Case study on institutional support in the federal management of Primary Health Care in Brazil

ABSTRACT The article analyzes the potentialities and the limits of the institutional support function as a strategy to democratize the management of health policies. This aim was investigated in the National Policy of Primary Health Care, in the period between 2011 and 2015. Qualitative epistemology was adopted as methodological perspective, with the use of in-depth interviews, focus groups, and participant observation. The results were assessed through two interpretative cycles. In the first one, of a descriptive nature, we seek to map out assignments, modes of insertion, intervention strategies, and organization of the institutional support work process. In the second cycle, of an analytical nature, the institutional patterns present in this experiment were explored. The theoretical framework of the study was based on the ergological approach and the concept of institution, according to the tradition of French institutionalism. We observed that the institutional support strategy generated and strengthened socio-technical networks articulated in function of the National Policy of Primary Health Care. However, the necessity of implementation of priority programs demands it to be better considered in the design of this management strategy.

摘要 本文分析了作为健康政策管理民主化策略的制度支持职能的潜力与局限。本研究以2011至2015年的国家初级卫生保健政策（National Policy of Primary Health Care）为研究对象展开探讨。研究采用质性认识论作为方法论视角，运用深度访谈、焦点小组讨论与参与式观察法开展研究。研究结果通过两个阐释循环进行评估：第一循环为描述性阶段，旨在梳理制度支持工作的任务范畴、介入模式、干预策略与工作流程组织；第二循环为分析性阶段，旨在探究该实践中蕴含的制度模式。本研究的理论框架基于法国制度主义传统下的工效学路径（ergological approach）与制度概念。研究发现，该制度支持策略构建并强化了围绕国家初级卫生保健政策形成的社会技术网络，但优先项目的落地实施要求该管理策略在设计层面得到更充分的考量。