ABSTRACT

The Permanent Health Education, contemplated by the Ministry of Health as an institutional policy, is one of the pillars of strategic potential for the transformation of the processes in the Unified Health System. This cross-sectional and descriptive study investigated the Brazilian panorama of Permanent Health Education, from secondary data of the Ministry of Health, extracted from the external evaluation census of the National Program for Improving Access and Quality of Primary Care in the 2nd Cycle (2013), carried out with Family Health Teams, with adherence to the Program in the period (n=10.213/100%); 90% (n=9.184) of the teams responded to participate in Permanent Health Education activities, with greater frequency in the Southeast, Northeast and South regions; the main Permanent Health Education activities reported were seminars, shows, workshops and discussion groups (n=8.243/80.71%) in addition to presential courses (n=7.808/76.45%). Of the options offered by the Ministry of Health, the least frequent was the Telemedicine University Network (n=475/4.65%); 87.62% (8.948). Family Health Teams had their Permanent Health Education demands met by management. The instrument presents data robustness and contemplates several aspects of management, including important elements of Permanent Health Education that can guide decision making and interfere with their own policies and programs in the services.

KEYWORDS
Unified Health System; Continuing education; Health evaluation

Introduction

Permanent Health Education (PHE) is defined by the Pan American Health Organization (Paho) as a dynamic teaching and learning process, active and continuous, with the purpose of analyzing and improving the training of people and groups, in the face of technological evolution, social needs and institutional objectives and goals. The expansion of the Brazilian health system, which began in the 1970s, and the consequent need to develop human resources for the sector led to the emergence of several training programs, which sought to build political-pedagogical models committed to promoting the dialogue between education and health service training¹1 Gigante RL, Campos GWS. Política de formação e educação permanente em saúde no Brasil: bases legais e referências teóricas. Trab. Educ. Saúde [internet]. 2016 [acesso em 2019 abr 10]; 14(3)747-763. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S198177462016000300747&lng=en&nrm=iso.
http://www.scielo.br/scielo.php?script=s... .

In this sense, the Unified Health System (SUS), in a more specific context of Primary Care (PC), due to its size and scope, is present in the arena of training processes in the health sector as a privileged place for teaching and learning, especially where health care is provided. Educating ‘through’ and ‘for’ work include the assumption of PHE: where there is production of care aimed at integration, shared responsibility and problem solving, there is simultaneously the scenario of pedagogical production, because this is where the meetings between workers and users are concentrated²2 Peixoto LS, Cortez EA, Cavalcanti ACD, et al. Educação Permanente, continuada e em serviço: desvendando seus conceitos. Rev. Enfermeria Global [internet]. 2013 [acesso em 2019 maio 11]; 12(1):307-323. Disponível em: http://scielo.isciii.es/pdf/eg/v12n29/pt_revision1.pdf.
http://scielo.isciii.es/pdf/eg/v12n29/pt...

3 Franco TB. Produção do cuidado e produção pedagógica: integração de cenários do sistema de saúde no Brasil. Interface (Botucatu) [internet]. 2007 [acesso em 2019 jan 9]; 11(23):427-438. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S141432832007000300003&lng=en.
http://www.scielo.br/scielo.php?script=s... ^-44 Merhy EE. Educação Permanente em Saúde em movimento. [internet] 2014. [acesso em 2019 jan 10]. Disponível em: https://www.youtube.com/watch?v=o-nApG0Wgks/.
https://www.youtube.com/watch?v=o-nApG0W... .

According to Ceccim⁵5 Ceccim RB. Educação permanente em saúde: desafio ambicioso e necessário. Interface - Comunic. Saúde, Educ. [internet]. 2005 [acesso em 2019 jan 20]; 9(16):161-178. Disponível em: http://www.scielo.br/pdf/icse/v9n16/v9n16a13.pdf.
http://www.scielo.br/pdf/icse/v9n16/v9n1... ⁽¹⁶¹⁾:

Thus, the dispute in the political scene of governmental spheres for ascending educational proposals, which induce changes in health services and that take into account the micropolitics of local contexts, is evident. The complexity of health work and the excess of attributions of the various professionals of PC cannot be learned through specific training⁶6 Queiroz DM, Silva MRF, Oliveira LC. Educação Permanente com Agentes Comunitários de Saúde: potencialidades de uma formação norteada pelo referencial da Educação Popular e Saúde. Interface (Botucatu) [internet]. 2014 [acesso em 2019 set 10]; 18(supl2):1199-1210. Disponível em: http://www.scielo.br/pdf/icse/v18s2/1807-5762-icse-18-s2-1199.pdf.
http://www.scielo.br/pdf/icse/v18s2/1807... .

