Avaliando o avaliador: evidências de um experimento de campo sobre as auditorias da CGU

O Brasil praticamente alcançou a provisão universal dos serviços públicos de educação, saúde e assistência social nos últimos anos, mas a qualidade desses serviços ainda está bem atrás da maioria dos países desenvolvidos. As instituições de controle são atores relevantes nesse contexto, pois é seu dever avaliar a efetividade e a eficiência da provisão desses serviços públicos. Entretanto, pouco se sabe sobre a efetividade dessas instituições, especialmente no Brasil. Os artigos de Olken (2007), Reinikka e Svensson (2004) e Di Tella & Schargrodsky (2000) trazem alguns elementos para essa discussão, ao mostrar como e onde políticas de boas práticas podem funcionar em outros países. No Brasil, estudos empíricos sobre essas políticas são escassos. Nesta tese, meu principal objetivo é trazer evidências sobre a efetividade da auditoria pública no Brasil. Utilizando um experimento de campo, eu avalio a efetividade do trabalho de auditoria da Controladoria-Geral da União (CGU) no âmbito do Programa de Fiscalização a partir de Sorteios Públicos. Os principais tópicos discutidos aqui são relativos à gestão de programas em nível local e aos processos licitatórios a eles associados. Os municípios no grupo de tratamento são submetidos a um aumento na probabilidade de receber uma auditoria, enquanto os de controle permanecem com probabilidade inalterada. Os resultados sugerem que os gestores locais são sensíveis ao tratamento quando focamos as licitações, mas não quando a questão é a gestão de programas. Em seguida ao experimento, utilizo um modelo "Fora da Amostra" para sugerir um mecanismo de alocação de recursos financeiros e humanos, para melhorar os níveis de eficiência do trabalho de campo da CGU

Parcerias com o setor privado em serviços de saúde e inovações na gestão da atenção básica: o caso da rede municipal de Suzano, SP

O objetivo dessa pesquisa é fazer uma avaliação dos resultados obtidos por novas políticas de saúde implementadas em escala municipal. Essa avaliação foi feita pela caracterização do processo de cessão parcial da rede de Atenção Básica de um município de médio porte - Suzano, SP - para gestão pelo setor privado por meio de convênio. A parceria com o setor privado na prestação de serviços de saúde é uma das mais importantes políticas introduzidas no Sistema Único de Saúde (SUS) desde sua criação; contudo, existem poucos estudos que avaliem o seu impacto na saúde da população ou no acesso aos serviços de saúde, e isso se deve à falta de compreensão sobre os variados tipos de interação entre o sistema de saúde e os atores sociais e instituições que estão envolvidos em sua implementação e gestão. O estudo foi realizado com pesquisa bibliográfica sobre a contratualização, convênios e parcerias na saúde brasileira, seguida de trabalho de campo no município de Suzano. Lá foram ouvidos gestores públicos na Secretaria Municipal de Saúde (SMS) e, depois, foram realizadas 19 entrevistas semi-estruturadas com gerentes, médicos e enfermeiros de 12 equipamentos de saúde da rede de Atenção Básica municipal. Depois foram realizadas outras 4 entrevistas com gestores da SMS. O conjunto de unidades investigado reflete a diversidade de bairros, populações e necessidades de saúde de um município de porte médio, com uma rede de saúde bastante sofisticada e avaliada positivamente dentro dos parâmetros nacionais. Verificou-se que, apesar das dificuldades e dos objetivos que ainda não foram alcançados, existe um padrão recorrente na gestão do SUS que é bastante positivo: as reformas federais que foram implementadas paulatinamente desde 1990 têm baseado-se em avaliações corretas sobre os problemas do SUS e, ainda que lentamente, têm conseguido produzir transformações positivas no mesmo.

