O apoio institucional e a gestão da Atenção Primária à Saúde: uma estratégia em construção.

Abstract

This study aims to analyze the contribution of Institutional Support (IS) for the management of Primary Health Care (PHC) in the city of Porto Seguro - Bahia. In addition, as specific objectives describe the vision of managers and health professionals of PHC about the IS; characterize the activities performed by the IS team in the PHC, and; analyze the limits and potentialities of the application of the IS model in Primary Health Care. This is a qualitative, descriptive and interpretive study, in which 23 interviews were conducted with health workers, including institutional supporters of PHC, directors of PHC, superintendent of PHC, nurses/coordinators of the Family Health Strategy (FHS) teams and Expanded Family Health Center (EFHC) professionals. The analysis of the results shows that the interviewees, at all levels, consider that IS contributes to PHC management, however, in activities of administrative nature that do not constitute the normative role defined for the IS in PHC, which are more appropriate for the role of supervisor. The lack of knowledge about the role, the high turnover and the working conditions were identified as limiting factors for the adequate exercise of the role, which ends up being configured much more as a management assistant, "a problem solver". Moreover, the professionals who play the role of IS are perceived to have low qualifications and are subjected to an overload of work that makes it difficult to develop the attributions related to the IS model of PHC. Despite this, it was found that the IS has created spaces for dialogue, listening and systematization of care and management practices and has been recognized as an important link between the FHS and the central administration. Thus, it was identified the need to rethink the IS model, its theoretical and methodological bases, working conditions, institutional role and implementation strategy in order to bring its practice closer to the different realities of Brazilian cities. We conclude that the IS is a powerful strategy for the re-signification of management practices, requiring the adoption of strategies that enable the implementation of the model in its fullness, strengthening the individual and collective subjects, building institutional democracy, promoting analysis and shared management of work, and may become an important tool to break the traditional model of administration. In this sense, the present study proposes, at the end of the data analysis and discussion, a proposal for the implementation of IS in PHC.