Permanent Education (PE) promotes and produces meanings (hence, the incorporation of the concepts of meaningful learning and problematization): one gives new meaning to the daily routine of training in health; the other understands that learning occurs in the action-reflection-action process, characterized by the commitment and self-involvement of the actors involved⁷7 Ceccim RB, Feuerwerker LCM. O quadrilátero da formação para a área da saúde: ensino, gestão, atenção e controle social. Physis [internet]. 2004 [acesso em 2019 set 9]; 14(1):41-65. Disponível em: http://www.scielo.br/pdf/physis/v14n1/v14n1a04.pdf.
http://www.scielo.br/pdf/physis/v14n1/v1... .

In addition, it aims to value work and workers, the participation of professionals in the teaching-learning process and in the transformations understood in the world of work⁸8 Barth P, Aires M, Santos JL, Ramos F. Educação permanente em saúde: concepções e práticas de enfermeiros de unidades básicas de saúde. REE [internet]. 2014 [acesso em 2019 set 10]; 16(3):604-11. Disponível em: https://revistas.ufg.br/fen/article/view/22020.
https://revistas.ufg.br/fen/article/view... .

It constitutes an indispensable and necessary strategy for the transformation of the reality of PC, in the reinvention of work and consequent change in practices⁹9 Bomfim E, Oliveira B, Rosa R, et al. Educação permanente no cotidiano das equipes de saúde da família: utopia, intenção ou realidade? Fund. Care Online [internet]. 2017 [acesso em 2019 set 10]; 9(2):526-535. Disponível em: http://www.seer.unirio.br/index.php/cuidadofundamental/article/view/5464/pdf.
http://www.seer.unirio.br/index.php/cuid... . Therefore, it is necessary to adopt instruments that allow the on-site evaluation of the instituted devices, participation and PHE demands, in order to provide subsidies for decision-making processes, financing and policy formulation supported by SUS principles and guidelines.

PHE contributes to the improvement of professional training and favors the strengthening of SUS, as well as it ensures the development of health workers and institutions, qualifying the management of systems and services¹⁰10 Ricaldoni CAC, Sena RR. Educação permanente: uma ferramenta para pensar e agir no trabalho de enfermagem. Rev. Latino-Am. Enfermagem [internet]. 2006 [acesso em 2019 set 10]; 14(6):837-842. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S010411692006000600002&lng=en.
http://www.scielo.br/scielo.php?script=s... .

The National Program for Improving Access and Quality of Primary Care (PMAQ-AB) was created on July 19, 2011, through Ordinance nº 1.654 Office of the Minister/Ministry of Health (MH), as a result of a negotiation process and agreement of the three SUS spheres, in debates that formulated solutions for the creation of a program that would allow the expansion of access and the improvement of the quality of PC throughout the Country¹¹11 Brasil. Ministério da Saúde. Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. Manual Instrutivo: Saúde Mais Perto de Você - Acesso e Qualidade. Brasília, DF: MS, 2011..

In view of the numerous challenges posed by reality, the PMAQ-AB proposes as a model for assessing the performance of health systems the induction of several initiatives to guarantee a quality standard at national, regional and local levels. Among its specific objectives, the following stand out:

The PMAQ-AB is an advance of the MH, which seeks to establish the evaluation culture in the Country and needs qualification and articulation, with planning and formulation of policies in line with the decision-making processes of the actors involved¹²12 Felisberto E, Albuquerque LC, Albuquerque AC. Avaliação na Estratégia Saúde da Família: os sentidos da institucionalização dessa prática. In: Sousa MF, Franco MS, Mendonça AVM, organizadores. Saúde da família nos municípios brasileiros: os reflexos dos 20 anos no espelho do futuro. Campinas: Saberes, 2014. p. 811-843..

