Books by Fabiana C. Saddi
Research project by Fabiana C. Saddi
This research will bring new knowledge regarding the Brazilian National Program for Access and Qu... more This research will bring new knowledge regarding the Brazilian National Program for Access and Quality Improvement in Primary Care/PMAQ. Researchers will employ framework analysis (Ritchie and Spencer 1994, Gale et al 2013) to explore if/how the reformulation and implementation processes of PMAQ/3rd round have contributed to strengthening the performance of health system leadership and workforce, in cities with distinct income/development levels, and unities with diverse management/leadership arrangements and organizational capacities. Researchers will conduct a rapid review, a mix of interviews (with policymakers, implementers and front-line staff), examine related documentation and triangulate secondary data with new data collected. Interviews will be conducted in two sates/regions of Brazil: Goiás and Pernambuco. Data from the review and interviews/documents will be thematically analysed taking into account relevant themes from Public Policy, the politics of performance and Health System literature. The partnership with the UK co-applicant will involve research collaboration, reciprocal visits and transfer of knowledge/skills to Brazil.
O objetivo geral desta pesquisa de implementação é, juntamente com o PAILI/SES-GO, realizar reuni... more O objetivo geral desta pesquisa de implementação é, juntamente com o PAILI/SES-GO, realizar reuniões com dois grupos de familiares/cuidadores de louco infratores em medida de segurança acompanhados pelo PAILI em cidades específicas do estado, e como forma de troca de experiência e estreitamento do relacionamento entre a equipe do PAILI e familiares/cuidadores. Iremos gerar evidências compreensivas/ contextualizadas sobre como fortalecer o relacionamento do PAILI com a família/cuidador e, assim, aprimorar o gerenciamento do acompanhamento realizado pelo programa junto a familiares/cuidadores.
General Objective: To explore if/how the implementation and re-formulation of P4P/PBF programs ha... more General Objective: To explore if/how the implementation and re-formulation of P4P/PBF programs have affected two (of the six) health system building blocks (leadership and workforce) in LMICs adopting varied/similar organizational models and at specific stages of development of PHC, in different Regions/Continents of the Globe. Specific Objectives: [Review & Framework] To develop a concept and state-of-the-art rapid literature review and further develop the comparative framework of analysis to compare countries with different/similar models/stages of development in PHC. [Implementation and Re-formulation] To characterize the implementation and re-formulation process of P4P/PBF according to relevant policy drivers (Table 1) in LMICs with different/similar models/stages of development in PHC. [Impact on HS] To explore how both the implementation and re-formulation processes related to P4P/PBF, in countries with distinct models/stages of development of PHC, have affected performance drivers (Table 1) and thus enabled (or not) changes in the HSSBB of leadership and workforce.
![Research paper thumbnail of COMPLETE RESEARCH PROJECT: What is the legitimacy of public policy? Qual a legitimidade política da política pública? - Uma análise política do problema da separação na política pública: O caso da atenção Básica à Saúde em Goiânia (projeto piloto)]](https://attachments.academia-assets.com/41488735/thumbnails/1.jpg)
1A. ABSTRACT
The purpose of this research project is to improve, apply and disseminate the ‘coef... more 1A. ABSTRACT
The purpose of this research project is to improve, apply and disseminate the ‘coefficients of legitimacy framework’ to assess the politics of primary health care policy in distinct cities/ democratic settings. The framework develops the concept of political legitimacy as the contested space existing between policy design at the level of the state and policy implementation on the ground (Annex 2). The framework has been already applied to the analyses of health care policies in Brazil and Mexico (Saddi, 2004) (Saddi 2005) (Saddi, 2014), and is currently been applied (as a pilot project) in the case of primary health care in Goiania.
