de las politicas de salud y representen a los ciudadanos en la garantia del derecho a la salud.OBJECTIVE To analyze the role of a Municipal Health Ombudsman and its contribution to the public health management from the perspective of the public health system users and the municipal health counselors. METHODS Qualitative research approach using the case study, descriptive and transversal methods. The unit of analysis was a Municipal Health Ombudsman, in the state of Minas Gerais, Southeastern Brazil, between May and August 2010. The study was observational in nature and data were collected through interviews with two groups of stakeholders: users and municipal health counselors. We interviewed 44 Brazilian Unified Health System users who had made direct use of the Municipal Health Ombudsman and all 20 municipal health counselors. The data obtained were analyzed based on three issues: (1) nature of the data obtained; (2) discussion of subsidies to qualify the ombudsman’s functioning as a management tool; (3) proposals for actions to improve democratic management in the area of public health. RESULTS The complaints to the ombudsman denoted difficulties in access to health care services running the risk of their being perceived as shortcuts to gaining accessibility, disregarding the principle of social justice. The role of the ombudsman has the citizens’ approval. Users reported the following main functions of the ombudsman: to support the resolution of health problems, to listen and to clarify issues regarding Brazilian Unified Health System operations and procedures. Information was emphasized by health counselors as an instrument of power and access to the rights of Brazilian Unified Health System users. They highlighted that the ombudsman has the role of ensuring justice to foster an effective health policy, besides playing an important mediating role between the board of the municipal health system, its managers and citizens. Furthermore, the ombudsman was shown to have an execution role that transcends its regular functions. CONCLUSIONS The study found that the ombudsman is a key management tool in monitoring the health care system. Therefore, the establishment of the ombudsman is an advance in the field of democratic management. Nevertheless, there are challenges to be overcome in order to improve ombudsman contribution to the execution of health policies and representing citizens in ensuring their rights to health care.

Ombudsmen in health care: case study of a municipal health ombudsman

OBJETIVO : Analizar el papel de la defensoria y su contribucion para la gestion de la salud publica segun usuarios de sistema de Salud y de consejeros municipales de salud. METODOS : Investigacion cualitativa, estudio de caso, descriptivo y transversal. La unidad de analisis fue una defensoria de salud, localizada en municipio del estado de Minas Gerais, Brasil, de mayo a agosto de 2010. El estudio fue de naturaleza observacional con datos colectados en entrevistas con dos grupos de stakeholders: usuarios y consejeros de salud. Se entrevistaron 44 usuarios del Sistema Unico de Salud que registraron manifestaciones presenciales en la defensoria y todos los 20 consejeros del municipio. Las informaciones obtenidas fueron analizadas con base en tres aspectos: (1) naturaleza de las informaciones obtenidas; (2) discusion sobre subsidios para cualificar el funcionamiento de la defensoria como herramienta de gestion; (3) proposicion de acciones para el mejoramiento de la gestion democratica en el campo de la salud publica. RESULTADOS : Las demandas reportadas en la defensoria indicaron dificultad de acceso a las acciones y servicios de salud, corriendo el riesgo de ser percibidas como atajos para la obtencion de accesibilidad, desconsiderando el principio de la justicia social. La actuacion de la defensoria conto con la aprobacion de los ciudadanos. Los usuarios relataron como principales funciones de la defensoria: ayudar a solucionar problemas de salud y oir y aclarar el funcionamiento del Sistema Unico de Salud. La informacion fue enfatizada por los consejeros de salud como instrumento de poder y de acceso a los derechos de los usuarios del Sistema Unico de Salud. Destacaron que la defensoria tiene como tarea garantizar justicia en la efectividad de la politica de salud y que desempena importante papel de mediacion entre el Consejo de Salud, los ciudadanos y los gestores del sistema municipal de salud. Aunado a eso, atribuyeron a la defensoria caracter ejecutivo que usualmente ella no abriga. CONCLUSIONES : La defensoria es una importante herramienta de gestion y actua en la fiscalizacion del funcionamiento del sistema de salud. La implantacion de la defensoria es un avance en el campo de la gestion democratica. Existen desafios a ser superados para que las defensorias contribuyan en la ejecucion de las politicas de salud y representen a los ciudadanos en la garantia del derecho a la salud.OBJECTIVE To analyze the role of a Municipal Health Ombudsman and its contribution to the public health management from the perspective of the public health system users and the municipal health counselors. METHODS Qualitative research approach using the case study, descriptive and transversal methods. The unit of analysis was a Municipal Health Ombudsman, in the state of Minas Gerais, Southeastern Brazil, between May and August 2010. The study was observational in nature and data were collected through interviews with two groups of stakeholders: users and municipal health counselors. We interviewed 44 Brazilian Unified Health System users who had made direct use of the Municipal Health Ombudsman and all 20 municipal health counselors. The data obtained were analyzed based on three issues: (1) nature of the data obtained; (2) discussion of subsidies to qualify the ombudsman’s functioning as a management tool; (3) proposals for actions to improve democratic management in the area of public health. RESULTS The complaints to the ombudsman denoted difficulties in access to health care services running the risk of their being perceived as shortcuts to gaining accessibility, disregarding the principle of social justice. The role of the ombudsman has the citizens’ approval. Users reported the following main functions of the ombudsman: to support the resolution of health problems, to listen and to clarify issues regarding Brazilian Unified Health System operations and procedures. Information was emphasized by health counselors as an instrument of power and access to the rights of Brazilian Unified Health System users. They highlighted that the ombudsman has the role of ensuring justice to foster an effective health policy, besides playing an important mediating role between the board of the municipal health system, its managers and citizens. Furthermore, the ombudsman was shown to have an execution role that transcends its regular functions. CONCLUSIONS The study found that the ombudsman is a key management tool in monitoring the health care system. Therefore, the establishment of the ombudsman is an advance in the field of democratic management. Nevertheless, there are challenges to be overcome in order to improve ombudsman contribution to the execution of health policies and representing citizens in ensuring their rights to health care.

