Abstract
Primary Health Care (PHC), under the responsibility of the municipal manager, is the preferred gateway and ordering unit of the health services network in the Brazilian Unified National Health System. However, management is being transferred noticeably to non-governmental institutions (NGI). This article aimed to analyze circumstances and elements that would motivate municipal managers to hire NGI for PHC management. Qualitative research was carried out using a case study in six municipalities in the state of São Paulo. Semi-structured virtual interviews were developed with 24 subjects, including managers, institution representatives, COSEMS, and Social Control segments, from October 2020 to February 2021. The main motivations are 1) reduction of the impact on the payroll (fiscal responsibility law); 2) flexibility in the administration of human resources, especially hiring doctors; and 3) agility in the acquisition of inputs and equipment. Based on these results and the lack of concern on the part of these actors to impose Primary Health Care attributes in contracting, it can be concluded that there is a potential risk of harm to the consolidation of Primary Health Care principles and guidelines.
Keywords:
Primary Health Care; Health Management; National Health System; Contracts