Implementação do apoio institucional na atenção primária à saúde no município do Rio de Janeiro: diálogo entre teoria e prática

Abstract

Institutional Support (IS) is being used as a healthcare management methodology, guided by institutional democratization and collective co-management. The institutional support manager occupies a privileged position of proximity to the healthcare workers, participating in the evaluation and planning activities alongside the health teams, collaborating with clinical training and improving health institutions democratization, which guarantees better care provision. However, it is known that the application of IS as described in the literature is a highly complex activity and requires preparation and work direction. The objective of this study was to analyze the processes of implementation of IS in the Primary Health Care (PHC) system in the municipality of Rio de Janeiro from 2009 onwards, through the analysis of official publications, normative on IS for PHC in the municipality and the experience of health managers working in the General Coordination of Primary Health Care (CAP). In the analyzed publications, there is little guidance on support practices in Rio de janeiro’s PHC system, although initiatives have been taken in the different CAP. Through the interviews carried out with managers, it shown the different ways IS was conducted; the challenges imposed by political crossings and reflections of the Covid-19 pandemic; the positive contributions of IS implementation in the relational field between managers and health teams; and the importance of this methodology as a health education catalyzer. It is identified that training focused on PHC strongly contributes to motivation not only for work, but also in conducting horizontal and collegiate management practices. However, it is still necessary to consolidate IS as a guide for the organizational culture of the Municipal Health Department of Rio de Janeiro. It was found that IS, even applied in an incipient way, brings benefits in the communication between strategic management and the operational sector, in addition to favoring educational practices. It is hoped that this research will stimulate the discussion about the current management model, valuing the product of relationships, in addition to technical and instrumental knowledge in management practice. As a product of this work, it was organized a matrix of expected competences for the exercise of the IA, to contribute to the formative processes for PHC management