It consists of three phases, in a continuous cycle of improvement of access and quality of the teams: Phase 1: Adhesion and contractualization; Phase 2: Certification (which includes the external evaluation); and Phase 3: Re-contractualization. In addition to these, it comprises a set of actions developed throughout the cycle, called the Transversal Strategic Axis for Development, composed of five pillars: self-assessment; institutional support; monitoring of health indicators; PE and horizontal cooperation¹³13 Brasil. Ministério da Saúde. Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ): Manual Instrutivo 3º Ciclo (2015-2016) [internet]. Brasília, DF: MS: 2015. [acesso em 2019 dez 20]. Disponível em: http://189.28.128.100/dab/docs/portaldab/documentos/Manual_Instrutivo_3_Ciclo_PMAQ.pdf.
http://189.28.128.100/dab/docs/portaldab... .

The program is permeated by the logic of PHE in all its phases, from the adhesion of the teams to the re-contractualization. There is a privileged space for collective production of initiatives for work, and the possibility of articulated development of the various actors of PC with a view to expanding the problem solving and access in the territory. Here, the dialectical relationship (education and work) is evidenced by meaningful learning and permeability to the reality of the territory where the teams act to promote changes and not only to achieve goals and indicators.

The assessment and practice of PHE begin to follow the same path, since the agreement of the indicators will require the reinvention and reformulation of the work processes and operation of the service:

In addition to the above, the data obtained in the external evaluation census with the Primary Care Teams (eAB) in the certification phase can provide important inputs for managers, researchers and policy makers at the local, regional and national level.

Objectives

Obtain a Brazilian panel of participation, devices and meeting the demands of PHE of the Family Health Teams (EqSF) in PC, based on the analysis of secondary data from the Ministry of Health, extracted from the PMAQ-AB external evaluation census in the 2nd Cycle (2013).

Material and methods

It is a cross-sectional descriptive study, with the analysis of secondary data obtained in the 2nd cycle of the PMAQ-AB. The responses obtained in the external evaluation census of the EqSF in the 2nd Cycle (2013) were evaluated using the variables of the external evaluation instrument related to PHE in module II – Interview with the health professional in the health unit, as shown in chart 1 The selected variables were collected by researchers/professors from universities/teaching and research institutes in the external evaluation stage (module II – Interview with the eAB professional) in Cycle 2 of the PMAQ-AB. The following inclusion criteria are used: EqSF with adherence to PMAQ-AB and participation in the external evaluation census of the Ministry of Health (n=10.213/100%). Teams (364/3.44%) were excluded due to the fact that they did not receive censors from the Ministry of Health at the time of the assessment. The data, freely accessible and available at http://aps.saude.gov.br/ape/pmaq/ciclo2/ were treated according to the simple frequency and the percentage of distribution of the variables. Filters and dynamic tables in Microsoft Excel® were used, crossing the data obtained from the selected variables. The research was approved by the Research Ethics Committee, under the consolidated opinion no 2.943.879, of October 5, 2018.

Results

Secondary data collected in the 2nd cycle of the PMAQ-AB were used in the external evaluation phase, in 2013. The data were collected by researchers linked to universities belonging to the PMAQ-AB research network. In this study, EqSF were considered, with a sample of n=10.213. In the first selected question (ES-II.7.1), if the team participates in PE actions organized by the municipal management, the following national panorama was obtained:

In this census, 90% of the teams (n=9.184) interviewed answered affirmatively about participation in PE activities. About 10% (n=991) answered that they did not participate in PE actions and 38 (0.37%) teams did not know or did not respond.

Analyzing the data by region, it can be observed that the Southeast (n=3.949/43% of the interviewed EqSF), the Northeast (n=2.112/23% of the sample) and the South (n=1.561/17% of the total) were the ones that most answered in the affirmative about participation in PE actions. The number of EqSF in these regions with adherence to the PMAQ-AB is higher than in the other interviewed during the collection period.

The teams that responded negatively to the PE actions were (n=991/9.7%), and the frequency was repeated.

