Abstract
This is a case study in the municipality of Rio de Janeiro about management in the Family Health Strategy based on the Social Organizations model. The aims were to characterize and analyze aspects of the governance system adopted by the Rio de Janeiro Municipal Health Department and identify limits and possibilities of this model as a management option in Brazil's Unified Health System. A qualitative study was performed based on a literature review, document analysisand interviews with key informants. This management model facilitated the expansion of access to primary healthcare through the Family Health Strategy in Rio - where the population covered increased from 7.2% of the population in 2008 to 45.5% in 2015. The results showthat some practices in the contractual logic need to be improved, including negotiation and accountability with autonomywith the service suppliers. Evaluation and control has focus on processes, not results, and there has not been an increase in transparency and social control. The system of performance incentives has been reported as inducing improvements in the work process of the health teams. It is concluded that the regulatory capacity of the municipal management would need to be improved. On the other hand, there is an important and significant process of learning in progress.
Highlights
The transformations that have taken place as a consequence of economic globalization in the relationship between the state, society and the economy, have provided an impulse to design and implementation of administrative reforms inspired by New Public Management since the 1980s, in the central countries, and in Latin America, in the subsequent decade
The Management Contract (MC) defines the group of services offered by each regulated unit, aspects of the quality of care and the role of the service contracted in the network of services of the SUS
The municipality of Rio de Janeiro began the restructuring of its primary healthcare in 2009, in three complementary dimensions: (i) greater participation of health in the municipal budget and greater participation of primary healthcare in the health budget – with a significant increase in funds invested; (ii) change in the healthcare model through expansion of the Family Health Strategy (ESF) and institution of Integrated Healthcare Territories (TEIAS); and (iii) adoption of the management model with OSSs, which due to the use of the rules of private sector law, made it faster to contract professionals, acquire input materials and equipment and build new health units
Summary
The transformations that have taken place as a consequence of economic globalization in the relationship between the state, society and the economy, have provided an impulse to design and implementation of administrative reforms inspired by New Public Management since the 1980s, in the central countries, and in Latin America, in the subsequent decade. One example was the multiplicity of employment links, most of them precarious, without the protection of Social Security, used in the contracting of professionals of the Family Health Strategy outside the apparatus of the State and within some organization of civil society (residents’ association, church, cooperative or support foundation) Added to this context is the belief of various public managers that decentralization and de-concentration of action by the state, with the concomitant establishment of a competitive contractual model, would increase the capacity of the state to implement public policies efficiently. We conclude that the complexity of the relationships of cause and effect inherent to the organizational and inter-organizational processes of the public sector would justify a permanent effort of monitoring, interpretation and assessment of the new management models in the SUS
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