Cadeia de valor da saúde: um modelo para o sistema de saúde brasileiro

This article presents a model of the healthcare value chain which consists of a schematic representation of the Brazilian healthcare system. The proposed model is adapted for the Brazilian reality and has the scope and flexibility for use in academic activities and analysis of the healthcare sector in Brazil. It places emphasis on three components: the main activities of the value chain, grouped in vertical and horizontal links; the mission of each link and the main value chain flows. The proposed model consists of six vertical and three horizontal links, amounting to nine. These are: knowledge development; supply of products and technologies; healthcare services; financial intermediation; healthcare financing; healthcare consumption; regulation; distribution of healthcare products; and complementary and support services. Four flows can be used to analyze the value chain: knowledge and innovation; products and services; financial; and information.

Uma metodologia de análise estratégica da tecnologia

This paper proposes a methodology for the strategic evaluation of technology in manufacturing companies. With this aim, the article discusses a technology concept and taxonomy, and adopts an extended set of manufacturing competitive criteria. On this basis, a methodology of strategic technology analysis is proposed which is based on the relationships between the proposed technology taxonomy and the set of competitive manufacturing criteria adopted. The proposed model also considers the technological-push and marketing-pull approaches as decision drivers for the adoption of new technology. This paper also presents a case study which considers the fuzzy set theory and some conclusions about the proposed methodology.

Defensorías públicas de la salud: estudio de caso en defensor municipal de salud

OBJETIVO : Analizar el papel de la defensoria y su contribucion para la gestion de la salud publica segun usuarios de sistema de Salud y de consejeros municipales de salud. METODOS : Investigacion cualitativa, estudio de caso, descriptivo y transversal. La unidad de analisis fue una defensoria de salud, localizada en municipio del estado de Minas Gerais, Brasil, de mayo a agosto de 2010. El estudio fue de naturaleza observacional con datos colectados en entrevistas con dos grupos de stakeholders: usuarios y consejeros de salud. Se entrevistaron 44 usuarios del Sistema Unico de Salud que registraron manifestaciones presenciales en la defensoria y todos los 20 consejeros del municipio. Las informaciones obtenidas fueron analizadas con base en tres aspectos: (1) naturaleza de las informaciones obtenidas; (2) discusion sobre subsidios para cualificar el funcionamiento de la defensoria como herramienta de gestion; (3) proposicion de acciones para el mejoramiento de la gestion democratica en el campo de la salud publica. RESULTADOS : Las demandas reportadas en la defensoria indicaron dificultad de acceso a las acciones y servicios de salud, corriendo el riesgo de ser percibidas como atajos para la obtencion de accesibilidad, desconsiderando el principio de la justicia social. La actuacion de la defensoria conto con la aprobacion de los ciudadanos. Los usuarios relataron como principales funciones de la defensoria: ayudar a solucionar problemas de salud y oir y aclarar el funcionamiento del Sistema Unico de Salud. La informacion fue enfatizada por los consejeros de salud como instrumento de poder y de acceso a los derechos de los usuarios del Sistema Unico de Salud. Destacaron que la defensoria tiene como tarea garantizar justicia en la efectividad de la politica de salud y que desempena importante papel de mediacion entre el Consejo de Salud, los ciudadanos y los gestores del sistema municipal de salud. Aunado a eso, atribuyeron a la defensoria caracter ejecutivo que usualmente ella no abriga. CONCLUSIONES : La defensoria es una importante herramienta de gestion y actua en la fiscalizacion del funcionamiento del sistema de salud. La implantacion de la defensoria es un avance en el campo de la gestion democratica. Existen desafios a ser superados para que las defensorias contribuyan en la ejecucion de las politicas de salud y representen a los ciudadanos en la garantia del derecho a la salud.OBJECTIVE To analyze the role of a Municipal Health Ombudsman and its contribution to the public health management from the perspective of the public health system users and the municipal health counselors. METHODS Qualitative research approach using the case study, descriptive and transversal methods. The unit of analysis was a Municipal Health Ombudsman, in the state of Minas Gerais, Southeastern Brazil, between May and August 2010. The study was observational in nature and data were collected through interviews with two groups of stakeholders: users and municipal health counselors. We interviewed 44 Brazilian Unified Health System users who had made direct use of the Municipal Health Ombudsman and all 20 municipal health counselors. The data obtained were analyzed based on three issues: (1) nature of the data obtained; (2) discussion of subsidies to qualify the ombudsman’s functioning as a management tool; (3) proposals for actions to improve democratic management in the area of public health. RESULTS The complaints to the ombudsman denoted difficulties in access to health care services running the risk of their being perceived as shortcuts to gaining accessibility, disregarding the principle of social justice. The role of the ombudsman has the citizens’ approval. Users reported the following main functions of the ombudsman: to support the resolution of health problems, to listen and to clarify issues regarding Brazilian Unified Health System operations and procedures. Information was emphasized by health counselors as an instrument of power and access to the rights of Brazilian Unified Health System users. They highlighted that the ombudsman has the role of ensuring justice to foster an effective health policy, besides playing an important mediating role between the board of the municipal health system, its managers and citizens. Furthermore, the ombudsman was shown to have an execution role that transcends its regular functions. CONCLUSIONS The study found that the ombudsman is a key management tool in monitoring the health care system. Therefore, the establishment of the ombudsman is an advance in the field of democratic management. Nevertheless, there are challenges to be overcome in order to improve ombudsman contribution to the execution of health policies and representing citizens in ensuring their rights to health care.