Avaliação da gestão do SUS para o planejamento em saúde no município de Sobral, Ceará.

Abstract

Health planning is a legal requirement, constituting a relevant mechanism that ensures the directionality of the actions and services of the Unified Health System (SUS), with a view to responding to the demands and needs of the population in its entirety. However, despite initiatives to recognize the importance of this mechanism, obstacles arise regarding its implementation. The present study aims to evaluate the quality of SUS management for health planning in the city of Sobral - CE, considering the implementation of the DigiSUS Gestor System: planning module as a time frame. This is an evaluative, descriptive study, with a mixed approach, which has as its methodological reference the evaluation triad proposed by Donabedian, based on the use of indicators representing aspects related to structure, process and result. The study participants were the coordinators of the Municipal Health Department, managers of Primary Health Care (PHC), as well as representatives of the Municipal Health Council (CMS), who are the key actors in the health planning process. In the structure category, a questionnaire based on an instrument created by the Ministry of Health for the PlanejaSUS system was applied to professionals allocated to the Planning Coordination. Regarding the process category, a semi-structured interview was carried out with the target audience about aspects of planning in the municipality. In the result category, management instruments were evaluated based on the implementation of the DIGISUS system: planning module. Quantitative data analysis was carried out using descriptive analysis and qualitative data was processed by NVivo 11 Software and Bardin content analysis. The study respected ethical principles and was submitted for evaluation by the Scientific Committee of the Municipal Health Department of Sobral and subsequently registered on Plataforma Brasil, with opinion number 6,252,207. In terms of structure, the municipality presented as potentialities the existence of a specific planning coordination in its organization chart, in addition to the use of management instruments and physical structure suitable for the work. As a restrictive aspect, the lack of adherence of the other coordinators to the planning processes, the lack of involvement in the planning team and the weakness in the application of planning methods in assistance services were listed. Within the scope of the process, it was possible to identify that managers understand the importance of health planning for the execution of programmed actions consistent with the reality in which they are inserted. The main challenges were issues related to the awareness of professionals, the high demand for services, turnover of professionals and their absence during planning moments. The ambience and fragility of the infrastructure of the units, together with the underfunding of healthcare were also aspects highlighted. As strategies to mitigate these challenges, discussions with the team were listed, continuous monitoring of actions through information systems and own spreadsheets, as well as the use of administrative tools such as the 5W2H matrix, PDCA cycle and SWOT Matrix to subsidy for construction times. From the perspective of goals, managers highlighted the prioritization of goals that are linked to the financing of services. The CMS reflected its role in the instrument deliberation process, however, it also argued the lack of technical knowledge regarding budgetary aspects. In terms of results, it was identified that the municipality of Sobral demonstrated compliance by forwarding all management instruments in accordance with the deadlines stipulated by legislation and with the minimum structure requirements, which were favorably evaluated by the respective CMS. It is observed that the municipality demonstrated a notable commitment to carrying out a comprehensive planning process, in which it outlined a significant number of goals that covered all coordinations belonging to the structure of the Municipal Health Department, achieving success in 255 of the 293 established goals. It is therefore concluded that the municipality of Sobral has a structured organization for planning, presenting considerable developments in this last cycle. However, it is necessary to work on communication with professionals, in order to qualify this process at the end, integrating them into the “macro” planning of management instruments. The participation of the Health Council should not be restricted only to the moment of deliberation, but in the construction of management instruments, with a propositional nature. There is a perceived need for greater sharing of goals linked to management instruments with the executing professionals, who are at the forefront, in order to make them protagonists of these actions and knowledgeable about the objectives and goals proposed by management. Finally, it is possible to identify that the continuous execution of planning is essential for achieving the agreed goals and indicators, which is manifested in the achievement of 87.03% of the goals agreed for the four-year period 2018-2021.