Processo de trabalho de gerentes de unidades de saúde da atenção primária de um Município do Estado da Bahia

Abstract

The work process (WP) of managers of Primary Health Care Units (PHCU) is a complex and dynamic practice, as it involves the interconnection of the WP constituent elements of the health work process, the essential attributes and derived from PHCU in different contexts, impacting on the actions of CU managers. The purpose of this study was to analyze the work process of managers of Health Units of Primary Health Care in a municipality of the State of Bahia. It is a field research, with a qualitative approach, performed in the Family Health Units (FHU) and the Basic Health Units (BHU). Participants were 18 managers of PHCU Health Units. The techniques of data collection were the semi-structured interview and the systematic observation. After a careful reading of the data, the sense nuclei were apprehended, which made it possible to apprehend the categories: Socio-demographic and occupational characterization of local PHC Health Unit managers.The work process dynamics of CU managers: the constituent elements, the contexts and the attributes of the PHC and The act of CU managers: limits / power for the strengthening of local PHC attributes. The data analysis method was thematic content analysis. The study indicates that there is a centrality in the US manager of the APS as agent of the managerial work process (MWP), with the contribution of professionals and health workers, different objects of the MWP are observed such as the health team, the user, the community and the organization of the CU, the purpose of the MWC is related to the individual demands of the users and the demands for organization and operation of the CU, the instruments used are the materials, the knowledges, the techniques and the hard, light and hard technologies of the health work. The political context is permeated by the power relationship, the decision-making process, the impasse of the municipal autonomy and the autonomy of the managers, besides the popular participation; the technical context encompasses professional training, insertion in the managerial role and function, and the professional qualification of CU managers; the organizational context reveals the structure and internal organization of the US, and finally, the relational context highlights the present relations in the CU between the team members and the subjective issues that reveal the thinking and acting on the management in the PHCU. The study points out that the MWP carried out in the PHCU requires knowledge, skills and attitudes to act in the face of the complexity and dynamicities that the managerial work of PHC Health Units possess, especially with regard to the attributes of PHC - first attention contact, longitudinality, completeness, coordination, family focus, community orientation and cultural competence. It also highlights the need of the manager to act in favor of the potentialities that favor the continuity of actions and practices and of the health teams focused on improving the health and well-being of the population. Thus, it is necessary to institute changes in the political administrative structure of the local health system, as well as within each US, aiming to break with the mechanistic, controlling and hierarchical model present in the daily work of the managerial work in the CU of the PHC and thus open the opportunity of to overcome the systemic and complex paradigm by working with managerial models based on innovative practices such as co-management and communicative management, in order to promote the strengthening of PHC attributes.