Banca de QUALIFICAÇÃO: DANILA AUGUSTA ACCIOLY VARELLA BARCA

Uma banca de QUALIFICAÇÃO de DOUTORADO foi cadastrada pelo programa.
STUDENT : DANILA AUGUSTA ACCIOLY VARELLA BARCA
DATE: 07/12/2021
TIME: 14:30
LOCAL: Remoto - video conferencia
TITLE:

META-EVALUATION OF PHC IN BRAZIL: THE CASE OF THE EXTERNAL EVALUATION OF THE PROGRAM TO IMPROVE THE ACCESS AND QUALITY OF PRIMARY CARE – PMAQ-AB

KEY WORDS:

Validation Study. Health Evaluation. Meta-evaluation. Primary Health Care.

PAGES: 140
BIG AREA: Ciências da Saúde
AREA: Saúde Coletiva
SUMMARY:

The Program for Improving Access and Quality of Primary Care (PMAQ-AB) implemented in 3 evaluation cycles between 2011 and 2019, represents a moment of inflection in the performance assessment of Primary Health Care (PHC) in Brazil. The Program has 3 components: Voluntary adhesion of municipal managers and Contracting of teams; External Assessment (AE) and Certification; and Re-contracting, in addition to a transversal development axis. This study aims to assess the quality of the AE of the PMAQ-AB in light of internationally recognized standards. It is a summative meta-evaluation using the qualitative Case Study as a method, preceded by the Indicator Content Validation Study. The instrument's indicator matrix was prepared based on the 4 principles/standards of the Joint Committee on Standards for Educational Evaluations (usefulness, feasibility, ownership and accuracy) and articulated at each step of the evaluation, (stakeholder engagement, description of the program, evaluation design, systematization and analysis of evidence, justification of conclusions and sharing of lessons learned). The validation used an intentional sample with 2 groups of judges (7 experts and 16 evaluators) in 2 rounds of the Delphi technique with each group and analysis using agreement indices. The Case Study, between July/2018 and December/2019 had 54 participants. Semi-structured interviews were used, 01 with coordinators from the Ministry of Health (MS) and 6 from universities, 01 focus group with technical staff from the MS and 6 from universities, in addition to the analysis of 07 formal documents of the Program. Data were categorized by dimensions (steps) and sub-dimensions (standards) and their respective criteria/indicators adapted to the context of the AE/PMAQ-AB. Categorization was done using the Atlas ti software. 8.4.24 and followed by Bardin's content analysis. As a result, strong points were observed in the dimension "Stakeholders Involvement", especially in terms of the agreement in the management instances of the Unified Health System, expansion of the adhesion of municipal managers and Primary Care Teams to each cycle and credibility of the evaluator (universities) with expertise in evaluation based on previous involvement in previous national evaluation experiences, reconciliation by the MS of certification interests (national management) and research (universities) and as a weak point the absence of users in the decision-making processes of project formulation, which had little participation from the social control. The "Program Description" was positive in terms of consistency with the desired changes with the inclusion of the AE in the PNAB 2011. The "Evaluation Design" positively showed a broad portrait of the Brazilian PHC, construction of comparable quality standards, defined certification criteria . The extensive use of Information Technology, the design of the logistics, national guidelines for training interviewers conferred homogeneity in the collection and implementation of feasibility, ownership and accuracy. At the same time, it was considered that the excessive number of more than 900 indicators with variations between cycles made it difficult to compare them and create a baseline, in addition to the risk of focusing improvements on those with the greatest potential for raising funds. The strengths of the "Systematization and Analysis of Evidence" were the development of online validation systems, offer of micro data, online reports made available by the MS with access to different stakeholders (managers, professionals, researchers and the public), but there were weaknesses in the transmission of the certification methodology questioned by municipal managers, incipient technical capacity empowerment strategies and partnerships with municipal managers and professionals for the interpretation and applicability of results, negatively impacting the dimension "Justification of Conclusions". In the “Sharing of Lessons Learned” the opinion prevailed about the usefulness of the AE/PMAQ-AB for a culture of evaluation in management, services, and academia.

BANKING MEMBERS:
Interna - 451.382.224-49 - CLÁUDIA HELENA SOARES DE MORAIS FREITAS - UFPB
Interna - 1245215 - SEVERINA ALICE DA COSTA UCHOA
Externa à Instituição - Tania Cristina Morais Santa Barbara Rehem