Computerization of primary health care in Brazil: the network of actors.

Eliete Albano de Azevedo Guimarães,Ricardo Bezerra Cavalcante,Simone de Pinho Barbosa,Maria José Menezes Brito,Cristiano José da Silva Esteves,Tarcísio Laerte Gontijo

doi:10.1590/0034-7167-2018-0381

Abstract

To analyze the network of human and non-human actors involved in the computerization of primary health care in the Brazilian federal government. A qualitative study that used as a theoretical reference the actor-network theory and as a methodological reference the cartography of controversies. Data analysis was carried out using Gephi software, and through the extraction of reports, informed by the actor-network theory. We found a network of 288 connections among 33 actors, composed mainly of nonhuman influencers of computerization. These actors are distributed throughout 3 inter-related communities, and manage the network by defining obligations, penalties, conflicts and intentionalities, thus influencing the success of the intended computerization. The network of actors at the federal level generates situations that, in many cases, hamper the successful implementation of a nationwide computerization strategy.

Highlights

In 2013, the Brazilian Ministry of Health established the e-SUS Primary Care strategy (e-SUS AB)(1), with the intention of computerizing Primary Health Care (PHC) throughout the national territory
The first one is comprised of the MINISTRY OF HEALTH and other actants, which appear in purple; the second is made by the components of the DAB SITE, in orange; and the third by the following agglomerate of actants: CIT; Council of Health Secretaries (CONASS); CONASEMS; CTIIS and its Technical Notes (NT), shown in green
The following procedures were performed[10,11]: exhaustive reading of the information extracted from the inscription devices; in-depth description of the social dynamics of the studied phenomenon, reaggregating events and ordering them chronologically; identification of the mediating actants described in the inscription devices and directly involved with the object of study; identification of the connections between actants based on the description of the object of study; creation of a database containing nodes and edges

Summary

Introduction

In 2013, the Brazilian Ministry of Health established the e-SUS Primary Care strategy (e-SUS AB)(1), with the intention of computerizing Primary Health Care (PHC) throughout the national territory. Its success depends on technical aspects, and on the acceptance of the various involved actors, and their mobilization towards the goal of computerization[4]. For a strategy that aims to computerize the entire PHC service to be successful, it needs to go beyond technical attributes per se. One needs to think in terms of sociotechnical relations as a network of human or nonhuman actors, at a given time and place[5]. In order to understand these sociotechnical relations, which underlie the e-SUS AB strategy, the Actor-Network Theory (ANT) is presented as an appropriate theoretical referential[6]— applicable in the context of health and nursing[7]

Methods

Results

Conclusion