We will apply the coefficient of legitimacy framework to measure the magnitude of the gap between two concepts-variables: political representativeness and identification in implementation. Concepts will be constructed according to actors’ perspectives (values/ideas and interests) and objective institutional capabilities. Degrees of tensions between ideas/interests and frontline actors’ identity , and degrees of conflicts between guidelines and realization will be used as analytical criteria in the classifications of those concept-variables. We will interview policymakers and politicians, and undertake surveys of three types of frontline actors. The conceptual basis for those criteria is the interpretativist strand of political sociology (Weber 1978, Berger and Luckmann 1967) and Interpretive Politics. We will first develop a pilot research in the city of Goiania (and afterwards extend it to other cities). Results are expected to pave the way for comparisons across a wider range of cities. The research programme has been divided into five main phases.
1) First phase: mapping of actors, literature review
2) Second phase: engaging stakeholders and designing surveys
3) Third phase: applying surveys, pursuing interviews
4) Fourth phase: organisation and analysis of data collected
5) Fifth phase: revising and writing papers, final workshop
We will develop a new comprehensive type of measurement and comparison, in which comprehensiveness requires a greater understanding of case studies (Hudson and Lowe 2004; Whitehead 2002; Saddi, 2005). Concepts will be measured taking into account actors’ perspectives and objective institutional capabilities, and classified in terms of ‘modalities’ and ‘levels’. Distinct ‘levels’ and ‘modalities’ will be anchored to points in the acceptance-rejection continuum, representing probabilities of translating policies into practice (0%-100%) (Annex 3).
We will collect a complementary set of information related to frontline actors’ values and attitudes with respect to the country’s policy guidelines. We intend to develop an interactive method of work during the design of surveys and elaboration of semi-structure questions to be used in interviews. Surveys will be designed with the help of selected frontline actors and scholars, while interview questions will be elaborated in collaboration with policymakers as well as scholars. Academic collaborators will be directly involved in the process. It is expected that this interactive research process will lead to revisions of the main hypotheses and questions before the final application of surveys and publications.
""Descrição: O objetivo geral desta pesquisa é efetuar uma análise política inter-relacionada dos... more ""Descrição: O objetivo geral desta pesquisa é efetuar uma análise política inter-relacionada dos processos de decisão e de implementação da política de atenção básica à saúde de forma comparada. Estudaremos o caso da cidade de Goiânia, em dois distritos sanitários (Noroeste e Sudoeste), durante o atual governo de Paulo Garcia na Prefeitura (desde 2012), e o governo de Dilma Rousseff na Presidência (desde 2011). Trata-se também do período de formulação/lançamento e implementação da nova Política Nacional de Atenção Básica à Saúde (PNAB), publicada em 2012, bem como do lançamento do PMAQ e do Mais Médicos. Iremos analisar as principais tensões (limites e possibilidades) concernentes aos processos de decisão (macro e micro) e de implementação (gestão/implementação) da atenção básica à saúde, as quais produzem diferentes graus de separação e de aproximação entre ambos os processos da política pública. Nosso objetivo alvo é avaliar a magnitude do espaço de conflito existente entre ambos os processos da política pública, no atual contexto de democracia com estabilização/reestruturação econômica, tendo como caso a cidade de Goiânia. Para tanto, iremos estabelecer correlações analíticas entre dois conceitos-variáveis principais: “modalidades de representação” na decisão (macro e micro) e “níveis de identificação” na implementação. Estes conceitos-variáveis serão construídos e medidos levando-se em consideração as perspectivas dos atores e as capacidades objetivas das instituições, sendo posteriormente classificados em termos de “modalidades” e de “níveis”, aplicados a cada ator, nos dois distritos sanitários no período político estudado. Distintos “níveis” e “modalidades” serão ancorados (relacionados) a pontos do contínuo aceitação-rejeição, o qual representa probabilidades de se implementar as políticas públicas na prática (0%-100%). Estas probabilidades serão interpretadas como coeficientes de legitimidade da política pública. [Projeto aprovado pelo Comitê de Ética em Pesquisa da UFG. Registrado no CEP-UFG/CONEP-MS (26584514.3.0000.5083) e no Sistema de Acompanhamento de Projetos (SAP) da UFG]
""
Papers by Fabiana C. Saddi
Sociedade E Cultura, 2018
James Macinko is a Professor and researcher in public health policy and health systems research a... more James Macinko is a Professor and researcher in public health policy and health systems research and equity, with extensive experience in primary care throughout the world, including the Brazilian Family Health Strategy. He is currently Professor of Health Policy and Management and Community Health Sciences at the UCLA Fielding School of Public Health. He previously held positions as Associate Professor of Public Health and Health Policy at New York University and former director of the NYU MPH program. He was a Robert Wood Johnson Foundation Health and Society Scholar at the University of Pennsylvania from 2006 to 2008 and a Fulbright Scholar in Brazil in 2002. He has worked and still works on several collaborative projects with Brazilian public health researchers and has been involved in both formal and informal consultations with the Department of Basic Care at the Brazilian Ministry of Health (DAB/MoH). This includes his participation in an international seminar on the PMAQ organ...
