O problema de agência nos contratos de gestão: as organizações sociais de saúde do Estado do Rio de Janeiro

Esse estudo objetiva compreender como são tratados os problemas de agência nos contratos de gestão com as Organizações Sociais de Saúde pelo Estado do Rio de Janeiro. Para tanto, realiza-se a revisão da literatura permitindo a construção da fundamentação teórica, referente à Nova Gestão Pública e ao paradigma pós-burocrático da contratação de parcerias pela esfera pública, identificando problemas na contratualização com foco nos problemas de agência. O contexto de estudo descreve, com base em pesquisa documental, o campo de análise da dissertação, a contratualização com Organizações Sociais pela Secretaria de Saúde do Estado do Rio de Janeiro. A análise dos resultados na perspectiva da teoria da agência, aplicada ao conteúdo do contrato de gestão e aos eventos do contexto de estudo, leva à conclusão de que a Secretaria de Saúde adota na delegação da gestão, de forma padronizada, salvaguardas contratuais que incorporam grande número de contingências, identificadas como problemas de agência, e exerce forte pressão como principal da relação, impondo custos de obrigação aos agentes e suportando custos de monitoramento e custos residuais. Privilegiam-se mecanismos de governança consistentes, apostando em sistemas de informação e no controle e acompanhamento permanente dos contratos por estrutura organizacional dedicada, com o monitoramento do comportamento para o alcance de resultado vinculado à remuneração do agente, sem a utilização de incentivos por recompensas. Não há uma substituição do clássico controle de meios pelo controle de fins, apregoado pela administração pública gerencial. Há, sim, um duplo controle, no qual a prestação de contas é uma obrigação e os resultados são um critério de avaliação para o repasse dos recursos e sustentabilidade da parceria, agregando qualidade ao gasto público.

Fragilidades dos mecanismos de controle das organizações sociais de saúde no município do Rio de Janeiro

Nosso problema de pesquisa neste trabalho é a avaliação do funcionamento dos principais mecanismos de controle das organizações sociais de saúde, no caso específico do Município do Rio de Janeiro. As reiteradas denúncias de irregularidades e ilegalidades pelo Tribunal de Contas do Município do Rio de Janeiro e pelo Ministério Público do Estado do Rio de Janeiro levantaram dúvidas acerca da adequação dos processos de monitoramento, fiscalização e controle dessas entidades. Disto decorre nosso objetivo central de pesquisa, que é identificar as fragilidades do novo modelo de gestão por organizações sociais de saúde, no caso da cidade do Rio de Janeiro. Para isso, foram analisados: o arcabouço jurídico-normativo do modelo local, a partir de análise comparativa da legislação municipal que regulamenta seu funcionamento (Lei 5.026/09) e sua contraparte federal (Lei 9.637/98); indicadores de saúde que mensurassem o desempenho das OSS; todas as inspeções realizadas pelo TCM-RJ até o fim de 2015; e o conjunto de recomendações enviado pelo MP-ERJ para a Prefeitura após deflagração da Operação Ilha Fiscal, que acarretou a desqualificação da OS BIOTECH e a prisão de seus dirigentes, acusados de desviar mais de R$48 milhões em recursos públicos. Ao final, constatouse que as fragilidades da legislação municipal e dos decretos executivos que regulamentam a atuação das OSS no MRJ não permitem o exercício efetivo do comando da parceria, em afronta, portanto, ao dispositivo constitucional que determina que a atuação de entidades privadas no âmbito do SUS pode se dar apenas de modo complementar. Ademais, verificou-se total inadequação da estrutura de controle pela Prefeitura, cuja principal consequência foi tornar o modelo de reforma gerencialista em um modelo que incentiva o comportamento patrimonialista no âmbito da saúde pública, uma vez que o controle de meios é absolutamente negligenciado.

Atividades educativas na prevenção da aids na rede básica municipal de saúde: participação do enfermeiro

TORRES, Gilson de Vasconcelos; ENDERS, Bertha Cruz. Atividades educativas na prevencao da AIDS em uma rede basica municipal de saude: participacao do enfermeiro. Rev.latino-am.enfermagem, Ribeirao Preto, v.7, n.2, p.71-77, abril 1999. Disponivel em: . Acesso em: 04 set. 2010.