Análise do custo-aluno das creches municipais diretas do município de Santo André

O presente estudo tem como foco o levantamento e análise do custo-aluno das creches, primeira etapa da Educação Infantil, que compreende as crianças de 0 a 3 anos de idade. Ele responde à situação problema apresentada pela Secretaria de Educação do Município de Santo André (SP), caracterizada pela necessidade do aprimoramento da gestão dos recursos financeiros em um cenário de dificuldades orçamentárias e aumento de demanda. Foram selecionadas 12 unidades municipais da rede direta, com atendimento exclusivo a crianças nesta faixa etária. A metodologia utilizada teve como base a utilização do Sistema de Informações do Orçamento Público municipal, a partir do qual foram realizadas as consultas e definições dos componentes do custo do objeto em estudo, sendo que a metodologia de acumulação de custos utilizada foi o custeio por absorção. Adicionalmente, os autores analisaram os processos administrativos relacionados aos itens de custeio e realizaram entrevistas com os diversos atores envolvidos nos processos de gestão daquela e de outras secretarias, bem como acadêmicos dedicados ao estudo de custos no setor público, cujas experiências relatadas subsidiaram a pesquisa e as avaliações realizadas. O estudo apontou um custo-aluno médio de R$ 11.970,72 sendo que, para melhor análise dos resultados, as unidades escolares foram agrupadas em três categorias de acordo com o número de alunos: i) pequeno porte: com até 149 alunos (três unidades); ii) médio porte: entre 150 e 190 alunos (cinco unidades); e, iii) grande porte: com mais de 190 alunos (quatro unidades). A partir dessa divisão foi possível concluir que as creches de grande porte apresentaram vantagem comparativa em relação às demais, com custo-aluno médio de R$ 11.684,03, seguidas das creches de médio porte, R$ 11.751,46 e pelas unidades de pequeno porte, que apresentaram o custo-aluno de R$ 13.235,88, ou seja, 13,23% acima das escolas de grande porte. Esses resultados indicam a existência de ganhos de escalas de acordo com o porte da creche e pode subsidiar a tomada de decisão dos gestores para futuros projetos de expansão da rede pública de creches.

Cartão de residente municipal: instrumento para aprimoramento da gestão no município: o caso de Louveira, SP

Para implementar políticas públicas nos municípios, um dos problemas é a ausência de dados que informem a realidade da situação local, o que evidencia o benefício e a necessidade dos instrumentos de tecnologia de informação para maior eficiência e eficácia na gestão pública. No município de Louveira, analisou-se o caso específico da implantação de uma ferramenta da tecnologia de informação que é utilizado por toda a prefeitura, denominado no local como Cartão Cidadão, que visa documentar o acesso e utilização dos serviços públicos municipais, porém no estudo do caso foi realizado um corte para averiguar o instrumento como estratégia de gestão para aprimorar o planejamento no município, mais precisamente na área da saúde. A gestão do sistema do Cartão Cidadão aliado aos registros em prontuário eletrônico de saúde deram maior confiabilidade ao banco de dados da saúde municipal, possibilitando averiguar e traçar estratégia definida para a gestão do Sistema Único de Saúde (SUS) local, assim como permitiu melhor averiguação dos desvios do sistema. Finalmente, apresentamos questionamentos sobre o sistema SUS frente a municipalização e ainda sobre e a questões do pacto de saúde e do próprio pacto federativo brasileiro.

A descentralização das políticas de desenvolvimento rural: uma análise da experiência do Rio Grande do Norte

MATOS FILHO, João. A descentralização das Políticas de desenvolvimento rural - uma análise da experiência do Rio Grande do Norte. 2002. 259f. Tese (Doutorado em Ciências Econômicas)– Instituto de Economia da Universidade Estadual de Campinas, Campinas, 2002.