Brazilian Journal of Political Economy
RESUMO Este artigo tem como objetivo apresentar uma interpretação alternativa da lógica de concep... more RESUMO Este artigo tem como objetivo apresentar uma interpretação alternativa da lógica de concepção e implementação do II PND. Utiliza a contribuição de Weber e de outros autores que desenvolveram o conceito de patrimonialismo para melhor compreender a forma como o Estado brasileiro conduziu esse projeto. Destaca que o plano não se pautou exclusivamente por uma lógica econômica, mas também por razões políticas.
This paper analyses how the Brazilian Collective Health Movement (CHM) and its main representativ... more This paper analyses how the Brazilian Collective Health Movement (CHM) and its main representatives have influenced the policymaking process for health policy during distinct political periods: from regime transition/re-democratization to democracy (1970s to 2014). We develop a contextual descriptive analysis, involving a literature and documentary review, and interviews with key players. We take into account the political macro contexts (democracy and economic model), governmental coalitions, ideas and actions of the CHM, relationships of the CHM within society, institutionalization of participatory channels, and the interrelations between the Ministries of Economics, of Health and of Social Security. Three main periods were identified: 1) The transition to democracy and Constituent Assembly period, with the fight for and creation of the new national Unified Health Care System (SUS). 2) The first years of re-democratization, during the implementation of the institutional foundation...
Brazilian Journal of Political Economy, 2003
RESUMO O objetivo deste trabalho é estudar a dinâmica política da reconstrução do federalismo no ... more RESUMO O objetivo deste trabalho é estudar a dinâmica política da reconstrução do federalismo no Brasil durante o governo Geisel, no início da transição brasileira para a democracia. Essa análise começará em novembro de 1974, quando os resultados da eleição levaram o governo federal a começar a usar as relações econômicas e políticas do federalismo para conduzir e controlar dois projetos complementares: a liberalização política controlada e o Segundo Plano Brasileiro para o Desenvolvimento.
Cadernos de saude publica, Oct 22, 2018
Although it is well known that a successful implementation depends on the front-liners' knowl... more Although it is well known that a successful implementation depends on the front-liners' knowledge and participation, as well as on the organizational capacity of the institutions involved, we still know little about how front-line health workers have been involved in the implementation of the Brazilian National Program for Improving Access and Quality to Primary Care (PMAQ). This paper develops a contingent mixed-method approach to explore the perceptions of front-line health workers - managers, nurses, community health workers, and doctors - regarding the PMAQ (2nd round), and their evaluations concerning health unit organizational capacity. The research is guided by three relevant inter-related concepts from implementation theory: policy knowledge, participation, and organizational capacity. One hundred and twenty-seven health workers from 12 primary health care units in Goiânia, Goiás State, Brazil, answered semi-structured questionnaires, seeking to collect data on reasons f...
