Planejamento municipal em saúde: desafios para os municípios da 9ª Região de Saúde da Paraíba

Abstract

This dissertation deals with the health planning process in the municipal context, with an emphasis on the perspective of Strategic Situational Planning. The main objective is to understand this process by analyzing the variables: Government Capacity, System Governability and Government Project, which make up the PES Government Triangle. The research adopted a qualitative, exploratory and descriptive methodological approach, based on documentary analysis. The study was carried out in the 9th Health Region of Paraíba, focusing on the Municipal Health Plans of thirteen municipalities in this region, as well as other documents from the Project to Improve Health Management, Planning and Regionalization Actions in Paraíba. Data analysis was structured into categories and interpreted according to the thirteen parameters of the Planning Manual of the Unified Health System. The results indicate that the preparation of the Municipal Health Plans took place in a context of disarticulation of the variables of the government triangle, characterized by low governability, reduced government capacity and incoherence in the government project. This situation resulted in fragmented health plans, weak social participation and difficulties in monitoring. Among the main challenges identified were the turnover of managers, the low involvement of health professionals in management issues, the lack of knowledge of technicians and managers about planning instruments and the overload of daily activities and demands. On the other hand, the strengths identified refer to the consolidation of bottom-up planning in the territories of the state of Paraíba and the involvement of local actors in the process. The conclusion is that, despite the progress made, there are still major challenges facing the implementation of a bottom-up, integrated planning process. These challenges involve the need for actions that increase the capacity of Unified Health System managers and actors to manage the system, taking into account territorial specificities and peculiarities.