Conselho Municipal de Saúde de Pedras de Fogo - PB: um estudo sobre participação

The present study aims to understand the process of Participation of the Health Council- CMS in the formularization, implementation and control of the Municipal health plan of Pedras de Fogo, through four criteria of quality of participation considered by Demo (1993): representation, legitimacy, base participation, and self-responsibility. The criteria of representation is related to the quality of politics of the representative over the representings. Legitimacy is related to the politics` quality of the process of participation based on norms and rules that stipulate the participation, the base participation is a necessary political support so that the power authorization directed to the representings can be effective and the self-responsibility refers to the capacity of being responsible when it concerns to the public service or property. Through the descriptive and exploratory study a qualitative method was adopted to consider the conditions of the participation of the twelve council members of the City council of Health of Pedras de Fogo, through a formulated Instrument based on the criteria of DEMO (1993). It was concluded that the quality of the participation of the council members of the CMS of Pedras de Fogo understands essential aspects of the criteria of quality considered by Demo (1993) but it shows fragilities as unfamiliarity with the norms that legitimize the performance of the council; unfamiliarity of its condition of being an agent and the importance of the participation of the base for the reinforcement of its participation, as well as inertia related to the check and rendering of accounts on its performance. This way it makes sense that the participation of the council in the four criteria of quality of politics considered in this paper needs to improve

O ouro branco abre caminho: o algodão e a modernização do espaço urbano da Cidade da Parahyba (1850-1924)

The present research deals with the modernization process of the Cidade da Parahyba2, between 1850 and 1924, and its relation with the cotton economy, which represented the main source of wealth accumulation for both the private and the public sectors throughout the First Republic. This study on urban history was developed by focusing on the understanding of the city s spatial formation, and despite its emphasis on the economic aspects involved, other factors that also contribute to the development of the social life were not put aside. The modernization process of the Cidade da Parahyba was also analyzed during the period established for the study according to a chronological and thematic approach that established comparisons with the financial situation of the State, whenever this was necessary, with special attention to the contribution of the cotton economy to the State´s revenues. It was possible to detect a lack of financial help and loans from the federal and municipal administrations for finishing several public works already underway in the capital, since the federal funds allocated to the State of Parahyba do Norte were rather employed in emergency works against droughts and in agricultural development. One can then conclude that the financial resources required for the urban interventions were withdrawn from the State s treasury itself, resources that were collected mainly from activities such as cotton exportation and cotton trading. Another factor shows the interdependence between the urban remodeling and the cotton economy: during the years marked by great droughts or by hard plagues on the cotton plantations, cotton production decreased, as well as the State s finances. The first measures taken by the State s administrators were to halt all projects of urban remodeling in progress in the Cidade da Parahyba, which was, clearly, the most privileged city by the State s presidents during the period analyzed. 2 The city of João Pessoa was named Cidade da Parahyba, a designation that remained until September 1930, when it received its present-day name in order to pay homage to the president of the State, João Pessoa Cavalcanti de Albuquerque, murdered in the city of Recife in August of that same year. At that time, the State of Paraíba was known as Parahyba do Norte. Since this work is limited to a period of time comprised within the First Republic, the names employed respect the terms used in those days

Limites e possibilidades do programa nacional de alimentação escolar enquanto estratégia de promoção da segurança alimentar e nutricional no municipio de Macaíba/RN

This dissertation aims to understand the importance of the National School Feeding as a strategy for ensuring the promotion of food and nutrition security in the municipality of Macaíba / RN, taking into account the implementation of the Law School Feeding, 11,947, 2009. The program was extended to all public basic education, youth and adults, in addition to ensuring that 30% of transfers from FNDE, were intended for the purchase of products from family farms. The survey was conducted with 160 students from public schools and farmers nesting Quilombo dos Palmares II, who produce on their land vegetables, fruits and cereals for their own consumption, for sale in local markets, in addition to providing for PNAE. The reciprocity between neighbors, such as mutual aid and sharing of common goods was noticeable in this group of farmers, since it was necessary to meet weekly deliveries of products to schools. As students, we applied a test of acceptability in two schools located in rural and in urban areas, to learn the opinion of ourselves in relation to school food consumed. It was concluded that to be most effective program in the region, there must be a better match in school menus, so that it can be attractive to students and to ensure greater use of fresh food, the main ingredient of same, practice of nutrition education in schools, to teach students the importance of food to health. In relation to local management, noted the need for adjustments bureaucratic as hiring staff for the departments, in order to be more agile in releasing payments to farmers, in addition to hiring assistants general services for schools, one Since the cooks exert dual role, the cooking while being responsible for cleaning the entire school environment. Government investments in the rural sector would be extremely valuable for farmers, since they need financial resources to purchase inputs, irrigation projects for gardens, availability of land for planting, transportation to facilitate the delivery of its products to schools and technical assistance more frequently

