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Previous issue date: 2015-08-03 === Objetivou-se analisar o Apoio Institucional na Aten??o B?sica ofertado ?s equipes pelas gest?es municipais das capitais brasileiras que aderiram ao Programa de Melhoria do Acesso e da Qualidade da Aten??o B?sica (PMAQ-AB). Possuiu car?ter explorat?rio descritivo, com abordagens qualitativa e quantitativa para an?lise dos dados. A coleta de dados foi realizada no per?odo de fevereiro a outubro de 2014 com dois grupos amostrais, sendo o primeiro composto pelos respondentes do m?dulo II que correspondeu a 2941 equipes, das 23 capitais que aderiram ao Programa e o segundo por 22 gestores da Aten??o B?sica das capitais brasileiras que responderam ao m?dulo IV (on line). Na fase quantitativa as vari?veis foram analisadas atrav?s da estat?stica descritiva, com uso do Software IBM SPSS Statistics 20 e os resultados organizados e agrupados em tr?s dimens?es: caracter?sticas do Apoio Institucional; processo de trabalho do Apoiador Institucional e Apoio ?s equipes para administrar e planejar processos de trabalho. Na fase qualitativa, analisaram-se as diretrizes gerais para o Apoio Institucional no munic?pio, descritos pelo gestor municipal no formul?rio on line. Para organiza??o e categoriza??o dos dados qualitativos foi utilizado o Atlas ti.7.1, e como m?todo de interpreta??o, a an?lise de conte?do. A partir da concep??o do Apoio como ferramenta democratizante, procedeu-se a aproxima??o de conceitos do Apoio Paideia (Campos), das rela??es de poder (Foucault) e da an?lise institucional (Lourau). Elencou- se as seguintes categorias de an?lise: Categoria 1- Dimens?o administra??o e planejamento de processos de trabalho com as Subcategorias: Apoio ? organiza??o do processo de trabalho das equipes; Apoio ao planejamento, monitoramento e avalia??o; Apoio ?s a??es das equipes; Apoio ao fortalecimento das redes de aten??o ? sa?de e a??es intersetoriais e estrutura organizacional e administrativa do Apoio no munic?pio. Categoria 2- Dimens?o Pol?tica com as Subcategorias: Apoio aos processos participativos de gest?o e est?mulo ao controle social; Apoio a constru??o de rela??es democr?ticas, cooperativas e dial?gicas; Apoio ?s a??es vinculadas ao PMAQ; descri??o do Apoio Institucional utilizando a mesma reda??o dos documentos oficiais do MS. Categoria 3- Dimens?o Pedag?gica com a Subcategoria: processos de forma??o e qualifica??o de profissionais e gestores. Observou-se que o Apoio Institucional ? uma realidade no contexto da Aten??o B?sica no Brasil, por?m identificou-se que, tanto nas a??es apoiadas quanto nas diretrizes propostas pelas gest?es evidencia-se um tra?o normalizador e burocr?tico nesse processo. Houve avalia??o positiva pelas equipes do Apoiador Institucional, embora esses profissionais encontrem-se sobrecarregados no exerc?cio dessa fun??o pelo n?mero excessivo de equipes sob sua responsabilidade, evidenciando-se a necessidade de um dimensionamento que leve em considera??o o modo de operar a fun??o Apoio. Nas capitais brasileiras observaram-se fragilidades nas condi??es de gerir os processos para a institucionaliza??o do Apoio, inferindo-se que as gest?es e equipes de gest?o da Aten??o B?sica precisam ser apoiadas na condu??o desse processo. Prop?e-se, assim, o aprofundamento da tem?tica e que nos outros ciclos do PMAQ-AB haja adequa??o dos instrumentos utilizados na avalia??o externa, referente ? dimens?o Apoio Institucional, a fim de avan?ar na valoriza??o das singularidades do Apoio, principalmente, no tocante ? cogest?o enquanto processo coletivo e democr?tico. === It was aimed to analyze one of dimensions of the Basic Attention offered by in primary care team by the municipal administrations of Brazilian cities that have joined Access Improvement Programme and Quality of Primary Care (PMAQ-AB in portuguese). Owned descriptive exploratory, by qualitative and quantitative approaches to data analysis. Data collection took place between February-October 2014 by two sample groups, the first one consisting of respondents of module II corresponding to 2941 teams of 23 capitals that have joined the program and the second one by 22 managers of Primary Care Brazilian cities that responded to the module IV (on line). In quantitative phase variables were analyzed using
descriptive statistics, using IBM SPSS Statistics Software 20 and organized and grouped results in three dimensions: characteristics of Institutional Support; Institutional Sketchpad the work process and support teams to manage and plan work processes. In qualitative phase, it was analyzed general guidelines for the Institutional Support in the municipal, as described by the municipal manager in online form.
For organization and categorization of qualitative data was used Atlas ti.7.1, and as a method of interpretation, content analysis. From the conception of support as a democratizing tool, it was proceeded to approach concepts Support Paideia (Campos), power relations (Foucault) and institutional analysis (Lourau). It was defined following categories of analysis: Category 1 - Dimension administration and planning work processes by subcategories: Support for organization of work process of teams; Support planning, monitoring and evaluation; Support the actions of teams; Support for the strengthening of health care networks and intersectoral actions and organizational and administrative structure of support in the city. Category 2 - Dimension Policy by following subcategories: Support for participative process management and stimulation of social control; Support the building of democratic relations, cooperatives and dialogical; Support for actions related to PMAQ; description of Institutional Support using the same wording of official documents of health ministry. Category 3 - Pedagogical dimension formed by Subcategory: formation and training of professionals and managers. It was observed that Institutional Support is a reality in context of Primary Care in Brazil, but it was found that in both actions supported as the guidelines proposed by managements is evident in a normalizing and trace this process. There was a positive evaluation by teams Sketchpad Institutional, although these professionals find themselves overwhelmed when exercising that function by excessive number of teams under their responsibility, demonstrating the need for a design that takes into account how to operate the Support function. In Brazilian cities were observed weaknesses in a position to manage the processes for institutionalization of support, the conclusion was that managements and management teams in Primary Care need to be supported in conducting this process. It is proposed thus deepening the theme and when other PMAQ-AB cycles tooccur be made adequacy of instruments used in external evaluation concerning the importance Institutional Support in order to advance the appreciation of uniqueness of support, especially regard to co-management as a collective and democratic process.
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