As relações da tríplice hélice no setor da carcinicultura do Rio Grande do Norte: uma análise a partir das abordagens da imersão social e da dependência de recursos

This work consists in a study of the Shrimp Industry in the state of Rio Grande do Norte, whose central issue relates to the understanding of how the Triple Helix (University, Government and the productive sector) interrelationship limits or expands the industry s innovation process. The study aims to understand how the Triple Helix relationship interferes in the innovation process of shrimp in Rio Grande do Norte. As the knowledge becomes the resource key for production methods, the generation of new technologies, new products and processes which demands joint and integrated action of the institutions comprising the Triple Helix: University, Government and productive sector, which possess the essential resources to innovate the process and can be maximized from cooperative relationships between the referred Institutions. Thus, in this work, it was sharply used the pioneering studies of Sabato and Botana (1968) regarding the cooperation relationship between the scientific-technological sphere, the governmental and the productive base, and studies on the Triple Helix approach, proposed by Etzkowitz and Leydesdorff (2000), in which the university has a key role in the process of technological and innovative development of countries and regions, and under which it is assigned to the very University - the character of the entrepreneurial institution, through the concept of entrepreneurial University. Aiming to overcome the criticism of Cooke (2005), regarding the limitations of the Triple Helix approach, in this study it was used - as analytical perspectives - the perspective of social immersion (Granovetter, 1985, 2005) and the theory of resources dependence (PFEFFER; SALANCIK, 1978). The analytical perspectives presented in here, despite of the different assumptions, are essential to eliminate the bias that one only approach can lead (ASTLEY; VAN DE VEM; 2007). The authors arguments focus on the fact that the integration is possible if the researcher acknowledged that different perspectives may have different descriptions of the same phenomenon. As a research strategy, this study is characterized as a study case, along with the proposed objectives - the qualitative method was used as an approach and, depending on the gathering of the sector s historical, a sectional longitudinal view approach was applied (VIEIRA, 2004). The primary and secondary data were used in order to understand the sector s evolutionary process and its inter-institutional relations - regarding the shrimp culture in Rio Grande do Norte - to promote the development, as the content was used for the technical analysis (BARDIN, 1977). The approach of social immersion and resources addiction dependence made it possible to understand that relationships are established within and between each sphere (university, government and productive sector) characterizing a network of low density relationships and strongly internal and external dependence. Based on the speech of Etzkowitz and Mello (2006), a successful Triple Helix strategy of innovation requires not only the involvement and commitment of the parts, within the institutional sphere and among them, but also the development of mechanisms to coordinate the multiple and complex interactions and interfaces, focusing on promoting both environment and context for innovation and learning; it can be acknowledge from study results that the shrimp in the State of the RN, although there are several institutional mechanisms to promote greater integration and technological development, has been presented disjointed - both internally and between the spheres - and under no legitimate practice when facing the innovational promotion and integration institutions. Due to those factors, the central institutions of the network are crucial to the promotion of innovations, spreading through their direct contacts the importance factor of the sustainable competitive activity in the world market and on the national level. However, it may be concluded, from the data, that the Triple Helix relations are interfering in a negative way on what concerns the promotion of innovations in the shrimp industry in RN

A implementação de ações de integração na segurança pública: o caso das polícias civil e militar do Rio Grande do Norte

The research aimed to understand the challenges for the implementation of the proposed integration between the Civil Police and the Military Police in Rio Grande do Norte to the proposals of the SUSP. This study aimed to explore the gap with regard to the deepening of the possible causes that may hinder the implementation of integrated working between the police in public security, through a specific analysis on the state of Rio Grande do Norte. Was based on a theoretical framework that includes policies: general concepts, the steps of a public policy, the implementation stage , public security : conceptual definitions, policies on security in Brazil, the structure of public security in Brazil and systems police, Military Police x Civil Police: Roles and conflicts , integrating public security: the challenges to be overcome, the Unified public Safety (SUSP) and the main difficulties in the integration of the police. Being classified as to the purposes as an exploratory research on how to approach ranks as qualitative. The research unit was the Center for Integrated Operations Public Safety (CIOSP) through three subjects who were the chief CIOSP, the representative of the military police acting with the CIOSP, and representative civil police also active with the CIOSP. These subjects were chosen because of the understanding that individuals occupying senior positions would have more ability to respond to questions that guide the research problem. Data were collected through a set of interviews, qualitative data analysis was performed based content analysis, based on the definition of categories of analysis, gated time cross. With the results, it was revealed that the main problems of integration between the state police are treatment protocols, lack of political will and lack of infrastructure. The relationship between the Military Police and Civil Police in Rio Grande do Norte has differing cultural aspect, but can be considered as good value, professionalism and integrated operations. The implementation of CIOSP-RN followed the characteristics of the top-down model, the main difficulties in implementing the proposals of the SUSP, lack of own resources, the lack of standardization in public safety and the lack of professional training of public safety. It was concluded that with respect to the challenges to the implementation of the proposed integration between the Civil Police and the Military Police in Rio Grande do Norte to the proposals of the SUSP, the actions follow the characteristics of the top-down model, with no autonomy of administrators public to say in decisions, which restricts the view of the public safety of the state