Os conselhos como mecanismos de democratização da política educacional :participação e poder de decisão nas ações do Conselho de Controle Social do FUNDEF no município de Parnamirim/RN

This study board the FUNDEF social control council implementation in Parnamirim/RN city, concerning their representatives participation in the accompaniment (decision power) in resort, in front of governmental politics of decentralization, unleashed in 90´s, seen in decentralization process needs the society participation in decisions of educative institutions and represent an efficient way of solve the problems difficult the educational management actions. For this, the council creation of Brazil manager configure, since the 80´s, detaching, and the single characterizing, in actual context. The objective is raise pertinent questions of thematic of representatives members participation of collegiate organs, evidencing the decision power of these, in public resource control. The theory-methodological referential the literature treat the participation and power decision of FUNDEF social control decision, such as politics directrix that rules this council. It utilizes as proceeding of collecting data the semi-structured interview and analyze of meeting register to understand the empirics of council implantation in this city, in view of that the electoral process configured in 2003, showed as a innovation, because the counselor is indicated by the local public power representatives (in this case the education municipal secretary). The research result show the representatives have difficult, to accompany the FUNDEF resources amount, particularly in concern in the financial resources (ratio) over plus. Finally, emphasize the importance of democratization in the relations between the state and civil society, elucidating and exciting reflections a: democratic participation in control of public recourses for education, educational management and civil society mobilization in access of public and cultural cash which the citizen has rights

Qualidade de vida em gestantes no contexto na Estratégia Saúde da Família

The pregnancy as a process in woman's life requires several biological, psychological, relational and socio-cultural changes for the preparation for motherhood. By modifying its capacity and, at the expense of these factors, it is observed that the physical, social and emotional problems experienced by women during pregnancy can affect their quality of life, especially related to health. It had as objectives of this research verifying the quality of life of women in the context of the Family Health Strategy in a municipality in Paraíba, in order to characterize the sociodemographic aspects, lifestyle habits, and obstetric care of pregnant women and to characterize the fields of quality of life of pregnant women according to the WHOQOL-bref. This is a descriptive exploratory study with cross-sectional and quantitative approach. The population consisted of 120 pregnant women in primary care in the municipality of Sousa-PB. Data collection occurred over a period of two months by the own master's degree student and two nursing students in applying a standard form about sociodemographic characteristics, and obstetric care and the WHOQOL-bref instrument. The data collected were organized into an electronic database of the Microsoft Excel application, coded, tabulated and presented in tables, charts and figures with their respective percentage distributions. Of the surveyed, the predominant were age group of 20 to 25 years, Catholic religion, with a steady partner, low education, no employment, wage income of 01 minimum wage. As for the data and obstetric care, almost all had never aborted and reported to the care received as excellent. The most frequent complaints were back pain and in lower abdomen. Regarding quality of life according to the WHOQOL-bref, dissatisfactions that predominated in the areas were in the physical pain and discomfort, sleep, rest, energy and fatigue. In the psychological domain, body image and appearance, memory, concentration and negative feelings. In the field of social relationships, sexual activity and the environment domain, the greatest dissatisfaction with facets scored: financial resources, leisure opportunities and transport. It is concluded that the quality of life of the users interviewed were deemed unsatisfactory for these facets, indicating that assistance to this target audience should be done comprehensively and holistically, in order to accommodate the affected facets to improve the quality of life pregnant women attended in primary care

Atenção à saúde mental na Estratégia Saúde da Família no Município de Parnamirim/RN: opinião dos profissionais, dos portadores de transtornos mentais e seus acompanhantes

