Participatory management in the Family Health Strategy: reorientation of demand in the light of the Paideia Method

Clemente, Mykaelly Pereira; Pinto, Antonio Germane Alves; Martins, Alissan Karine Lima

doi:10.1590/0103-1104202112905I

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ORIGINAL ARTICLE • Saúde debate 45 (129) • Apr-Jun 2021 • https://doi.org/10.1590/0103-1104202112905I copy

Participatory management in the Family Health Strategy: reorientation of demand in the light of the Paideia Method

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The objective was to describe the construction of a co-responsibility action plan involving managers, professionals and users, aimed at reorienting spontaneous demand in a Family Health Unity, by means of participatory management tools. This was an interventional research study, the action-research type, carried out with a Family Health Strategy team in the municipality of Petrolina (PE). The study involved eleven participants, who were selected using the qualitative representativeness sampling technique, and included three primary care managers in the municipality, four health professionals from the Family Health Strategy involved in the study and four community leaders, representatives of users. The theoretical framework adopted for the analysis of the intervention was the method of analysis and co-management of collectives – the Paideia method. The study revealed the unpreparedness of collectives to act in participatory management, while showing that possibilities of restructuring services are optimized when thought of in a democratic and co-responsible way. It was considered that the main contributions of this research were the awareness and the mobilization of the subjects to act in a participatory way in the planning and management of health problems.

KEYWORDS:
Family Health Strategy; Health management; Health service needs and demands; Community participation

THE DEMAND PROBLEM WAS ASSOCIATED TO THE UNAWARENESS OF THE WORK PROPOSAL BY THE FHS AND WAS UNDER CULTURAL INFLUENCE OF THE BIOMEDICAL MOODEL (SURCH FOR EXAMS AND PROCEDURES)
GOAL/OBJECTIVES:	Specific: Perform communitarian sensibilization as to the FHS; Measurable: Hand out educational leaflets to all domiciles in the locality covered by CHA; Attainable: CHA already used to visit every domicile every month, and could help for this mass sensibilization; Relevant: Population aware could optimize the use of BHU’s services and contribute for demand re-orientation; Delay: Start-out within 90 days and continuous permanence.
STRATEGY:	Promote educational and community re-orientation processes in the areas and in waiting room.
PLAN OF ACTION:	Professionals would produce an educative folder or leaflet to meant to orient the community about the purpose of the FHS and operation of th BHU. Management would be responsible for copies to be delivered to the domiciles during CHA’s visits and would be used in educative activities in the waiting room by other FHS employees. And also in local activities promoted by communitarian leaders.
RESULTS EVALUATION:	The strategy will be evaluated by the analysis of the reason for going do the BHU, the records of assistance to spontaneous demand and by reports produced by the electronic medical report.
POTENTIALITIES AND FRAGILITIES OF THE STRATEGY: Servants needed for this action would already be available, not requiring new FHS teams to be created. The effect on behavior and culture changes are long term processes.

THE DEMAND PROBLEM WAS ASSOCIATED TO THE INSUFFICIENT NUMBER OF TEAMS TO RECIVE THE POPULATION AND WORSENED DUE TO INADEQUATE PHYSICAL STRUCTURE OF THE BHU
GOAL/OBJECTIVES:	Specific: Enlarge the number of FHT groups and improve the physical structure of the unit; Measurable: Acquire two more teams and create a new BHU nearby; Attainable: Join the BHU off the Program Health Just in Time so as to involve a temporary team to be later changed into a FHT; Relevant: A new team would help carrying out part of the service. Later on, with two teams, the population would be reorganized so as to optimize procedures.
STRATEGY:	At first, improve the physical structure in place; reorganize the population enrolled, following the National Policy for Basic Care, with two more FHS teams nearby; and temporary adherence to the Program Health Just in Time. All those actions in place, the problem would be under control for a while, until new teams are in place and works are concluded.
PLAN OF ACTION:	With municipal funds, renovation would improve the structure, with painting, electric and hydraulic services. Based on the number of users per 25km²2. Franco TB, Merhy EE. A produção imaginária da demanda e o processo de trabalho em saúde. In: Pinheiro R, Matos RA. Construção social da demanda: direito à saúde, trabalho em equipe, participação e espaços públicos. Rio de Janeiro: Cepesc; Uerj; Abrasco; 2005. p. 181-93., two extra teams would be required to the Ministry of Health. A Parliamentary Amendment would raise money to build the second headquarter, a more easily accessible one, and to reshape the first one, at the village. As this would be a long and bureaucratic process, managers would produce a provisional cadaster at the Health Just in Time Program, thus allowing for hiring a new team to enlarge the reception period at the unit, with a reorganization of the users enrolled, unburdening the existing teams.
RESULTS EVALUATION:	The external evaluation tool of the program Access and Quality Improvement (PMAQ) concerning item Observation at the Basic Health Unit would be used to evaluate improvements resulting from this strategy.
POTENTIALITIES AND FRAGILITIES OF THE STRATEGY: Then interest revealed by the managers to put in place and assign priority to this action was a strategy power; and the fragility turned to the political dependence, due to the possibility of delays, as procedures depend on parliamentary amendments and ministerial terms.

THE DEMAND PROBLEM WAS ASSOCIATED TO THE FRAGILITY OF THE RECEPTION
GOAL/OBJECTIVES:	Specific: Make sure people looking for the service would be well cared for; Measurable: Receive every day all users coming to the unit; Attainable: Select one professional with graduation level to receive exclusively those classified as risk users; Relevant: Check the needs of users who come for care; Delay: 60 days.
STRATEGY:	Doctors and nurses would be responsible, in turns, for the reception and the classification of risk of users who come for spontaneous demand.
PLAN OF ACTION:	In a team meeting with the other professionals, those with graduation level present at the intervention, would organize an assistance agenda in order to have one doctor and one nurse free for the reception, in turns, if necessary, considering vacations or day-off, according to the scale.
RESULTS EVALUATION:	Every three months a research on users’ satisfaction would check the efficacy of the strategy adopted. The verification would also take place in demands books and electronic systems of assistance records, and on users who leave without being seen by the doctor.
POTENTIALITIES AND FRAGILITIES OF THE STRATEGY: The office of the professional in charge for the day could be used for reception, risk classification and care procedures, thus avoiding works to open new areas for those procedures. In case of absence of the professional for health problems or other reasons, should there be no professional to replace him/her a technical agent would take that function for the day.

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E-mail: revista@saudeemdebate.org.br

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[1] Collaborators

Clemente MP (0000-0002-5613-8872)^* * Orcid (Open Researcher and Contributor ID). contributed substantially to the conception, planning, analysis and interpretation of the data. Pinto AGA (0000-0002-4897-1178)^* * Orcid (Open Researcher and Contributor ID). and Martins AKL (0000-0002-9382-1144)^* * Orcid (Open Researcher and Contributor ID). contributed significantly to the critical review of the content.