Educação permanente como estratégia de formação de gestores municipais de saúde: a experiência do Fórum de Educação Permanente da Região de Saúde de Bragança Paulista (FEP-BP)
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Data
2008
Autores
Sato, Wanda Nascimento dos Santos [UNIFESP]
Orientadores
Cecílio, Luiz Carlos de Oliveira [UNIFESP]
Tipo
Dissertação de mestrado
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Resumo
A educação permanente em saúde (EPS) é a política proposta pelo Ministério da Saúde para qualificar os trabalhadores do SUS. Tem como estratégia a diminuição da fragmentação das ações em saúde e do ensino e ampliar a democracia, buscando a integralidade e eqüidade nos serviços de saúde, no SUS. Pretende transformar a assistência à saúde da população, através de um processo educacional contínuo do trabalhador, tornando-o um instrumento de desenvolvimento social. O presente estudo
é um desdobramento da pesquisa financiada pelo convênio FAPESP-CNPq-SUS e realizada no Departamento Regional de Saúde de Campinas (DRS-VII), com o objetivo de “Identificar e analisar o papel do município e as relações que se estabelecem entre os gestores municipais e o gestor estadual, em uma Diretoria Regional de Saúde (DRS) da Secretaria Estadual de Saúde (SES-SP), visando à garantia da integralidade do cuidado e na perspectiva da descentralização da gestão do SUS”. Sentiu-se a necessidade da realização de um estudo complementar a essa pesquisa, com objetivo de identificar o quanto a educação permanente em saúde pode se constituir em estratégia de capacitação de gestores municipais na atual etapa de implantação do SUS, através de um Fórum de Educação Permanente (FEP) que vinha sendo operacionalizado na região de Bragança Paulista e que se constituiu em espaço privilegiado para a obtenção de dados para a pesquisa. No estudo, escrevemos o funcionamento do FEP, caracterizamos seus aspectos positivos e suas principais
dificuldades, a avaliação que os gestores municipais fazem da sua participação no FEP, procurando identificar os princípios da EPS que ele operacionaliza. Procuramos problematizar, também, os pré-requisitos necessários para sua reprodutibilidade. Como metodologia, utilizamos a técnica de observação participante, e a coleta de dados foi feita por meio de diários de campo e fita de gravação magnética, além de utilização de material oriundo da pesquisa acima referida. Como o FEP não havia estabelecido competências a serem adquiridas, o estudo, com a metodologia adotada, restrita à
observação dos gestores no FEP, não consegue avaliar os impactos efetivos na capacidade de governo dos gestores, em particular as transformações em suas práticas locais. Nas considerações finais destacamos os aspectos que o FEP consegue operacionalizar dos princípios da EPS e os ganhos observados no processo de regionalização a partir do seu funcionamento, em particular o aumento da capacidade de articulação política dos gestores municipais com outros atores institucionais, em contexto bastante desfavorável do SUS, em particular no que se refere ao insuficiente financiamento para as ações de maior complexidade, a reprodução da Medicina tecnológica e sua articulação com o complexo médico-industrial, a precarização da força de trabalho e a terceirização de serviços.