The second selected question (G-II.7.2) sought to identify which PE actions the EqSF participated in. According to the data collected, in summary, in table 1, it can be concluded that, in the Brazilian panorama, participation in PE actions, from EqSF, has been materialized mainly through seminars, exhibitions, workshops and discussion groups (n=8.243/80.71%), in addition to on-site courses (n=7808/76.45%). Of the options offered by the Ministry of Health, the least frequent was the Telemedicine University Network (Rute) (n=475/1.32%). Some teams reported not participating in any PE action (n=577/1.61%). In the Southeast region, which covered most of the sample, it was also observed that many teams responded using resources such as exchange of experience (3,033 / 16.42%), distance education courses (2,310 / 12.5%), Telehealth (1.754/9.49%) and SUS Open University (Unasus) (1.261/6.83%) as PHE resources.

The third question (G-II.7.10) sought to investigate whether the demands and needs of PE of the EqSF were addressed, that is, whether the offers of training actions offered by the management considered the real need of the PC workers. In general, it can be said that the training needs of most workers were met by management.

Discussion

The PMAQ-AB appears in line with the rights hard won in the Health Reform movements and with the enormous significance of SUS and, in particular, of PC, which is the care provider and coordinator of health care networks: a huge three-dimensional human map in transformation, which is defined as a key concept for the materialization of PHE in work processes, practices, in the production of new knowledge and in the role of all actors involved in the health system (workers, managers and users).

The data described here reveal a national and regional panorama of the PE offers, of the participation of EqSF in these activities and of the opinion of these teams on the contemplation of their training needs. An evaluation of this 2nd Cycle reveals that 90% of the teams claimed to participate in some PE activity, which demonstrates an expansion, when compared to the data treated by MH researchers in 2012¹⁵15 Pinto HA, Ferla AA, Ceccim RB, et al. Atenção Básica e Educação Permanente em Saúde: cenário apontado pelo Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). Divulg. saúde debate [internet]. 2014 [acesso em 2019 set 9]; (51):145-160. Disponível em: http://cebes.org.br/site/wp-content/uploads/2014/12/Divulgacao-51.pdf.
http://cebes.org.br/site/wp-content/uplo... .

Likewise, the adhesion and participation of the teams in the Southeast, Northeast and South regions in PE activities promoted by the management proved to be greater than in the others surveyed. It is important to note that the allocation of financial resources released by the Ministry of Health (or National Health Fund) to EqSF is the responsibility of the municipal management, which decides where the financial incentives will be allocated.

Another factor that should be considered is the discontinuity in the development of improvements in work processes, which occurred with numerous substitutions for managers and health workers, promoting disruptions in the service’s qualification actions¹⁶16 Flôres GMS, Weigelt LD, Rezende MS, et al. Gestão pública no SUS: considerações acerca do PMAQ-AB. Saúde debate [internet]. 2018 [acesso em 2019 set 9]; 42(116):237-247. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S010311042018000100237&lng=pt.
http://www.scielo.br/scielo.php?script=s... . Some studies demonstrate the need for better structuring of management actions with a view to implementing changes in municipal and state programs of PE¹⁷17 Barbosa MR. Análise do 1 Ciclo do Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ AB) em um município de médio porte [dissertação] [internet]. Juiz de Fora: Universidade Federal de Juiz de Fora; 2014. 105 p. [acesso em 2019 set 11]. Disponível em: http://www.ufjf.br/pgsaudecoletiva/files/2014/02/Disserta%C3%A7%C3%A3o-Milena-Rocha-Barbosa.pdf.

18 Rizzotto MLF, Gil CRR, Carvalho M, et al. Força de trabalho e gestão do trabalho em saúde: revelações da Avaliação Externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica no Paraná. Saúde debate [internet]. 2014 [acesso em 2019 set 8]; 38(esp):237-251. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S010311042014000600237&lng=en.
http://www.scielo.br/scielo.php?script=s... ^-1919 Seidl H, Vieira SP, Fausto MCR, et al. Gestão do trabalho na Atenção Básica em Saúde: uma análise a partir da perspectiva das equipes participantes do PMAQ-AB. Saúde debate [internet]. 2014 [acesso em 2019 set 8]; 38(esp):94-108. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S010311042014000600094&lng=en.
http://www.scielo.br/scielo.php?script=s... .