Integração de modelos espaciais e temporais para predições de níveis freáticos extremos

O objetivo deste trabalho foi avaliar cenários de níveis freáticos extremos, em bacia hidrográfica, por meio de métodos de análise espacial de dados geográficos. Avaliou-se a dinâmica espaço‑temporal dos recursos hídricos subterrâneos em área de afloramento do Sistema Aquífero Guarani. As alturas do lençol freático foram estimadas por meio do monitoramento de níveis em 23 piezômetros e da modelagem das séries temporais disponíveis de abril de 2004 a abril de 2011. Para a geração de cenários espaciais, foram utilizadas técnicas geoestatísticas que incorporaram informações auxiliares relativas a padrões geomorfológicos da bacia, por meio de modelo digital de terreno. Esse procedimento melhorou as estimativas, em razão da alta correlação entre altura do lençol e elevação, e agregou sentido físico às predições. Os cenários apresentaram diferenças quanto aos níveis considerados extremos - muito profundos ou muito superficiais - e podem subsidiar o planejamento, o uso eficiente da água e a gestão sustentável dos recursos hídricos na bacia.

Morte como desafio afetivo para o profissional da saúde: ansiedade e sentimentos de quem lida com o paciente terminal com câncer

It is a Cross-sectional and multi-disciplinary study whose population selection was made by department of human resources (composed by a Manager, an Oncologist and a Psychologist) from the hospital where this research was realized. They also collaborated with important information about the work of that professionals in the hospital. We also counted on a Statistic who made study design calculating the sample and analyzing data. This research issued Evaluating health professionals anxiety levels who care for cancer terminally ill and their feelings about that work as well as identifying the factors which have influence on it. 100 health professionals from the Hospital which is a reference on cancer caring in Brazil situated in the city of Natal, state of Rio Grande do Norte, participated of this research. There was a sample loss of 21%. Data were collected through a questionnaire and State-Trait Anxiety Inventory (STAI). Results showed that 15% of the professionals have low State Anxiety levels, 70% Medium State Anxiety levels and 15% high State anxiety levels. The Number of Patients and Working in another Institution have interfered in the anxiety levels. Doctors and Nursing Assistants and Technicians have got the highest high State Anxiety percentage (25%). 73% of them declare to feel some sort of different behavior and/or feelings in caring for terminally ill. The most remarkable professionals feelings were Suffering and Sadness, and Terminally ill Children was the most difficult age group to care for. We conclude that work overload and having more than one job can interfere in professional stress levels and anxiety. Dealing with terminally ill, specially children one, can cause on the professionals psychological suffering. It s recommended the development of supporting and training strategies to reduce and/or to prevent Stress and Anxiety high levels

Financiamento e gasto público em saúde: o caso do Rio Grande do Norte

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Avaliação do cuidado na estratégia saúde da família em metrópoles do nordeste brasileiro

