Sentidos do trabalho para gerentes de Unidades Básicas de Saúde em contextos de vulnerabilidades

Abstract

With the decentralization of the Unified Health System (SUS, in Portuguese acronym), the municipalities assumed the leading role in the management of their territories, being responsible for Primary Health Care. In this context, the manager began to play a prominent role, giving direction and meaning to the workers’ actions in specific contexts. The performance of the managerial function in order to achieve the institutional objectives requires the manager to understand the work process and to assign meaning to the actions put into practice. A job makes sense when it is considered important, useful and true. This study aimed to understand the meanings of work for managers of Basic Health Units located in a local branch office with high index of vulnerability. This is a qualitative, interpretative and analytical study, whose scenarios were the Basic Health Units of the Northern Region of Belo Horizonte, state of Minas Gerais, in which nineteen managers participated in the research. Two sources of evidence were used as data collection instruments: the face-to-face interviews with semi-structured script and observation. The data collection took place between September 2018 and March 2019 and, during the interviewer's stay in the Basic Unit for the interview, it happened simultaneously to the observation of the facts. The researcher's impressions were recorded in a field journal. Regarding the data analysis, the content analysis methodology proposed by Bardin (2016) was used. The results were categorized into two themes: directions of the manager's work in primary care and the interface of vulnerability in the manager's work context. The meanings of work were analyzed in the light of individual, organizational and social dimensions, permeated by daily work. Managers' identities were built on the work done and also on the relationships established with workers, users and the community. As for the second thematic category, referring to the singularities of the manager's workplace, characterized by high vulnerability index, the need for mobilization of competences and differentiated profiles was identified. The role of the manager in vulnerable populations influenced the configuration of their identity and the attribution of meanings to the work performed. The manager was considered as an extremely relevant player in the organization of health services, given his role as an articulator and in the implementation of policies proposed by SUS. His performance demands a formation that promotes, above all, the establishment of interpersonal relationships and the recognition of the specific needs of the population he serves. The excess of activities performed negatively interferes in the management of care. Initiatives aimed at redefining work processes may be necessary for the manager to effectively assume his or her actual duties. Therefore, regarding the dimensions of the meaning of work, it is clear that the elements listed in the individual dimension and especially in the social one overlap those of the organizational one. Attention should be drawn to the fact that the hindering aspects have stood out in the organizational dimension. The role of the manager in vulnerable populations significantly influences this construction.