Organização do trabalho em saúde: a gestão de recursos humanos no Programa de Saúde da Família e a reorientação da atenção básica

• Autor(a) principal: Junqueira, Túlio da Silva
• Data de Publicação: 2008
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: LOCUS Repositório Institucional da UFV
• Texto Completo: http://locus.ufv.br/handle/123456789/1920
• topic: Administração pública; Saúde pública; Gestão em saúde; Recursos humanos; Public administration; Public health; Health management; Human resources; CNPQ::CIENCIAS SOCIAIS APLICADAS::ADMINISTRACAO::ADMINISTRACAO PUBLICA

Since middle 70 s, Brazil has gone through important political- democratic transformations being framed in years of changes in the health paradigms. With the 1988 Constitution and the creation of Single Health System SUS, promoters, workers and users of such system were confronted with a new way of thinking, structuring, developing and providing services and assistance in health social production model. Fundamental for organizing the basic attention to SUS, the Family Health Program (PSF) was created in 1994 and regulated by the 1996 SUS Norma Operacional Básica - NOB/SUS-96, what defined its financial model, including it in the Piso da Atenção Básica PAB. Thus, the PSF is a reorganization strategy of SUS by means of the primary health care. However, in order to promote the development of the real rupture of the former sanitary model - Flexnerian - , the work relations must overcome the work precarization by taking measures such as consistent investments in the human resource areas with the creation of debates for a democratic management. The understanding of such aspects by all players involved population, professionals and mainly by the Municipal Health Councilors (SMS) which should be the protagonists on the organization of such actions is fundamental for discussing the work process in health, managing process, permanent/continuous education and service evaluation. The scopes of this work are to analyze the guiding and definer conditions of the management practices of SMS and understand the health concept under which its management is based, evaluating their level of apprehension and knowledge of the principles and guidelines involving the SUS and PSF, pointing out the importance of such players in the context of sanitary system reformulation in the Brazilian counties. The reference is the administration of human resources (HR) in the PSF of 52 counties which belong to the Southwest Macroregion of Minas Gerais State and 12 counties from the sanitary microregion of Carangola, MG. It is a quantitative- qualitative study in which a semi-structured questionnaire addressed to the SMS was performed as a tool to collect information. The sanitary data of Carangola microregion showed that 47.5 years was the average age of the SMS, 66.7% from those were male. Only 25.0% completed college and form these, 16.7% were health professionals. The city halls are responsible for 91.7% of the hired health professionals. Casual hired employers and the ones selected by politicians are found in, respectively, 75.0% and 50.0% of the counties. Regarding to the Southwest Macroregion of Minas Gerais State, the average age of the SMS was 39.4 years, 53.3% from those were male. Only 28.9% completed college and 13.3% from those were health professionals. The city halls are responsible for 93.3% of the hired health professionals. The major ways used for hiring and selecting such professionals with college degree were casual employments (85.6%) and employees selected by politicians (55.6%); that confirm the failure of the employee political and social rights, with the paradox of being the Government - via municipal management the one responsible for the law unfulfillments. Regarding to the health concept and the level of apprehension and knowledge of the principles and guidelines involving the SUS and PSF, it was found that the knowledge and apprehension level of the SMS about the SUS and PSF principles were inadequate, what reinforces the confirmation that the health setting policy might have been given by simply transferring functions, which were previously performed by hospitals and health care facilities, to basic health units. The hospital is not the center of health works anymore, as idealized by the sanitation project improvement, but in reality, it does not change much in the logic of the attention given to health (the logic still being curative and individual, instead of preventive, promoting and collective). The lack of a proper level of information from SMS jeopardizes the adoption of new practices in the perspective of a new model of attention and generates the necessity of establishing a qualification process for such managers, and widening of the discussions about the introduction of professional management models in public administration that confront the clientelism and corporativism for instance, employees selected by politicians leaving behind the technical, professional and managing competence that are needed for performing professional and leading jobs. In this way, one points out the importance of making managers conscious for handling both health services and practices that are focused on home health care, as a major challenge to the success of the model proposed health. It is expected that the contradictions showed in this study may be solved so that the municipal managers will have ethical, political and technical commitment with their citizens.