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• W2203094133 abstract "The Family Health Program is a fact in expansion in Brazil. In 2005, it reached 76 million Brazilians. Its goal is to foster equity and responsivity related to primary care access.The great interest of policy makers and scholars on the program has increased the production of studies on the program’s implementation processes and what they reveal on the projects, arguments and conflicts in the field of health politics.This study discussed the adequacy and the heuristic possibilities of the Model Ambiguity – Conflict, developed by Richard Matland (1995) as applied to the characteristics of the implementation process of the Family Health Program in a small municipality in the State of Rio de Janeiro.The model is based on two key variables - ambiguity and conflict - that crossed with to the categories High and Low, allow the construction of a four axis matrix of analysis: Administrative Implementation, Political Implementation, Experimental Implementation and Symbolic Implementation.Regarding the FHP, the following topics were analysed: conditions ofimplementation of the program; situation of the local human resources; supervision and coordination of the staff, and articulation between actions and between programs.It was found that the Health Department of the State of Rio de Janeiro did not achieve to establish a process of follow up that satisfied the needs of directing and capacity building expected by local, municipal, authorities; the profile of the medical professionals did not show appropriate to the performance of the functions requested by the program. Shortage and high turnover were the main characteristics of the local human resources, turning the day off practice into a mechanism of getting the professionals stay in the municipality.The activities of coordination and supervision of the teams were limited to the control of the technicians and health agents activities. Questions about the goals of the program remained unanswered. Work was guided by common sense and, when necessary, by the improvisation.The centralized structure of the State of Rio de Janeiro’s Health Department did not favour the work of supervision of the program; the investigation of accusations related to the doctors’ workload was, in the studied period, the activity which took more time by the State of Rio de Janeiro’s Health Department’s officials. Because they worked in different ways, the traditional health programs were not coordinated to the FHP.The use of Matland’s model to the findings of the fieldwork showed theexistence of a hybridism regarding the model of implementation. The directives defined by the Federal level characterize the FHP as an inducing policy that is brought into effect through rules, objectives, resources and proceedings; mechanisms of financing, monitoring and evaluation.The implementation process, on a national scale, begins through anadministrative, top-down, perspective. Nevertheless, these directives, when coming into the state and municipal levels, undergo other influences determined by local contexts, resulting in an implementation process combining differentiated levels of ambiguity and conflict.The category ambiguity, in its most general sense – that of a situation that takes place when there are many alternatives or means to think the same circumstances or phenomena – has great heuristic force in the studied context. It results from the hybrid characteristic of the implementation model in the municipality, which can be considered as an experimental type in great part of his development. Depending on specific circumstances, however, the process assumes the characteristics of administrative and / or political implementation, merging the types of implementation theoretically discussed.The advantages of the use of the model Ambiguity - Conflict reside principally i) the possibility of identification and characterization of type(s) of implementation that can be in motion in each stage of the process, and ii) in the opportunity resulting from this initial capacity, of using new criteria to analyse implementation processes." @default.
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• W2203094133 date "2006-01-01" @default.
• W2203094133 modified "2023-09-23" @default.
• W2203094133 title "Programa de Saúde da Família: estudo sobre o processo de implementação em município do Rio de Janeiro a partir do modelo ambiguidade-conflito" @default.
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