Avaliação da Política Nacional de Humanização no município de Maceió : um olhar para Atenção Primária em Saúde

Abstract

Introduction: The PNH, more than a formally established policy, is configured as a practice that materializes within the scope of the micropolitics of health work, being permanently crossed by disputes, tensions, and different management and care projects. In primary health care, its implementation implies the reorganization of work and care practices, aiming for a more ethical, inclusive system centered on the needs of users. Research question: How was the implementation of the PNH carried out in the PHC of Maceió and what structural and political-institutional challenges impacted its effectiveness and sustainability? Objectives: Evaluate the implementation of the PNH in primary health care in Maceió (2003–2023), analyzing its historical trajectory, its process of institutionalization, and the perceptions of the municipal management of the PNH and primary health care workers regarding its effectiveness. Methodology: Evaluative, exploratory case study with a qualitative approach, carried out in two stages. Initially, a documentary analysis of management instruments and institutional records of the policy (2009–2025) was conducted. Subsequently, 13 semi-structured interviews were carried out with PNH managers and APS workers in Maceió, between June and December 2024, defined by theoretical saturation. The analysis combined Donabedian's normative evaluation with Minayo's hermeneutic-dialectical approach, integrating the normative dimension with the experiences of the subjects. Results: The results indicate that the implementation of the PNH in Maceió (2003–2023) was marked by advances and weaknesses. The training of supporters, the creation of spaces for co-management and the engagement of PHC workers stand out, favoring the reorganization of work and the expansion of access. However, implementation remains partial and uneven, with structural and organizational weaknesses, such as precarious bonds, limitations in the environment, absence of institutional spaces for listening, and low effectiveness of participatory management. The insufficiency of political- institutional support, the discontinuity of actions and interfederative conflicts compromise the sustainability of the policy at the municipal level. Final considerations: The study reveals that PNH in Maceió has advanced in the process dimension, with the training of supporters, expansion of co-management, and incorporation of humanizing practices in primary health care. Weaknesses persist in the structure dimension, such as precarious employment ties, managerial turnover, and limited political-institutional support. In terms of results, there are improvements in care quality and in the protagonism of workers, still conditioned by management instability. The consolidation of the policy requires structural strengthening and institutional continuity. Applicability in Family Health: The study supports the planning and evaluation of the PNH in the SUS, strengthening the management of work and permanent education. Based on the structure–process–outcome model, it offers a replicable methodology and shows that the consolidation of humanization in PHC depends on the alignment between structure, management, and quality of care.