Analysis of Primary Care in Five Municipalities of Western Amazonia, with Emphasis on Family Health Program

O objetivo deste artigo ?? analisar o processo de gest??o da aten????o b??sica, a?? inclu??do o Programa de Sa??de da Fam??lia (PSF), em cinco munic??pios da Amaz??nia Ocidental. A descentraliza????o, entendida como meio de aprimoramento da gest??o local, tamb??m foi investigada. Trata-se de um estudo qualitativo, que explorou o plano pol??tico-institucional dos sistemas de sa??de dos munic??pios, atrav??s das dimens??es projeto de governo, capacidade de governo e governabilidade. A coleta de dados foi realizada por meio de t??cnicas combinadas: an??lise da documenta????o oficial dos sistemas municipais de sa??de; realiza????o de entrevistas semiestruturadas junto aos gestores municipais de sa??de e gerentes intermedi??rios da aten????o b??sica, do PSF e da dire????o de unidades de sa??de (PSF e n??o PSF) para subsidiar estudo sobre o modelo de gest??o e aten????o ?? sa??de, e consulta aos sistemas nacionais e municipais de informa????o. Os resultados mostraram baixa capacidade gestora, dificuldade em definir prioridades para a sa??de, inexist??ncia ou incipi??ncia de a????es intersetoriais, limita????o na autonomia financeira e uma base de apoio pol??tico prec??ria; limitada forma????o t??cnica dos gestores e de suas equipes, com car??ncia de aperfei??oamento profissional; quadro t??cnico dos profissionais da rede de servi??os insuficiente em n??mero e em qualifica????o para efetuar uma ger??ncia qualificada de servi??os de aten????o prim??ria ?? sa??de.The objective of this paper was to analyze the primary healthcare management process, including the Programa Sa??de da Fam??lia (PSF - Family Health Program), in five municipalities located in the western part of the Amazon region. Decentralization, understood as a means of improving the local management, was also investigated. This was a qualitative study that explored the political-institutional level of the municipalities??? healthcare systems through the dimensions of government project, government capacity and governability. Data collection was accomplished by means of combined techniques: analysis of official documentation from the municipal healthcare systems; conduction of semi-structured interviews with municipal healthcare managers, managers of the primary healthcare services, of PSF and of the administration of healthcare units (both PSF and non-PSF) to subsidize a study on the healthcare provision and management model; and consultation of the national and municipal information systems. The results showed low management capacity, difficulty in defining healthcare priorities, nonexistent or incipient intersectoral actions, limited financial autonomy and a precarious political support base; limited technical training of managers and their team; insufficient and low-qualified technical staff of the services network, which prevent them from performing a skilled management of primary healthcare