This study aims to analyze and compare the opinion of professionals, managers and users about the mental health care in the Family Health Strategy (FHS). It is characterized as an Operations Research or Health System Research with a cross-sectional design and a descriptive quantitative nature. The study was developed from the application of the Opinion Measurement Scale allied to techniques of observation and structured interview in the city of Parnamirim / RN. The sample consists of 409 subjects, 209 professionals of the Family Health Strategy, 30 of the Oral Health Strategy, 19 of the Family Health Support Center, 24 directors of Basic Health Units, plus 68 users with mental disorders and 59 caregivers, respecting the ethical parameters of Resolution 196/96 of the National Health Council, trial registration number: CAAE 0003.0.051.000-11. Quantitative data were submitted to the Epi-info 3.5.2 for analysis. The network of mental health in Parnamirim involves the flow between the FHS, Psychosocial Care Centers, clinics and hospitals, having as main barriers the fragility of the referral and counter-referral system, of the municipal health conferences, of the FHS teams by the limitations in material and human resources as well as the population´s lack of acknowledge about the organization of the mental health network, issues that affect the integral attention. Even though the FHS professionals recognize the importance of their actions, they question their role in mental health care, experiencing difficulties in accessing psychiatric services (76.5%). Although most agree that the mentally ill is best treated in the family than in hospital (65.2%), the community health workers were the predominant category in the partial or total disagreement of this statement (40.8%), who is the professional in greater contact with the family. Nevertheless the caregivers miss the support of the FHS as the main focus of attention is on revenue control. The views of professionals, mental patients and caregivers converged in several statements, showing the main weaknesses to be focused by the mental health network of the city, as the perceptions that: (a) physical strength is needed to take care of mental patients for its tendency to aggression, requiring it to stay in the sanatorium for representing danger to society, (b) only a psychiatrist can help the person with emotional problems, (c) the user of alcohol and drugs does not necessarily develop mental illness, (d) the access barriers and doubts about the quality of psychiatric services, (e) caring of a mental health patient does not bring suffering to professionals. Therefore, the commitment to consensus building, monitoring and evaluation of the network are important mechanisms for an effective management system, reflecting in the importance of strengthening the health conferences and approximating different institutions. The results reinforce the importance of strengthening primary care through programs of continuing education focusing on the actions and functions of professionals in accordance with its competences and duties what contribute to the organization and response of mental health care, favoring user´s care and the promotion of family health

Atuação do enfermeiro na estratégia de atenção integrada às doenças prevalentes na infância

This study aimed to describe nurses' actions in the strategy of Integrated Management of Childhood Illness in the city of Natal, Rio Grande do Norte. This is a qualitative study with descriptive approach. The universe consisted of nurses from the Family Health Strategy, totaling 16 participants. For the research project was submitted for approval by the Ethics Committee of the Universidade Federal do Rio Grande do Norte, obtaining Opinion No. 187/2012. Data were obtained in two ways: a questionnaire survey to profile the training of nurses and an interview guided by a structured interview. Interviews were treated in the light of analysis of thematic category Bardin. The results showed the central thematic study "Integrated Management of Childhood Illness in the context of nursing activities" category and three analyzes: "Understanding the Integrated Management of Childhood Illness", "Difficulties invibializam use IMCI "and" Working conditions for nurses in the Integrated Management of Childhood Illness. " It is observed that nurses consider the Integrated Management of Childhood Illness useful, effective and important to keep sick children within the logic curative. However disregard the character of health promotion and disease prevention thereof. It was found that the participants still hold the attendance of crinaças within the biomedical model and that these same professionals are subjected to increasingly precarious working conditions and unhealthy due to lack of human and material resources. It was found that the interviewees do not follow the protocols of strategy because of barriers related to prescription medications by nurses, the medical, the lack of incentives, training and supervision by the municipal health and the Regional Nursing Council

Do Fundef ao Fundeb: avaliando o passado para pensar o futuro: um estudo de caso no município de Pirapozinho-SP