Objective: To evaluate the implementation of the Family Health Strategy (FHS) in Brazilian cities of the Northeast, expanding coverage, analyzing the progress, challenges and innovations. Methods: Multicentric Evaluation Research, Studies Baselines in urban centers, using as a case study method. Selected cases of Aracaju, being capital, advanced coverage with extended team, and Fortaleza, capital coverage incipient and minimal staff. In Fortaleza, purposive sample of 11 Units Primary (APS), 03 managers, 53 professionals and 109 users. In Aracaju, 09 units of APS, 02 managers, 36 professionals, and 90 users. Structured interviews for managers, and structured to professionals and users. Descriptive analysis focusing on the political and institutional dimensions, organization and comprehensive care. Results: There was consensus that the ESF is the preferred port users and acts as inducing changes in care. In the case of Fortaleza, the specificities were: care protocols and community activities aimed at chronic conditions (100%) , with greater participation of doctors and nurses (93%) ; conjunction with more complex services, but the teams reported difficulties with the examination center and experts, the long waits and poor access to local services were the main difficulties reported by users., As innovative practice, the therapeutic group of elderly caregivers mentioned by respondents; There was intersectoral initiatives and teams 87 % of users have participated in meetings about health problems. In the case of Aracaju, care protocols were directed to the lines of care and formulated locally, 85 % coverage of the population with FHS counterpart local financing; employees hired by public tender; 70 % of teams with expertise in public health center for continuing education acting; democratization in management; access technologies, welcoming and computerization in different integrated networks, and evaluation matrix. Conclusions: The ESF has promoted access to health care and inclusion of disadvantaged populations. Different perceptions and practices in the organization of care, with distinct trajectories of reorganization. In the case of Fortaleza, predominance of model programs valuing older, with evidence of advances in care practices and teamwork, but restricted to primary care practices and incipient in public policy perspective. In Aracaju, had network integration with technologies related to the family, in which the ESF is consolidated as public policy. It can be argued that the XII APS expanding coverage, exhibited efficacy, despite the challenges inherent to the different degrees of implementation

Qualidade de vida do servidor da Universidade Federal do Rio Grande do Norte em condição crônica de saúde

The study aimed to analyze the influence of chronic health conditions (CHC) on quality of life (QOL) of UFRN servers assaulted by CHC. It is a descriptive and cross-sectional study with prospective data and quantitative approach, accomplished in the ambulatory clinic of the Department of Server Assistance (DSA) of the Pro-Rectory of Human Resources, during three months. The sample was composed by accessibility, totaling 215 people, being 153 active and 62 inactive servers, in chronic health condition. The data were collected through the application of the sociodemographic characterization, health, environmental and laboral form, the Medical Outcome Study 36-Item Short Form (SF-36). The study was evaluated by the HUOL Ethics Committee (CAAE no. 0046.0.294.000.10), obtaining assent. The results were analyzed in the SPSS 15.0 program through the descriptive and inferential statistics. It was identified servants predominantly male (59,1%), under 60 years old, married or in stable union, Catholics, brown color, living in the capital and residents in own home. Regarding labor issues, there was a predominance of active servers technical-administrative with intermediate and medium level positions and small proportion of docents. Among the CHC, the non-communicable diseases - NCDs (95.8%) had a higher frequency, followed by persistent mental disorders - PMDs (18.6%) and, finally, the continuous and structural physical deficiency - CSPD (16.9 %). The QOL of servers was considered good, with a mean score of 72.5 points in the total score, with the most affected domains: physical (59.1), general health (66.2), bodily pain (66.3) and functional aspects (72.0). The mental health dimension (76.5) had a better average than the physical dimension (68.0 points). It was found that the decrease in QOL scores is significant statistically related to higher number of CHC (ρ <0.001), with no statistical significance regarding the functional situation (p = 0.259). The administrative technicians of elementary, primary, secondary levels and docents had the worst QOL scores. After the correlation analysis of CHC with the domains and dimensions of the SF-36, there was statistically significant, negative and weak correlation of the domains: functional aspect (ρ = 0.002, r = -0.207), physical aspects (ρ = 0.007; r = -0.183), vitality (ρ = 0.002, r = -0.213), social function (ρ = 0.000, r = -0.313), emotional aspects (ρ = 0.000, r = -0.293), mental health (ρ = 0.000 , r = -0.238), physical health dimension (ρ = 0.002, r = -0.210) and mental health dimension (ρ = 0.000, r = -0.298). The presence of PMD isolated or together, contributed to a lower SF-36 scores, being the domains variation of mean significant, except for bodily pain, general health and physical aspects. By correlating the categories of CHC and QOL, there was a weak correlation (r ≤ -0.376) and significant (ρ ≤ 0.011), mainly related to the NCD, PMDs and NCD + PMD, affecting the mental health, social function, emotional aspects, vitality and functional aspect domains. Front of the results, it was concludes that the servers quality of life is influenced by the CHC. Thus, it was inferred that the presence of CHC causes a negative effect on quality of life, leading the active and inactive servers to exposure their overall life activities and work over the years, due to the morbidity affected, mainly related to NCDs and PMDs. Descriptors: Quality of life. Chronic disease. Occupational Health. Nursing

