O processo de trabalho do coordenador municipal da estratégia de saúde da família

Abstract

The increase of township responsibility to the care of the populations health and the expansion of the strategy for family health (ESF) in Brazil showed the need for the townships to develop their ability to run health services. In this context, the township coordinator is brought up with the proposition of reducing the management demand, especially what concerns the planning of the work process of the teams for Family Health (SF). However, there are not, up until now, general directives of how the work of said coordinator should be carried out, its functions, activities, characteristics which are usually defined by whoever occupies a position. The following paper, based on the strategy of studies of qualitative cases, tries to understand the day-to-day work of the township coordinator under his perspective and that of the secretariat of health and doctors and nurses of the medical staff. The sets of the study were six cities, where the headquarters of the Sanitary Micro regions that constitute the Macro region of Divinópolis in Minas Gerais state are located. The subjects of such research were six coordinators, five health secretaries, six nurses and four doctors of SF teams, adding up to twenty-one informers. The collection of data took place trough recorded interviews, following semi-structured scripts, analyzed through the content analysis method and were organized into the following empirical categories: the professional path of the coordinators and their insertions into the township area; the characteristics of the work as a township coordinator; the coordinators posture towards difficult situations at work; the coordinators work seen by the managers, doctors and nurses of SF teams. The analysis showed that the coordinators have education in Health, with the majority of them in Nursing, that already worked in SF teams or already knew the health service provided at the township and took this manager job due to the expansion of the number of SF teams. They built their work strategies on the development of daily activities, facing the demands as they presented themselves, with no legal attribution or previous planning. Amongst these, they describe periodical meetings with the teams and managers, supervising the teams work, not always scheduled, but attending to the demands. They appear as a link between the professionals of the SF teams and the managers, responsible of carrying on the townships health policy and also with the other levels of government, because they implement and capacitate the teams. If, on the one hand, they face innumerous hardships, such as work overload, political interference, lack of autonomy, the vertical posture of implementing politics, on the other hand these hardships are means to professional growth and value. As far as the secretaries of health are concerned, the coordinators are considered co-workers, the right arm, not only contributing with the management of the township but also seen as capable of providing political balance to the work of the managers. The doctors and nurses consider them professionals with a good amount of knowledge about public health and the townships family health strategy, with whom them have a good relationship and whose job is important for supporting the actions developed by the teams. It is clear, therefore, that the coordinators develop extremely important management functions township wise, for the teams and for the managers. However, limiting and planning their attributions and responsibilities on what concerns daily work is needed to ensure the optimization of their work and a possible improvement on the health care to the population at hand.