Este artigo, que envolve a combinação de procedimentos quantitativos e qualitativos, traz resultados de pesquisa que analisou o impacto do Fundef na estruturação da rede municipal de ensino de Pirapozinho-SP, e mostra como estes resultados trazem subsídios para um funcionamento mais adequado da atual política de financiamento da educação. Constatou-se que, mesmo sem aumentar os recursos financeiros do ensino fundamental, o Fundef racionalizou e tornou mais eficiente a sua aplicação, diminuindo desvios e desperdícios, e que a instituição dos Conselhos de Acompanhamento e Controle Social possibilitou maior participação popular na fiscalização do executivo aumentando a transparência dos gastos com educação, que a constituição do Fundef abriu a possibilidade de implantação do Fundeb atualmente em vigor e que a melhoria no funcionamento deste está relacionada ao aumento da participação da sociedade nas decisões da política educacional e ao investimento na qualificação desta participação.

Atenção precoce do câncer de mama :um olhar sobre o cotidiano institucional de uma unidade de saúde de Natal

Breast cancer has been considered a grave global public health problem due to its increase in incidence, in women s mortality and in the amount of financial resources spent on the therapeutic interventions used in the treatment of this neoplasia. However, this scenario presents some variations. In developing countries, the incidence of breast cancer is increasing but, on the other hand, the mortality is declining among patients because of public health actions toward early diagnostic that also result in cure of patients and decreasing levels of physical and psychosocial stress. In Brazil, we face of both the increasing number of breast cancer incidence and number of mortalities. Almost always the reason for that is a delayed detection that will provide a late diagnostic. The early detection of breast cancer has been studied in several researches. Some of them are concerned with women s experiences. Despite that, there is a lack of researches on dynamic comprehension of early attention to breast cancer from the health professionals points of view. The present research was carried out at the Unidade Mista de Felipe Camarão (UMFC) and it was conducted with 11 professionals who work in the Family Health Program (PSF). The aim was to understand how early diagnostic and attention to breast cancer is being planned, discussed and accomplished by health professionals in their day-to-day actions. Semi-structure interviews were held individually with each professional, in a way that they could feel free to express their ideas about several issues. All the information from these interviews was analyzed and discussed using an Institutional Ethnographic approach. It was observed that the actions of health professionals working with early detection of breast cancer does not take place in a vacuum; they occur within institutional, relational and social ways. This interdependence influences their actions and points of view on the theme

Saúde mental em operadores de petróleo do Rio Grande do Norte

The importance of identifying the consequence of the hours worked on people in society has been well recognized within Organizational and Work Psychology. From this point of view, the present research had the objective of analysing the effects of work regimes on the mental health of petroleum operators of Petrobrás. The sample totaled 144 subjects, corresponding to 27% of the work population. The mental health of the participants was evaluated using the following instruments of measurement: QSG-12, Scale of self-esteem, Scale of Positive and Negative Affections and the Scale of Valuable Attributes of IMST, each representing an empirical factor used to indicate and measure the five dimensions of mental health. The subjects perceptions of their work regime and the rest of their conditions of work were evaluated using scales of descriptive attributes of IMST, by applying a semi-structured questionnaire and by use of interviews. A socio-demographic file was used to collect information related to the biographical and socio-occupational profile of the worker sample. The answers to the questionnaire were inserted into the data bank of SPSS (Statistical Package for Social Science), for statistical analysis, and the interviews were analised based on the technique of Contents Analysis recommended by Bardin (1995). The main results revealed that one third of the worker sample were tense; however, the mental health of the majority was preserved. Cluster Analysis applied to the group of seven factors which measured the five dimensions of mental health identified four profiles of psychological well-being shared between members of the sample. It was observed that the people working in the system of Continuous Shift Alternation (TIR) and in the system of Pre-advising tended to present balanced and satisfactory profiles, while the ones which worked in the Administrative Field tended to present anxious and oscillating profiles, and thus were more affected psychologically. These were also the ones that also perceived the more negative aspects of their laborious conditions (reduced chances of self-improvement, physically stressful and financial resources below expectations with which to supply family and personal necessities. In agreement with the ecological model formulated by Warr (1987), the present study concluded that the positive and negative effects on the psychological well-being tended to occur as a consequence of the perceptions the petrol operators developed to face their work conditions