Primary Health Care Community of Practice: collective health management horizon memory

Abstract The research that originated this article aimed to identify experiences of institutional support within the scope of Primary Health Care, in order to understand how the proposal is disseminated, the limits, difficulties and results it has achieved in different contexts and realities. The mapping was carried out through documentary research in the Primary Care Community of Practice, resulting in the inclusion of 38 experience reports. The data corroborate the potential of institutional support to foster shared management practices and arrangements in the implementation of health policies and programs, in promoting changes in the teamwork process and in intra- and inter-institutional integration. It is used as a resource to transform normative indicators into social relations and organizational devices in the daily care and management of the Brazilian Unified Health System. The main challenges identified refer to resistance arising from cultural and communicational dynamics related to management concepts and practices influenced by the classical administration model, in addition to a set of operational issues that negatively affect the results achieved. The systematization of experiences made it possible for us to understand that institutional support demands complex mediation skills, which need to be better understood and implemented, especially with regard to community participation.

摘要 本文所依托的研究旨在识别初级卫生保健（Primary Health Care）范畴内的机构支持实践经历，以明晰该举措的传播路径、在不同情境与现实场景中所面临的局限、困难及取得的成效。本研究依托初级卫生保健实践共同体开展文献调研，最终纳入38份实践经验报告。研究数据证实，机构支持具备多重实践潜力：可在卫生政策与项目的实施过程中培育协同管理实践与运行机制，推动团队工作流程变革，同时促进机构内部与跨机构的整合协作。在巴西统一卫生系统（Brazilian Unified Health System）的日常照护与管理工作中，机构支持可作为将规范性指标转化为社会关系与组织运行机制的重要支撑手段。本次研究识别出的主要挑战包括：受古典行政管理模式影响的管理理念与实践所衍生的文化与沟通层面的抵触情绪，以及一系列对既定成果产生负面影响的实操性问题。通过对实践经验的系统化梳理，我们得以明晰：机构支持工作需要具备复杂的协调沟通能力，此类能力仍有待进一步深化认知与落实，尤其在社区参与相关领域。