The role of PHC in times of crisis: an analysis of discretion of health workers during the COVID-19 pandemic

Fernandez, Michelle; Magri, Giordano; Maia, Barbara; Lotta, Gabriela

doi:10.1590/1413-812320232812.09312023EN

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ARTICLE • Ciênc. saúde coletiva 28 (12) • Dec 2023 • https://doi.org/10.1590/1413-812320232812.09312023EN copy

The role of PHC in times of crisis: an analysis of discretion of health workers during the COVID-19 pandemic

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Crises are exceptional events that alter the structural arrangements under which street-level bureaucrats (SLBs) normally operate, generating resource shortages, the suspension of rules and routines, and changes in work practices. These characteristics highlight the importance of room for discretion, since quick decisions need to be made in a context pervaded by unpredictability. This study analyzed the impact of the COVID-19 pandemic in Brazil on the discretion of primary health care workers, seeking to understand which factors influence the exercise of discretion, focusing on organizational, emotional and scientific aspects. We used data from an online survey comprising open- and closed-ended questions conducted in March 2021 with 1218 primary care workers. The results show that, unexpectedly, discretion of SLBs does not become a panacea for the crisis. A large portion of professionals continued to operate within the rules, demonstrating a tendency to seek support at work, either through better organizational conditions, the reduction of uncertainty or from science.

Key words:
Health workers; Primary Health Care; Street-level bureaucracy; Discretion; COVID-19

Aspects	Variable	Question	Types of question
Organizational	Changes in work processes	What changed?	Open-ended
	Preparedness for handling the crisis	What contributes most to you feeling this way?	Open-ended
	Perceptions of the future	How do you imagine your job in the few months?	Open-ended
Emotional	Changes in work processes	What changed?	Open-ended
	Preparedness for handling the crisis	What contributes most to you feeling this way?	Open-ended
	Perceptions of the future	How do you imagine your job in the few months?	Open-ended
Scientific	Changes in work processes	What changed?	Open-ended
	Preparedness for handling the crisis	What contributes most to you feeling this way?	Open-ended
	Perceptions of the future	How do you imagine your job in the few months?	Open-ended
Discretion	Likelihood of overriding the rules to benefit patients	We are aware the during your work certain rules need to be adapted to work during the pandemic. With this in mind, how likely would you be to override the rules if you thought it would benefit patients?	Very unlikely or unlikely
			Likely or unlikely
			Neither likely, nor unlikely
	Likelihood of overriding the rules to benefit work processes	Still thinking about specific needs related to the pandemic, how likely would you be to override the rules if you thought it would benefit your work processes?	Very unlikely or unlikely
			Likely or unlikely
			Neither likely, nor unlikely

	Likelihood of overriding the rules to benefit patients		Likelihood of overriding the rules to benefit work processes
	n	%	n	%
Prone	417	36.04	362	31.29
Not prone	460	39.76	482	41.66
Indifferent	280	24.20	313	27.05

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva