Análise da implementação do Programa Mais Médicos e seus efeitos na atenção básica de saúde em Minas Gerais
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2020-06-09
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Universidade Federal de Viçosa
Resumo
Como primeiro nível de atenção e acesso à saúde pública, tem-se a atenção básica de saúde, que é considerada a porta de entrada a tais serviços. Considerando-se que nessa modalidade grande parte dos problemas são resolvidos ou evitados, foram criados arranjos institucionais, que culminaram com a elaboração e implementação de programas de fortalecimento desse nível, visando sua efetividade. Dentre esses programas destaca-se o Programa Mais Médicos (PMM), criado em 2013, com o objetivo de levar mais médicos para regiões onde há escassez ou ausência desses profissionais (eixo de provimento emergencial), prevendo ainda, investimentos para construção, reforma e ampliação de Unidades Básicas de Saúde (eixo de infraestrutura), além de qualificar a formação desses profissionais (eixo de educação). Com o intuito de trazer conhecimentos sobre a trajetória do PMM, em termos de continuidades e avanços, e a visualização teórica da forma pela qual encontra-se estruturado, este trabalho contribui para promover melhorias à realidade onde foi analisada sua implementação, de acordo com seu arranjo institucional. Assim, este trabalho teve como objetivo geral analisar a implementação do eixo de provimento emergencial do PMM no estado de Minas Gerais e seus efeitos na Atenção Básica de saúde, buscando compreender o papel dos arranjos institucionais neste processo. Especificamente, pretendeu-se: descrever a teoria do Programa Mais Médicos e analisar a implementação do seu eixo de provimento emergencial no nível local, a partir da perspectiva de arranjos institucionais; Analisar os efeitos do eixo de provimento do Programa Mais Médicos na Atenção Básica de Saúde nos municípios de Minas Gerais; e analisar os efeitos do Programa Mais Médicos na atenção básica de saúde a partir da ótica dos atores envolvidos na implementação do programa no nível local. Para responder aos objetivos propostos por este trabalho, foi utilizada uma abordagem mista, com técnicas qualitativas (entrevistas semiestruturadas, análise documental e análise de conteúdo) e quantitativas (Propensity Score Matching, com recorte temporal entre 2012 e 2018). A importância deste trabalho se deve à possibilidade de contrastar os resultados estatísticos com os achados da pesquisa de campo, que demonstram que os benefícios do PMM vão além dos números, partindo para o subjetivo, fortalecendo a Atenção Básica através do vínculo e das inovações criadas em cada localidade que recebe o Programa. Contrastando os resultados estatísticos com a pesquisa de campo, foi possível perceber que o PMM consegue cumprir com seu objetivo de fortalecer a Atenção Básica de Saúde, propiciando um maior acesso ao sistema de saúde, ao passo em que trabalha para satisfazer as necessidades em saúde da população. O Programa também se mostrou promissor em relação à resolutividade, longitudinalidade e à integralidade da atenção básica de saúde. Em relação ao arranjo institucional do PMM, identificou-se que este foi estruturado de forma pertinente ao retratado na teoria do programa, com promissoras integração horizontal e territorialidade. Por fim, como pontos de atenção, têm-se as trocas de gestão e as recentes mudanças ocorridas no desenho do Programa, que trazem incertezas em relação à continuidade do mesmo nos próximos anos. Palavras-chave: Programa Mais Médicos. Atenção Básica de Saúde. Implementação. Arranjos Institucionais. Avaliação de Políticas Públicas.
