A atenção básica na perspectiva de gestores(as) públicos municipais do Sistema Único de Saúde : estudo qualitativo

Abstract

Primary Care (in Brazil, Basic Care) refers to first level of care through which citizens can access tnational health system longitudinally and continuously. Its management articulates proposals, methods and institutional organization. In fact, the perspective of municipal public managers expresses coherences (or inconsistencies) established for operationalization and affirmation of social values, such as right to health, for example. Ten managers of Primary Care in a municipality in State of Mato Grosso were interviewed in order to understand their perspectives for action. Data were processed qualitatively by thematic Content Analysis and referenced by strategic thinking in health, within scope of Collective Health, based on two axes of analysis: a) Health Management in Primary Care and b) Service to population. Such axes allowed identification of five thematic nuclei: (1) Turnover in Primary Care management; (2) Fragmentation of shares; (3) Emergency in acting; (4) Opposition between humanization and technique and (5) Vertical health promotion. Management actions, although well-intentioned, were focused on assistance and specific actions. The top down organization seems to have reinforced inconsistencies between comprehensive proposal of Primary Care and method of daily operating by put out fires, situation that hinders problematization necessary for transformation work processes. The managers performance reflected dialectically the organization of health system, going beyond merely volitional direction of their actions. The investigation highlighted the need for greater qualification for management in Primary Care, notably with regard to strategic planning; creation of spaces that strengthen the communication and interaction in Health Care Network; and inclusion of users as active citizens capable of responding to what affects them and in which they participate directly, within scope of health services.