The objective is to describe the implementation and development of the Training Program for Health Surveillance Actions (2013-2018), which focuses on improving the performance of health surveillance. It is an evaluation research with a qualitative method. Key informants were interviewed, and documents and literature were analyzed. The analysis enabled the construction of the timeline, the retrieval of the chronology of the events that marked the development of the program, its implementation, and the identification of innovations and controversies. The authors identified three organizational axes: conception/formulation, implementation/monitoring, evaluation/communication. They found that the program went beyond the traditional approach to surveillance and met regional diversities. There were controversies about the responsibility for monitoring the program's actions, whether they belonged to the technical areas related to the indicators or to the management of the program at the Ministry of Health.
TopIntroduction
In this chapter we will show the outcome steps of an evaluation research about the Health Surveillance Actions Qualification Program (PQA-VS), which was done to the Health Surveillance Secretariat (known in Brazil by the initials SVS), a branch of Brazilian Ministry of Health. The study was conducted by the Laboratory of Evaluation and Analysis of Regional Endemics Situations (known as LASER) – a branch of Samuel Pessoa Department of Endemic Disease, Sergio Arouca National School of Public Health (ENSP)/Oswaldo Cruz Foundation (Fiocruz), in a partnership with Health Evaluation, Monitoring and Surveillance Laboratory from Aggeu Magalhães Institute (Fiocruz) and the State Health Secretariat of Pernambuco.
PQA-VS was settled in 2013 (Brasil, 2013) with the aim of improving the performance of health surveillance actions (VS) in the country through financial incentive as an inductor of actions improvement processes. The program has the purpose of reaching favorable results in fourteen indicators, with established goals which are annually revised, related to the country's most prevailing health problems, being the object of health surveillance actions (VS).
The chapter describes the PQA-VS timeline from its origin up to 2018, identifying the relevant events throughout the period, considering the actors, the organizations and the involved context dimensions (Joly et al., 2015); and presents an analysis of challenges and potentialities to the full development of the federal manager role as an inductor of VS actions improvement and qualification.
In order to achieve it, a participatory evaluation was carried out with the involvement of stakeholders, aiming to qualify the management processes institutionally developed by the applicant, in this case, the Ministry of Health. When conducting participatory evaluations, different stages of the decision-making process are shared between evaluators and stakeholders. The most regular steps include involving the joint accomplishment of the evaluation design, definition of questions, collection and analysis of evidence, as well as the preparation of reports with their recommendations. The level of participation of the actors or stakeholders will depend on the interests involved and on the context factors which may favor or hinder adherence (Cousins, Whitmore, 1998; Cardoso et al., 2019).
After deciding the type of evaluation to be articulated, relevant research questions and field work, investments were made in the development of evaluative technical capability of the involved individuals, based on a discussion of evaluative methodologies and their main stages in each moment of this construction, as a way of contributing to the incorporation of continuous monitoring and evaluation practices, favoring the proposal appropriation by those involved.
The Timeline that had been traced, besides promoting the understanding of the events implied in the referred program implementation and evolution, served as an instrument of approach between the team of researchers and the team who was demanding the study; furthermore, it allowed the analysis and achievement of the results expected by the program. The reconstitution of this trajectory filled with present contextual elements throughout the implementation period favors the comprehension of how and why the program has worked in certain given context.