As the first level of care and access to public health there is the primary health care, which is considered the gateway to such services. Considering that in this modality a large part of the problems is solved or avoided, institutional arrangements were created, which culminated in the elaboration and implementation of programs to strengthen this level, aiming at its effectiveness. Among these programs, the Mais Médicos Program, created in 2013, stands out, with the objective of taking more doctors to regions where there is a shortage or absence of these professionals (emergency supply axis), also foreseeing investments for construction, renovation and expansion of Basic Health Units (infrastructure axis), in addition to qualifying the training of these professionals (education axis). In order to bring knowledge about the Mais Médicos trajectory, in terms of continuities and advances, and the theoretical visualization of the way in which it is structured, this work contributes to promote improvements to the reality where its implementation was analyzed, according to its institutional arrangement. Hence, this work aimed to analyze the implementation of the Mais Médicos emergency supply axis in the state of Minas Gerais and its effects on Primary Health Care, seeking to understand the role of institutional arrangements in this process. Specifically, the intention was to: describe the theory of the Mais Médicos Program and analyze the implementation of its emergency supply axis at the local level, from the perspective of institutional arrangements; Analyze the effects of the supply line of the Mais Médicos Program on Primary Health Care in the municipalities of Minas Gerais; and to analyze the effects of the Mais Médicos Program on primary health care from the perspective of the actors involved in the implementation of the program at the local level. To respond to the objectives proposed by this work, a mixed approach was used, with qualitative techniques (semi-structured interviews, document analysis and content analysis) and quantitative (Propensity Score Matching, with time frame between 2012 and 2018). The importance of this work is due to the possibility of contrasting the statistical results with the findings of the field research, which demonstrate that the benefits of the PMM go beyond the numbers, moving to the subjective, strengthening Primary Care through the bond and the innovations created in each location that receives the Program. Contrasting the statistical results with the field research, it was possible to realize that the PMM is able to fulfill its objective of strengthening Primary Health Care, providing greater access to the health system, while working to meet the health needs of the population. The Program also proved to be promising in terms of resolvability, longitudinality and the comprehensiveness of primary health care. In relation to the Mais Médicos institutional arrangement, it was identified that it was structured in a pertinent manner to that portrayed in the program's theory, with promising horizontal integration and territoriality. Finally, as points of attention, there are the changes that have occurred in the management and, recently, in the design of the Program, which bring uncertainties regarding its continuity in the coming years. Keywords: Mais Médicos Program. Primary Health Care. Implementation. Institutional Arrangements. Public Policy Evaluation.
As the first level of care and access to public health there is the primary health care, which is considered the gateway to such services. Considering that in this modality a large part of the problems is solved or avoided, institutional arrangements were created, which culminated in the elaboration and implementation of programs to strengthen this level, aiming at its effectiveness. Among these programs, the Mais Médicos Program, created in 2013, stands out, with the objective of taking more doctors to regions where there is a shortage or absence of these professionals (emergency supply axis), also foreseeing investments for construction, renovation and expansion of Basic Health Units (infrastructure axis), in addition to qualifying the training of these professionals (education axis). In order to bring knowledge about the Mais Médicos trajectory, in terms of continuities and advances, and the theoretical visualization of the way in which it is structured, this work contributes to promote improvements to the reality where its implementation was analyzed, according to its institutional arrangement. Hence, this work aimed to analyze the implementation of the Mais Médicos emergency supply axis in the state of Minas Gerais and its effects on Primary Health Care, seeking to understand the role of institutional arrangements in this process. Specifically, the intention was to: describe the theory of the Mais Médicos Program and analyze the implementation of its emergency supply axis at the local level, from the perspective of institutional arrangements; Analyze the effects of the supply line of the Mais Médicos Program on Primary Health Care in the municipalities of Minas Gerais; and to analyze the effects of the Mais Médicos Program on primary health care from the perspective of the actors involved in the implementation of the program at the local level. To respond to the objectives proposed by this work, a mixed approach was used, with qualitative techniques (semi-structured interviews, document analysis and content analysis) and quantitative (Propensity Score Matching, with time frame between 2012 and 2018). The importance of this work is due to the possibility of contrasting the statistical results with the findings of the field research, which demonstrate that the benefits of the PMM go beyond the numbers, moving to the subjective, strengthening Primary Care through the bond and the innovations created in each location that receives the Program. Contrasting the statistical results with the field research, it was possible to realize that the PMM is able to fulfill its objective of strengthening Primary Health Care, providing greater access to the health system, while working to meet the health needs of the population. The Program also proved to be promising in terms of resolvability, longitudinality and the comprehensiveness of primary health care. In relation to the Mais Médicos institutional arrangement, it was identified that it was structured in a pertinent manner to that portrayed in the program's theory, with promising horizontal integration and territoriality. Finally, as points of attention, there are the changes that have occurred in the management and, recently, in the design of the Program, which bring uncertainties regarding its continuity in the coming years. Keywords: Mais Médicos Program. Primary Health Care. Implementation. Institutional Arrangements. Public Policy Evaluation.
Descrição
Palavras-chave
Programa Mais Médicos - Avaliação - Minas Gerais, Cuidados primários de saúde, Política pública, Política de saúde
Citação
MAU, Gabrielle Fontes. Análise da implementação do Programa Mais Médicos e seus efeitos na atenção básica de saúde em Minas Gerais. 2020. 121 f. Dissertação (Mestrado em Administração) - Universidade Federal de Viçosa, Viçosa. 2020.