The PMAQ-AB also seeks to integrate the PHE activity offerings and support the intra-team qualification processes through changes occurred in the program. The treated data show that the participation of EqSF in PE actions occurs mainly through seminars, exhibitions, workshops and discussion groups (n=8.243/80.71%). The role of health workers in training and educational actions is evidenced through the light and light-hard technologies²⁰20 Merhy EE, Chakkour M, Stéfano E, et al. Em busca de ferramentas analisadoras das tecnologias em saúde: a informação e o dia a dia de um serviço, interrogando e gerindo trabalho em saúde. In: Merhy EE, Onocko R, organizadores. Agir em saúde: um desafio para o público. São Paulo: Hucitec; 2006. p. 113-150. used in the daily work of PC. Team meetings, the construction of therapeutic projects, educational groups, inter-consultations, workshops and matrix support, among other resources, denote the exchange of knowledge and the dynamics of enormous wealth for the production of care and knowledge within the scope of SUS.

In the current political situation, the countless difficulties faced in a context of historical underfunding of the system, ruptures and discontinuities of some programs and a wave of setbacks promoted by the abysmal freeze on health spending and fiscal austerity must be considered. In addition²¹21 França T, Pierantoni C, Belisario AS, et al. A capilaridade da Política Nacional de Educação Permanente em Saúde no Brasil. Atas-Investig. Qualit. Saúde [internet]. 2016 [acesso em 2019 set 10]; (2):66-75. Disponível em: https://proceedings.ciaiq.org/index.php/ciaiq2016/article/view/738/725.
https://proceedings.ciaiq.org/index.php/... , other factors, such as the option of some managers who favor production (goals) to the detriment of the inclusion of health professionals in training and PE initiatives, and the precarious infrastructure (space, computers, internet and mobile devices) impose on teams the creation of contingent strategies to reinvent work and reality itself. Thus, in a complex and multifaceted reality, the need for greater investments and qualification of PC workers is recognized.

The offer of on-site courses was the second most frequent answer (n=7.808/21.74%), demonstrating that the hegemonic training practice²²22 Almeida Filho NM. Contextos, impasses e desafios na formação de trabalhadores em Saúde Coletiva no Brasil. Ciênc. Saúde Colet . [internet]. 2013 [acesso em 2019 ago 20]; 18(6):1677-1682. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S141381232013000600019&lng=en.
http://www.scielo.br/scielo.php?script=s... (of punctual, transmissive and transitory training) has not yet been broken and that, given its complexity, PE needs to be deepened, as well as an understanding of its meaning for health managers and workers.

Some teams reported that they did not participate in any PE action (n=577/1.61%), which revealed a worrying data in several aspects, which need more clarity: they may come from a lack of understanding about the meaning of PHE, from absence of offers for management, work overload and/or lack of interest from workers/managers, which requires an approximation with the reality of these teams.

The third question sought to investigate whether the demands and needs of PE of the EqSF were addressed, that is, whether the offers of training actions offered by management considered the needs of PC workers. The active participation and protagonism of PC workers in decision-making processes is an assumption of PHE and the data collected showed that most teams (n=8.949/87.62%) answered that their needs were met by management.

Rizzotto et al.¹⁸18 Rizzotto MLF, Gil CRR, Carvalho M, et al. Força de trabalho e gestão do trabalho em saúde: revelações da Avaliação Externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica no Paraná. Saúde debate [internet]. 2014 [acesso em 2019 set 8]; 38(esp):237-251. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S010311042014000600237&lng=en.
http://www.scielo.br/scielo.php?script=s... , analyzing data on work management and PHE in the state of Paraná, reveal that, although 80.4% of the interviewees affirm that there are PE actions, only 58.1% of the workers stated that the actions met the team demands, revealing a contradiction with the PE’s assumption, which must arise with the full demand and participation of workers. Comparing the statement of the authors with the data of the 2nd Cycle in that state, there is an evolution in the relationship between the demands of workers and management, since 85% (n=535) of the teams claimed to participate in PHE actions and only 2.99% (n=16) teams did not have their training needs addressed.