A Pró-Reitoria de Pós-graduação e Pesquisa da Universidade de São Paulo, pelo auxílio para aprese... more A Pró-Reitoria de Pós-graduação e Pesquisa da Universidade de São Paulo, pelo auxílio para apresentação de trabalho no Congresso da Sociedade de Estudos Latino-Americanos (SLAS). A Brasilio Sallum Junior, meu orientador, incentivador e responsável direto pela minha inserção no estudo comparativo, cujos ensinamentos e sugestões foram essenciais para o desenvolvimento deste trabalho final. A Carlos Alba, do Centro de Estudos Internacionais do Colégio do México, pelo auxílio concedido a pesquisa de campo no México.
Revista de Economia Política
ABSTRACT
Uploads
Books by Fabiana C. Saddi
Research project by Fabiana C. Saddi
The purpose of this research project is to improve, apply and disseminate the ‘coefficients of legitimacy framework’ to assess the politics of primary health care policy in distinct cities/ democratic settings. The framework develops the concept of political legitimacy as the contested space existing between policy design at the level of the state and policy implementation on the ground (Annex 2). The framework has been already applied to the analyses of health care policies in Brazil and Mexico (Saddi, 2004) (Saddi 2005) (Saddi, 2014), and is currently been applied (as a pilot project) in the case of primary health care in Goiania.
We will apply the coefficient of legitimacy framework to measure the magnitude of the gap between two concepts-variables: political representativeness and identification in implementation. Concepts will be constructed according to actors’ perspectives (values/ideas and interests) and objective institutional capabilities. Degrees of tensions between ideas/interests and frontline actors’ identity , and degrees of conflicts between guidelines and realization will be used as analytical criteria in the classifications of those concept-variables. We will interview policymakers and politicians, and undertake surveys of three types of frontline actors. The conceptual basis for those criteria is the interpretativist strand of political sociology (Weber 1978, Berger and Luckmann 1967) and Interpretive Politics. We will first develop a pilot research in the city of Goiania (and afterwards extend it to other cities). Results are expected to pave the way for comparisons across a wider range of cities. The research programme has been divided into five main phases.
1) First phase: mapping of actors, literature review
2) Second phase: engaging stakeholders and designing surveys
3) Third phase: applying surveys, pursuing interviews
4) Fourth phase: organisation and analysis of data collected
5) Fifth phase: revising and writing papers, final workshop
We will develop a new comprehensive type of measurement and comparison, in which comprehensiveness requires a greater understanding of case studies (Hudson and Lowe 2004; Whitehead 2002; Saddi, 2005). Concepts will be measured taking into account actors’ perspectives and objective institutional capabilities, and classified in terms of ‘modalities’ and ‘levels’. Distinct ‘levels’ and ‘modalities’ will be anchored to points in the acceptance-rejection continuum, representing probabilities of translating policies into practice (0%-100%) (Annex 3).
We will collect a complementary set of information related to frontline actors’ values and attitudes with respect to the country’s policy guidelines. We intend to develop an interactive method of work during the design of surveys and elaboration of semi-structure questions to be used in interviews. Surveys will be designed with the help of selected frontline actors and scholars, while interview questions will be elaborated in collaboration with policymakers as well as scholars. Academic collaborators will be directly involved in the process. It is expected that this interactive research process will lead to revisions of the main hypotheses and questions before the final application of surveys and publications.
""
Papers by Fabiana C. Saddi
The purpose of this research project is to improve, apply and disseminate the ‘coefficients of legitimacy framework’ to assess the politics of primary health care policy in distinct cities/ democratic settings. The framework develops the concept of political legitimacy as the contested space existing between policy design at the level of the state and policy implementation on the ground (Annex 2). The framework has been already applied to the analyses of health care policies in Brazil and Mexico (Saddi, 2004) (Saddi 2005) (Saddi, 2014), and is currently been applied (as a pilot project) in the case of primary health care in Goiania.