Permanent Education in Health (Educação Permanente em Saúde – EPS) is the policy proposed by the Brazilian Federal Health Department to qualify workers from the Brazilian National Health Care System (Sistema Único de Saúde – SUS). Its strategy is aimed at reducing the fragmentation of actions in health and education, in addition to expanding democracy to search for integrality and equity in the health services related to SUS. It is intended to transform health care by means of a continuous educational process concerning workers so that they are turned into social development instruments. The present paper stems from the research financed by an agreement involving The State of São Paulo Research Foundation (FAPESP), the National Council for Scientific and Technological Development (CNPq), and SUS, which was carried out at the Regional Health Department of the City of Campinas (DRS-VII), devoted to the "Identification and analysis of the role played by the local government and the relationships established between the local managers and the State manager in a Regional Health Executive Board (DRS) connected to the State Health Bureau of the State of São Paulo (SES-SP), aiming at the warranty of integrality involving health care and at the perspective of decentralizing the management of SUS”. An additional piece of study was required to complement this research, with the objective of identifying to what extent permanent education in health can be conceived as a strategy for the qualification of local managers in the current SUS deployment stage. This was performed through a Permanent Education Forum (FEP), which was made operational in the region of Bragança Paulista and became a privileged source to obtain information for the research. The study describes how FEP works and characterizes its positive aspects as well as its main shortcomings, the assessment made by local managers about their own participation in FEP, so that the EPS principles that it puts into effect are identified. The study also tries to bring the requirements for its reproducibility into question. The participant observation technique was the methodology in use. The collection of data was handled through field reports and magnetic tape recording, in addition to the use of materials resulting from the “parent research”. Since FEP had not set up competencies to be acquired, the study, whose methodology was restricted to the observation of managers in FEP, is not able to evaluate the effective impact upon the managers’ leadership abilities, particularly the transformations occurred in their local practices. As final considerations, emphasis is given on the aspects that FEP is able to make effective from the EPS’s principles and the gains observed along the regionalization process derived from its way of functioning, mainly the increase in the political capacity of local managers to deal with other institutional actors within a quite unfavorable SUS context – especially in relation to the insufficient financing of more complex actions, the reproduction of technological Medicine and its articulation with the medical-industrial complex, the increasing precariousness of workforce, and the outsourcing of services.
Permanent Education in Health (Educação Permanente em Saúde – EPS) is the policy proposed by the Brazilian Federal Health Department to qualify workers from the Brazilian National Health Care System (Sistema Único de Saúde – SUS). Its strategy is aimed at reducing the fragmentation of actions in health and education, in addition to expanding democracy to search for integrality and equity in the health services related to SUS. It is intended to transform health care by means of a continuous educational process concerning workers so that they are turned into social development instruments. The present paper stems from the research financed by an agreement involving The State of São Paulo Research Foundation (FAPESP), the National Council for Scientific and Technological Development (CNPq), and SUS, which was carried out at the Regional Health Department of the City of Campinas (DRS-VII), devoted to the "Identification and analysis of the role played by the local government and the relationships established between the local managers and the State manager in a Regional Health Executive Board (DRS) connected to the State Health Bureau of the State of São Paulo (SES-SP), aiming at the warranty of integrality involving health care and at the perspective of decentralizing the management of SUS”. An additional piece of study was required to complement this research, with the objective of identifying to what extent permanent education in health can be conceived as a strategy for the qualification of local managers in the current SUS deployment stage. This was performed through a Permanent Education Forum (FEP), which was made operational in the region of Bragança Paulista and became a privileged source to obtain information for the research. The study describes how FEP works and characterizes its positive aspects as well as its main shortcomings, the assessment made by local managers about their own participation in FEP, so that the EPS principles that it puts into effect are identified. The study also tries to bring the requirements for its reproducibility into question. The participant observation technique was the methodology in use. The collection of data was handled through field reports and magnetic tape recording, in addition to the use of materials resulting from the “parent research”. Since FEP had not set up competencies to be acquired, the study, whose methodology was restricted to the observation of managers in FEP, is not able to evaluate the effective impact upon the managers’ leadership abilities, particularly the transformations occurred in their local practices. As final considerations, emphasis is given on the aspects that FEP is able to make effective from the EPS’s principles and the gains observed along the regionalization process derived from its way of functioning, mainly the increase in the political capacity of local managers to deal with other institutional actors within a quite unfavorable SUS context – especially in relation to the insufficient financing of more complex actions, the reproduction of technological Medicine and its articulation with the medical-industrial complex, the increasing precariousness of workforce, and the outsourcing of services.
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Citação
SATO, Wanda Nascimento dos Santos. Educação permanente como estratégia de formação de gestores municipais de saúde: a experiência do Fórum de Educação Permanente da Região de Saúde de Bragança Paulista (FEP-BP). Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2008.