In Mato Grosso do Sul, a study²³23 Machado JFFP, Carli AD, Kodjaoglanian VL, et al. Educação Permanente no cotidiano da Atenção Básica no Mato Grosso do Sul. Saúde debate [internet]. 2015 [acesso em 2019 ago 19]; 39(104):102-113. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S010311042015000100102&lng=en.
http://www.scielo.br/scielo.php?script=s... on PHE actions demonstrated a privileged position of the capital over hinterland municipalities and found the need to address the problems inherent in PHE policy. After evaluating the responses of the participating teams, it cannot be said if there were significant changes in the processes during the period, since the sample evaluated in the study does not have EqSF (n=27) adhering to the PMAQ-AB in the capital.

Despite the amount of data on PE collected in a pioneering and innovative evaluation process²⁴24 Pinto HA, Sousa ANA, Ferla AA. O Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica: várias faces de uma política inovadora. Saúde debate [internet]. 2014 [acesso em 2019 set 7]; 38(esp):358-372. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S010311042014000600358&lng=en.
http://www.scielo.br/scielo.php?script=s... ^,2525 Pinto HA, Sousa A. O Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica: Reflexões sobre o seu desenho e processo de implantação. RECIIS [internet]. 2012 [acesso em 2019 set 10]; 6(2):1-19. Disponível em: https://www.reciis.icict.fiocruz.br/index.php/reciis/article/view/492/1142.
https://www.reciis.icict.fiocruz.br/inde... , the instrument used to establish management policies and decision-making processes demonstrates a modest appropriation of the meaning of PE, which should be the subject of new studies with qualitative methodological approach in the municipalities where the program is adhered to. Several works converge to the relevance of investments that strengthen participation and commitment in an articulated way with the interests and needs of SUS workers¹⁵15 Pinto HA, Ferla AA, Ceccim RB, et al. Atenção Básica e Educação Permanente em Saúde: cenário apontado pelo Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). Divulg. saúde debate [internet]. 2014 [acesso em 2019 set 9]; (51):145-160. Disponível em: http://cebes.org.br/site/wp-content/uploads/2014/12/Divulgacao-51.pdf.
http://cebes.org.br/site/wp-content/uplo...

16 Flôres GMS, Weigelt LD, Rezende MS, et al. Gestão pública no SUS: considerações acerca do PMAQ-AB. Saúde debate [internet]. 2018 [acesso em 2019 set 9]; 42(116):237-247. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S010311042018000100237&lng=pt.
http://www.scielo.br/scielo.php?script=s...

17 Barbosa MR. Análise do 1 Ciclo do Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ AB) em um município de médio porte [dissertação] [internet]. Juiz de Fora: Universidade Federal de Juiz de Fora; 2014. 105 p. [acesso em 2019 set 11]. Disponível em: http://www.ufjf.br/pgsaudecoletiva/files/2014/02/Disserta%C3%A7%C3%A3o-Milena-Rocha-Barbosa.pdf.

18 Rizzotto MLF, Gil CRR, Carvalho M, et al. Força de trabalho e gestão do trabalho em saúde: revelações da Avaliação Externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica no Paraná. Saúde debate [internet]. 2014 [acesso em 2019 set 8]; 38(esp):237-251. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S010311042014000600237&lng=en.
http://www.scielo.br/scielo.php?script=s... ^-1919 Seidl H, Vieira SP, Fausto MCR, et al. Gestão do trabalho na Atenção Básica em Saúde: uma análise a partir da perspectiva das equipes participantes do PMAQ-AB. Saúde debate [internet]. 2014 [acesso em 2019 set 8]; 38(esp):94-108. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S010311042014000600094&lng=en.
http://www.scielo.br/scielo.php?script=s... .

Final considerations

Through the selected variables of the external evaluation instrument, it was possible to identify that the Program investigated the training processes in a macropolitical way when considering the great Brazilian geopolitical regions, and in a micropolitical way when it looked at the intra-team locus in Basic Health Units. In general, a PHE panel was obtained, in which almost all the teams adhering to the PMAQ-AB claimed to participate in PE actions, with their training needs addressed by the management. The instrument presents robust data and includes several aspects of management, including important elements of PHE that can guide decision making and interfere in PHE policies and programs in services. Given the privileged position of PE, particularly in SUS, greater investments in educational research are recommended, considering other variables not included due to the limits and applicability of the instrument.

References

Publication Dates

History