We will apply the coefficient of legitimacy framework to measure the magnitude of the gap between two concepts-variables: political representativeness and identification in implementation. Concepts will be constructed according to actors’ perspectives (values/ideas and interests) and objective institutional capabilities. Degrees of tensions between ideas/interests and frontline actors’ identity , and degrees of conflicts between guidelines and realization will be used as analytical criteria in the classifications of those concept-variables. We will interview policymakers and politicians, and undertake surveys of three types of frontline actors. The conceptual basis for those criteria is the interpretativist strand of political sociology (Weber 1978, Berger and Luckmann 1967) and Interpretive Politics. We will first develop a pilot research in the city of Goiania (and afterwards extend it to other cities). Results are expected to pave the way for comparisons across a wider range of cities. The research programme has been divided into five main phases.
1) First phase: mapping of actors, literature review
2) Second phase: engaging stakeholders and designing surveys
3) Third phase: applying surveys, pursuing interviews
4) Fourth phase: organisation and analysis of data collected
5) Fifth phase: revising and writing papers, final workshop
We will develop a new comprehensive type of measurement and comparison, in which comprehensiveness requires a greater understanding of case studies (Hudson and Lowe 2004; Whitehead 2002; Saddi, 2005). Concepts will be measured taking into account actors’ perspectives and objective institutional capabilities, and classified in terms of ‘modalities’ and ‘levels’. Distinct ‘levels’ and ‘modalities’ will be anchored to points in the acceptance-rejection continuum, representing probabilities of translating policies into practice (0%-100%) (Annex 3).
We will collect a complementary set of information related to frontline actors’ values and attitudes with respect to the country’s policy guidelines. We intend to develop an interactive method of work during the design of surveys and elaboration of semi-structure questions to be used in interviews. Surveys will be designed with the help of selected frontline actors and scholars, while interview questions will be elaborated in collaboration with policymakers as well as scholars. Academic collaborators will be directly involved in the process. It is expected that this interactive research process will lead to revisions of the main hypotheses and questions before the final application of surveys and publications.
""
Questions
Who were the main actors, ideas and interests involved in the reformulation of P4P/PMAQ and to what extent the reformulation has been characterised by policy learning, feedback and communicative strategies with front liners? To what extent front liners health workers know the program and how participated in the implementation of the program? How the main performance drivers (policies, structures, behaviour) produced change in the leadership process of work at the front line? These questions and related assumptions will be presented in relation to the Brazilian case.
Methodology
The framework employs a comprehensive literature review, interviews with key stakeholders and secondary analysis of data. Interviews will be made with policymakers and assessors and with policy managers and front liners in the cities. Data from each literature/transcript will be coded and analysed under determined policy and performance drivers. Combinations of policy drivers will be associated with effective levels of integration(ELIs) between implementation and re-formulation, while combinations of performance drivers will be classified as levels of perceived impact on performance(LPIPs). In the case and comparative analyses, we will explore the relationship between ELIs and LPIPs.
Also, secondary data will be organised and classified into levels of result-based performance(LRBPs). We will then triangulate/integrate the data between ELIs and LRBPs, exploring the extent to which qualitative process indicators(ELIs) are associated with result-based indicators(LRBPs) in the case and comparative analyses. Our main assumption is that integrative policy drivers are capable of strengthening HSSBB. Using framework analysis will enable us to better understand how/in what conditions integrative policy processes(ELIs) have, and can affect process(LPIPs) and result-based(LRBPs) performance indicators, highlighting changes that strengthen leadership and workforce. We will present the general framework and its assumptions/hypothesis and operationalization to the Brazilian case as well. This project is developed under the British Academy Newton Advanced Fellowship.
Applying it to the Brazilian case:
We develop a framework and contingent mixed method research design in four phases. Purposive sample (N = 180): policymakers, other actors involved in the formulation, municipal managers and frontline health staff in six cities with diverse management/leadership arrangements and organizational capacity, in Goias and Pernambuco.
The Qualitative Evidence Synthesis (QES) will search for qualitative and mixed methods studies in six databases and via supplementary searches in English and Portuguese. Data will be extracted and analyzed against the evidence matrix of the framework.
