Silva Vanessa Costa E, Barbosa Pedro Ribeiro, Hortale Virgínia Alonso
Escola Nacional de Saúde Pública, Fiocruz., Brasil,
Cien Saude Colet. 2016 May;21(5):1365-76. doi: 10.1590/1413-81232015215.23912015.
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.
这是一篇关于里约热内卢市基于社会组织模式的家庭健康战略管理的案例研究。其目的是描述和分析里约热内卢市卫生局所采用的治理体系的各个方面，并确定该模式作为巴西统一卫生系统管理选项的局限性和可能性。基于文献综述、文件分析以及对关键信息提供者的访谈进行了一项定性研究。这种管理模式通过里约热内卢的家庭健康战略促进了初级医疗保健服务的可及性扩大——覆盖人口从2008年的7.2%增至2015年的45.5%。结果表明，合同逻辑中的一些做法需要改进，包括与服务供应商进行自主谈判和问责。评估与控制侧重于过程而非结果，透明度和社会监督并未提高。据报告，绩效激励制度促使卫生团队的工作流程得到改善。结论是，市政管理的监管能力有待提高。另一方面，目前正在进行一个重要且意义重大的学习过程。
