Meta-avaliação da atenção primária à saúde: Enfoque no padrão de factibilidade

Abstract

Introduction: Currently, in almost all countries, the evaluation of Primary Health Care is part of the reform of national health systems that aim to address, on the one hand, the responses to the growing health needs of the population in the face of profound socioeconomic, sanitary and on the other, rising health costs amid austerity policies and international sustainable development pacts. Thus, the adoption of measures that foster the institution of evaluative practice is fundamental for the improvement of health services in Brazil Objective: to assess the feasibility of evaluating Primary Health Care within the scope of the three cycles of the External Evaluation of the Access Improvement Program and the Quality of Primary Care, from the Ministry of Health, part of the National Primary Care Policy. Methodology: This is a meta-evaluation study carried out through a Case Study with a qualitative approach, triangulating documentary analysis, semi-structured interviews and focus groups. Seven interviews and seven focus groups were carried out with coordinators and an evaluation team from the Ministry of Health and the Teaching and Research Institutions, and analysis of 36 documents. For qualitative analysis of the textual corpus, the Atlas.ti software and analysis of Bardin's thematic content were used. Results: three categories were created related to the Feasibility standard: Practical procedures: paths that led to the feasibility of the EA; Marks of adversity in the political scenario of planning and conducting the External Evaluation; and Cost effectiveness of AE beyond the best use of resources. In this sense, some procedures were adopted in order to make the assessment feasible, such as the participation of managers in the process of conducting the EA, the presence of the supervisor in the collection field as an important factor for the execution of the EA, as well as the demystification of the EA. punitive character for the evaluation. The political arrangements for planning and conducting the External Evaluation were affected by the adverse political scenario resulting from the change in national governance, in the third cycle of the evaluation, and by the latest edition of the PNAB, in 2017, marked by inflections in Primary Care. The positioning of all stakeholders throughout the External Evaluation was affected by the incipient participation of users. Regarding the cost-effectiveness of the evaluation, it was noticed that the criteria established by the DAB for the distribution of resources among those involved were unknown. In contrast, the cost-effectiveness ratio was considered positive by the participants, going beyond the expected results for AE. Final considerations: the evaluation proposed by the PMAQ-AB proved to be feasible, within a complex scenario for its operationalization. The adopted procedures proved to be effective in making the evaluation feasible, however the standardization of the evaluation in Brazil was the main challenge in face of the plurality that characterizes the Brazilian scenario. So it goes, the political scenario is who gives the measure of the political viability of the evaluation process. The EA presented a positive cost effectiveness ratio in view of the results presented by the evaluation process. In this way, evaluating feasibility provides knowledge about the effectiveness and efficiency of the planning and conducting the evaluation process, facilitating the execution of other quality standards.