Interviews will be conducted with 180 actors involved in the formulation and implementation. Indexing, sorting, summary and display of data will be performed in the NVivo. The QES and analysis of interviews will generate common synthesis indicators: effective policy integration levels (EPILs) – between formulation and implementation -, performance impact perception levels (PIPLs) and levels of system strengthening (LHSS) in leadership and workforce.
In the quantitative analysis, secondary data from the PMAQ database will be organized and classified into different result-based performance levels (RBPLs) by health teams. We will also carry out correlations and Linear Regressions.
Mixed methods analysis will expand understandings about the relations between process and result indicators. We will develop joint displays arraying interviews and QES results and perform crosstabulations and Linear Regressions between quantitative and qualitative (transformed into numeric variables) synthesis indicators.
Keywords: public policy, pay for performance, implementation, health system research, PMAQ, Brazil
This paper has been divided in three main sections. Firstly, we present how mapping of actors and institutions are used to classify distinct ‘modalities of representativeness’ (in policymaking) with respect to societies’ values and interests in the formulation of new guidelines in primary healthcare in Brazil. Classification of four probable ‘modalities of representativeness’ are done taking into account degrees of tensions between ideas/interests and frontline actors’ identity (institutional capabilities and institutionalised patterns of socialisation) in Goiania. Those tensions are associated with points in the obedience-rejection continuum, on a scale that ranges from null to full correspondence. These points are interpreted as possibilities of translating policies into effective practice, and used in the formulation of hypotheses and analyses.
Secondly, we focus on the construction of the second variable and its sub-variables: the general mean level of identification, attributed to front line actors, and the disaggregated mean levels of identification, related to the three micro dimensions selected (local managers, heath teams and users). Degrees of conflict existing between guidelines and realization will be used as analytical criteria in the definition of four probable levels of identification (possibilities of implementing the legalities constructed by macro-politics) with macro/micro policy-making. Data gathered from questionnaires and statistics will be organised so as to position actors in one of the four levels of identification, and to come up with an average level of identification for each sanitary district and city. ‘Levels’ will be connected with points in the acceptance-rejection continuum.
We will afterwards explore how the identification point can be associated to the representativeness point in the legitimacy continuum. The distance between both points in the continuum will be interpreted as coefficients of political legitimacy of the policy. Legitimacy is defined in terms of levels of true acceptance and effective realisation, leading to distinct but closer proximities between macro and micro spheres/actors. The proposition is that the closer the representativeness point is to the identification point in the continuum, the higher the level of responsiveness and legitimacy construction of the policy would be.
This method intends to construct evidences on how it would have been possible to promote higher levels of political reciprocity in public policy. It can be used to inform policy and anticipate problems to which policy will need to respond.
Este trabalho objetiva mostrar de que forma o PAILI conseguiu integrar a atenção primária à saúde e outros serviços públicos, sociais e jurídicos, à saúde mental, de modo a garantir os direitos humanos e o acesso aos serviços públicos para pessoas com transtornos mentais em conflito com a lei. Tem como objetivos específicos sistematizar a discussão com a literatura no que se refere às barreiras e recomendações, bem como ressaltar o desenho institucional inovador do Programa, seus procedimentos, ferramentas/rotinas e, por fim, evidenciar como o PAILI inova em relação às recomendações vigentes.
A metodologia consiste na revisão da literatura de políticas públicas de saúde e direitos humanos e de documentos do PAILI, condução da mesa de diálogo (policy dialogue) baseada em evidências. Estas são categorizadas e comparadas a fim de subsidiar o fortalecimento de programas congêneres. Trata-se de produto de projeto de pesquisa em andamento.
A capacidade organizacional é caracteriza pela literatura como uma dentre as principais barreiras ou facilitadores que influenciam na execução de políticas públicas. E o feedback/percepção dos atores de linha frente tido como essencial na re-avaliação das políticas.