IIRSA: outro passo na pilhagem, exploração e (des) integração dos povos e territórios sul-americanos

La llamada Iniciativa para la Integración de Infraestructura Regional Suramericana (IIRSA) es un acuerdo multinacional celebrado entre los 12 países de América del Sur desde el año 2000, materializado a través de 10 ejes de comercialización orientados a la construcción de varios proyectos de infraestructura, que incluye la construcción de una enorme red de energía, de comunicación y transporte. Estos proyectos han sido financiados principalmente por los organismos multilaterales (BID, CAF, FONPLATA) profundizando la dependencia económica y política de los países involucrados, en especial mediante el aumento de la deuda externa, las empresas transnacionales garantizarán la infraestructura necesaria para la explotación más acentuada de nuestros recursos naturales y de la mano de obra barata, asegurando el abastecimiento de sus mercados. En este sentido, el discurso de crecimiento económico regional creará los mecanismos necesarios para la reproducción ampliada del sistema capitalista, mediante la promoción de la liberalización de los mercados internacionales, tales como intenta los Estados Unidos a través del Área de Libre Comercio de las Américas. En realidad, es un Desarrollo Regional de los países del Norte, un plan estratégico de ordenamiento territorial construido por transnacionales y dictado por el imperialismo de Norteamérica. Bajo la dirección del gobierno de Brasil ha sido implementado sigilosamente, para que los jefes de Estado, sin nombrarlo, ejecuten sus planes de desarrollo como parte de esta tan evidente estrategia de saqueo, entusiasmados y convencidos de que serán generosamente recompensados. Proclaman e inauguran proyectos de infraestructura que las empresas multinacionales y transnacionales consideran indispensables para el saqueo de los recursos naturales que aún quedan, después de cinco siglos de explotación continua de América Latina. En este sentido, nuestra investigación se volvió hacia el análisis de lo sector energético de lo Eje Perú-Brasil-Bolivia, por considerarlo de suma importancia para el mantenimiento de la explotación y consolidación hegemónica de las corporaciones multinacionales en América Latina

Acordos internacionais sobre a produção compartilhada de recursos naturais: a unitização interestatal na área do petróleo e gás sob o enfoque constitucional brasileiro

The apportionment of natural resources between sovereign States is a subject that relates many aspects of International law, as long as Constitutional Law, at the execution and application phases of international treaties that regulates the exploration of common goods. In this sense, because of their natural characteristics that creates an environment of constant migration and fixation in transboundary regions, terrestrial or maritime, the petroleum and the natural gas bound a complex juridical apparatus that can control the sovereign rights involved. This research is aim at accomplishing a study concerning the international agreements that enable the non-unilateral action, specifically the unitization treaties between sovereign States, as a manner to resolve situations related to the individualization of oil and/or gas reservoirs that go across their national borders. These agreements will be analyzed considering the international public law sources theory, bearing in mind yet the already existed experiences in this sense, not disregarding the way that this fact could affect Brazil. It will begin with an historical incursion over the unitization institute, covering its main characteristics and its formation and execution procedures, and finally it will address the Brazilian legal system and the comparative law threats the institute. The clauses of these relevant agreements will be analyzed in details, concerning its particularities and its contents. Because these agreements are international obligatory rules of law, it is indispensable that they are considered under the auspices of the international law system, focusing their nature and the subjects of international law and establishing them as sources of the international law, analyzing them, then, as international rules and the applicable law to these juridical relations, the conventional established, the consolidated international custom and the applicable International Law principles, appearing the State s responsibility as an important subject for the verification of the acts lawful practiced by States. The analysis of the apportionment of these natural resources ends with the individualization of possible exploitable marine oil fields located between the exclusive economic zone and the continental platform ends and the region administrated by the International Seabed Authority. At last, the Brazilian constitutional system appears as the mechanism of integration, application and execution of the international unitization agreements in Brazil, detaching the format and the proceedings that the international treaties take to acquire validity at the national legal system, passing through the treaties interpretation and the applicable constitutional principles, coming to its application in Brazil, considering the existing constitutional peculiarities and the role played by the National Agency of Petroleum, Natural Gas and bio-fuel ANP