0024/2020 - Problemas e estratégias de gestão do SUS: A vulnerabilidade dos municípios de pequeno porte Management problems and strategies: The vulnerability of small-sized municipalities
O processo de descentralização exerce forte impacto nas finanças dos Municípios de Pequeno Porte (MPP) e estes são o ente mais vulnerável da federação. Objetivou-se analisar os principais problemas e as estratégias de gestão utilizadas pelos MPP para enfrentar as desigualdades decorrentes do processo de descentralização. Pesquisa qualitativa desenvolvida por meio de grupos operativos com 55 trabalhadores das equipes gestoras de MPP da macrorregião norte do Paraná. Foi realizada análise compreensiva e interpretativa utilizando a Teoria do Jogo Social como referencial teórico. Dentre os problemas, estão a insuficiente capacidade para fazer a gestão dos municípios e para ofertar atenção integral à saúde aos munícipes. A constituição de Consórcios Intermunicipais de Saúde, a compra de serviços por contratos paralelos com prestadores privados e a adesão a programas do estado e da União são estratégias para o enfrentamento dos problemas, porém estas desencadeiam um intercâmbio de problemas. Para minimizar a vulnerabilidade dos MPP, é preciso fomentar o empoderamento do gestor municipal, implantar processos de escuta dos MPP e de uma cultura de enfrentamento dos problemas de forma coletiva e compartilhada entre os entes federados, para que haja uma gestão interfederativa.
Palavras-chave:
Descentralização; Gestão em saúde; Sistema Único de Saúde; Municípios de Pequeno Porte.
Abstract:
The decentralization process has a strong impact on the finances of Small-Sized Municipalities (SSMs) and these are the most vulnerable entity of the federation. It aimed to analyze the main problems and management strategies used by the SSMs to address the inequalities resultedthe decentralization process. This is qualitative research developed through operative groups with 55 workersthe management teams of SSMs in the northern macro-region of Parana. A comprehensive and interpretative analysis was conducted using the Social Game Theory as a theoretical reference. Among the problems are the insufficient capacity to manage municipalities and provide comprehensive health care to citizens. The constitution of Inter-Municipal Health Consortiums, the purchase of services through parallel contracts with private providers, and the adhesion to state and federal programs are strategies to address the problems, but they trigger an exchange of problems. In order to minimize the vulnerability of the SSMs, it is necessary to foster the empowerment of the municipal manager, implement processes of listening to the SSMs and culture of facing the problems in a collective and shared way among the federated entities, so that there is an interfederative management.
Keywords:
Decentralization; Health Management; Public Health System; Small Sized-Municipalities.
Management problems and strategies: The vulnerability of small-sized municipalities
Resumo (abstract):
The decentralization process has a strong impact on the finances of Small-Sized Municipalities (SSMs) and these are the most vulnerable entity of the federation. It aimed to analyze the main problems and management strategies used by the SSMs to address the inequalities resultedthe decentralization process. This is qualitative research developed through operative groups with 55 workersthe management teams of SSMs in the northern macro-region of Parana. A comprehensive and interpretative analysis was conducted using the Social Game Theory as a theoretical reference. Among the problems are the insufficient capacity to manage municipalities and provide comprehensive health care to citizens. The constitution of Inter-Municipal Health Consortiums, the purchase of services through parallel contracts with private providers, and the adhesion to state and federal programs are strategies to address the problems, but they trigger an exchange of problems. In order to minimize the vulnerability of the SSMs, it is necessary to foster the empowerment of the municipal manager, implement processes of listening to the SSMs and culture of facing the problems in a collective and shared way among the federated entities, so that there is an interfederative management.
Palavras-chave (keywords):
Decentralization; Health Management; Public Health System; Small Sized-Municipalities.
Pinafo, E, Nunes, E. F. P. A., Carvalho, B.G, Mendonça , F.F, Domingos, C.M, Silva, C.R. Problemas e estratégias de gestão do SUS: A vulnerabilidade dos municípios de pequeno porte. Cien Saude Colet [periódico na internet] (2020/Fev). [Citado em 07/11/2024].
Está disponível em: http://cienciaesaudecoletiva.com.br/artigos/problemas-e-estrategias-de-gestao-do-sus-a-vulnerabilidade-dos-municipios-de-pequeno-porte/17506?id=17506