Objetivos:
Apresenta resultados preliminares de uma das seções dos cinco surveys realizados com gestores, equipes de saúde (ACS, enfermeiros e médicos) e usuários da ESF em Goiânia, e no que diz respeito ao indicador capacidade organizacional (CAPORG) e seus subindicadores.
Metodologia:
Realizamos uma análise interpretativa aliada à quantitativa. Efetuamos revisão da literatura e elaboramos questionários com perguntas fechadas segundo quatro indicadores amplos: entendimento sobre a ESF, CAPORG, interação da equipe, aproximação como Estado O indicador CAPORG envolve aspectos físico-estruturais, organizacionais e de capacitação do pessoal da ESF. Questionários foram aplicados para três tipos de atores de linha de frente, sendo 24 médicos, 48 enfermeiros, 96 ACS, 12 gestores e 384 usuários, em 12 Centros do Saúde da Família CSF, localizados em 3 Distritos Sanitários de Goiânia. Realizadas entrevistas aberta com alguns atores. Pesquisa autorizada pelo CEP-UFG.
Resultados:
Na perspectiva da maioria dos atores de linha de frente em relação à CAPORG, os CSFs apresentam estrutura física inadequada para a ESF, sendo que se verifica uma sub-utilização da capacidade física nos CSF recém-construídos, tendo em vista a escassez de pessoal, materiais e alguns equipamentos. Observa-se também de forma unanime a restrição de materiais e equipamentos, e na manutenção dos equipamentos vigentes. Agentes Comunitários e Enfermeiros executam seu trabalho por meio da aquisição de alguns materiais básicos. Insumos faltam para realização de procedimentos médicos, são substituídos por outros afins. Equipes desfalcadas de pessoal, procuram se reorganizar.
Conclusões/Considerações:
Dentre os outros indicadores assinalados, o CAPORG foi o que obteve avaliação mais baixa, e no cálculo da média/agregação dos indicadores ele será ponderado pelos demais, uma vez que a INTEA é muito bem avaliada, e os demais com avaliação média. Evidencia-se, no entanto, que além de se adequar a estrutura, o aprimoramento do planejamento seria importante para o fortalecimento da CAPORG e do cuidado na ESF.
Uma das grandes problemáticas das políticas públicas refere-se à lacuna existente entre os processos de elaboração e os de implementação, e deve-se ao fato da implementação ser marcada por tensões contraditórias às decisões elaboradas. Esta problemática permite-nos avaliar a política pública do ponto de vista da legitimidade política, e como resposta que visa aproximar governantes e governados.
Objetivos:
Efetuaremos uma análise política inter-relacionada das principais tensões (limites e possibilidades) envolvidas na elaboração e implementação a fim de se avaliar a magnitude da lacuna. Apresentaremos metodologia construída e resultados preliminares .
Metodologia:
O método concilia a análise política de cunho interpretativo à quantitativa. Estabeleceremos correlações entre dois conceitos-variáveis: “níveis de identificação” na implementação (NI) e “modalidades de representação” na elaboração (MR). Estamos realizando entrevistas semi-estruturadas para elaboradores, e estruturadas para três tipos de atores de linha-de-frente: gestores locais, equipe da ESF e usuários, em unidades de três Distritos Sanitários de Goiânia. Dados são agrupados em distintos “níveis” (NI) e “modalidades” (MR), e ancorados a pontos do contínuo aceitação-rejeição, que representa probabilidades de executar a ESF, e serão interpretados como coeficientes de legitimidade (CL).
Resultados:
Resultados preliminares mostram que a modalidade de representação tende a ser manter no patamar nível médio baixo, em que prevalece a adoção de estratégias a partir de planos do governo federal e discussões realizadas na SMS. O nível de identificação dos gestores locais, médicos, enfermeiros e agentes comunitários, tendem a ser manter no nível baixo e, e alguns sub-indicadores do indicador NI oscilam entre os níveis médios e baixo, tendo em vista falhas/distorções relacionados a: compreensões sobre o significado da ESF, capacidade organizacional, interação entre as equipes e entre unidades e distritos, desvalorização do profissional, não/baixa-participação na decisão.
