O trabalho gerencial no contexto da Atenção Primária à Saúde

Abstract

This study aimed to understand the managerial work in the context of primary health care. This is a case study of qualitative approach, with the backdrop of the city of Betim. Participants were twelve managers of Primary Health units and four central managers, totaling 16 participants. They were used as sources of evidence to document analysis, observation, interview with semistructured script and Gibi Technical. Data collection was conducted from September to November 2015. Data were analyzed using content analysis proposed by Bardin (2011). The results were organized into four categories, namely: Work Restructuring in Betim city; Singularities of managerial work; Symbologies and meanings attributed to managerial work; decision-making and governance of Primary Health of Betim. The analysis of evidence obtained through interviews, observation and description of the figures used in Gibi technique revealed that the managers' daily work is marked by a hard practice, but at the same time enjoyable. Managers mention in their daily work carry an overload of activities, which are often non-specific function, which has compromised the development of managerial activities. Managers do not have a fixed routine work, acting in a fragmented and discontinuous and therefore can not define priorities and perform throughout the day, and so end up meeting the demands as they arise. There are, by some managers, dissatisfaction with their pay, which is not consistent with the burden of commitments and responsibilities. In the organizational aspect it was found that the physical structure of primary care units determines precarious working conditions that limit managerial performance, reinforced by the absence of professional and effective lack of material resources. Other difficulties are the constant interpersonal conflicts, bureaucratic issues and partisan political barriers. The job of the manager is equipped with symbologies expressed in the form of metaphors, referring to being angels, witches, mad, iron machines and erasers fire. In addition, managers give meaning to their professional practice through the ability to help others, to motivate and lead their team. As for the decision-making and governance in the context of primary care managerial exercise is marked by ambiguous situations in their daily lives, traveling through greater autonomy of action and decision-making, to impotence and lack of governance to transform realities and needs identified by them . While managers recognize the importance of exercise teamwork and intersectoral, and stimulating the implementation of collegial bodies within the organization, not always their actions and decisions are made with the participation of all social actors, namely - managers, professionals and users. It concludes that despite the managers recognize the importance of the decisions being corresponsabilizadas, and the Health Department to mobilize change for a collegial management, yet managers reinforce often in their practice centralization of decisions, perpetuate a traditional management model, with hierarchical, bureaucratic actions and control over strategic and participatory planning of health actions.