A gestão do trabalho em saúde: as implicações no cuidado da população idosa do Distrito Leste de Manaus

Abstract

The management of health work is strategic for the management of the Unified Health System - SUS, with a view to complying with what the 1988 Constitution calls for, through integral care, politically and administratively decentralized and with social participation. Ouverney and Noronha (2009) point out the challenge of a participative management that contemplates the real health needs of the population, from the field of micro-work pervaded in the daily work to the macro work of the regionalization arrangements. In the context of basic care, Castanheira (2000) argues that the management of units can be strategic for policies to be concretely translated into actions and services. The objective of this study is to evaluate the management of health work and its implications for the health care of the elderly population in the basic units of the eastern sanitary district in Manaus, Amazonas. The specific objectives were: to describe the services and programs directed to the elderly in the health units of the districts of the eastern district; To identify how the management of elderly-oriented health work in these selected units is organized; Characterize the multiprofessional work of the health team that turns the health care of the elderly person in the selected units; To unveil the implications of this work management on the health care conditions of elderly people who use the services of these selected health units. The methodological design responds to the following question: What are the implications of work management on the health care of the elderly population in the basic units of the eastern sanitary district (DISAL) in Manaus, Amazonas? The methodology used was qualitative in nature to collect data and information through a case study. And quantitative secondary data from the Municipal Health Department, Ministry of Health, IBGE among others on the subject. The case study was carried out through the following data and information surveys: Bibliographic, Documentary and Field. Regarding the universe and the sample, DISAL has 58 units, of which 16 are the traditional basic units, we selected an intentional sampling of 03 of these units on the basis that they have services for the elderly and have local management council (Basic health Unit Dr. José Amazonas Palhano, located in the São Jose; and Basic health Unit João Nogueira da Matta, located in Zumbi) And a basic health unit converted into NASF (Basic health Unit nurse Ivone Lima dos Santos, located in Coroado III). Regarding the intentional sample of the research subjects, we have central informants of the 03 units: 03 physicians, 03 social workers, 03 nurses, 03 nursing technicians, being one professional from each unit. We also have 02 unit management professionals. Of the elderly, 30 elderly (10 of each unit). As techniques, we use: systematic observation, semi-structured interviews and application of forms. Results: we found that although there is a relative progress in participatory management processes, in the field of micro-work we still detect the challenge of guiding integral, interdisciplinary practices and needs more studies of the health needs of the territory. It points out the need to strengthen the Local Management Councils in the units for greater control of health actions on their need by the population, including the elderly. The issue of co-management of work in units encompassing managers, workers and users in some is precarious and others reasonable but it is still a challenge. When there is a change in management, we identify the need for a management transition policy so that there is continuity in the actions. n view of the evaluation carried out in this research, we propose that work management should be critical-propositive with strategies of co-management and active participation of the actors to improve the quality of services provided to the population.