Conclusões/Considerações:
A pesquisa produzirá indicadores mais compreensivos sobre potencialidades de execução da ESF, os quais enfatizam a necessidade de aproximação da gestão com a linha de frente, e destes com os usuários. Indicadores CL, NI e CA poderão ser utilizados para inovar e aprimorar as ferramentas de análise e decisão, e os serviços de saúde.
http://www.saudecoletiva.org.br/programacao/exibe_trabalho.php?id_trabalho=2921&id_atividade=665&tipo
• Falar do que se trata o Programa Mais Médicos: de sua complexidade e desafios envolvidos para extensão do acesso e melhoria da qualidade na Atenção Primária à Saúde (APS).
• Lançar os termos do debate de hoje, isto é: aprsentar um desafio para os participantes da mesa e para o público em geral.
Quero começar dizendo que os dados atuais do Programa Mais Médicos apontam que ele é um sucesso. Pesquisa de Opinião Pública da Presidência realizada com famílias, dados de março, mostra que 68% das pessoas entrevistas são a favor do Programa. No entanto, apesar de se verificar uma melhora na percepção da população sobre o Programa, chamo a atenção para a necessidade de olharmos a questão do déficit de medico e da atuação do medico de família e de comunidade dentro de um processo mais amplo. E observe que este horizonte de longo prazo já se encontra presente no Programa Mais Médicos. Para a maioria da população, contudo, o Programa significa apenas contratação de médicos estrangeiros. Ou melhor, consiste apenas na contratação de médicos cubanos.
No entanto o Programa Mais Médicos para o Brasil é mais amplo. Podemos dizer que ele possui dois pilares principais:
1) Medidas de curto prazo: que é a contratação de médicos estrangeiros por 3 anos (no entanto isto apenas aconteceu após as vagas abertas para profissionais brasileiros não terem sido preenchidas).
2) Prever também medidas de caráter estruturantes: incentivar a formação de médicos de família e comunidade no país, com mudanças no currículo de medicina, criação de escolas de medicina especializada. Há todo um trabalho sendo feito nesta área.
Então o Programa Mais Médicos não implica apenas contratação de médicos estrangeiros e de intercambistas brasileiros por tempo determinado. O Mais Médicos olha para a necessidade de se criar bases estruturantes para a formação de médicos de família. E ao fazer isto, o próprio programa estabelece uma relação necessária que existe entre a estrutura da APS (e da ESF em especial) e a atuação de seus profissionais de linha de frente:
Cumprir as diretrizes da politica nacional de APS (PNAB) significa melhorar o acesso, o acolhimento, o vinculo e continuidade do cuidado, aprofundar a integração da APS com os demais níveis da atenção (dentre outros). Este trabalho de construção de uma APS universal, descentralizada e de qualidade, requer portanto que outras iniciativas paralelas e complementares estejam ocorrendo:
...
https://books.google.com.br/books?id=GQIvDwAAQBAJ&pg=PA109&lpg=PA109&dq=fabiana+saddi&source=bl&ots=mWd5vVICOs&sig=-PuxuNga-bBt1Wl23sAvpBxhfdk&hl=pt-BR&sa=X&ved=2ahUKEwie0M7YvKjYAhUKI5AKHaiVAb44FBDoATAEegQICBAA#v=onepage&q=fabiana%20saddi&f=false
IPPA 4th International Public Policy Conference, Panel T17P09 Pay for performance, Montreal, June 2019
We carry out a framework analysis, using survey results, qualitative literature and interview data to explore the relations between public policy process (formulation and implementation), performance drivers and system strengthening in pay for performance (P4P), also known as performance based-financing (PBF).
Framework analysis hypothesis are explored via Crosstabulations (forthcoming Ordinal logistic regressions) and a mixed method meta-inference analysis.