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O planeamento no contexto da imprevisibilidade : algumas reflexões relativas ao sector da saúde
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RESUMO - As previsões feitas no planeamento tradicional, com base
na quantificação, carecem de substituição por uma visão
prospectiva que valorize os parâmetros qualitativos, com
recurso à metodologia dos cenários, a qual, entre outras
características, deve descrever a evolução do sistema estudado,
tendo em conta as evoluções mais prováveis das
variáveis-chave a partir de jogos de hipóteses do comportamento
dos actores.
O planeamento deve equacionar o contexto em que se
actua, os múltiplos interesses e as relações de poder, de
influência ou de conflitualidade entre os vários actores
sociais. Ao nível do sistema de saúde, o processo de planeamento
deve basear-se numa estrutura descentralizada que
valorize as soluções adequadas a cada território e a aceitação
de uma abordagem diferente numa óptica de mercado;
deve assumir a forma de um processo de negociação, perspectivado
num contexto de mudança, o que facilita a
obtenção dos objectivos e aumenta a capacidade de aprendizagem
e de inovação dos actores.
Importa reforçar a ideia da interligação entre os centros de
saúde, hospitais e cuidados continuados, quer ao nível do
sector público, quer social, os quais, no espaço onde
actuam, possam encarar a saúde com uma abordagem
mais alargada, associada directamente à qualidade de vida,
em que sejam valorizadas, além das dimensões tradicionais,
também a relacional, cultural, ambiental e espiritual.
A saúde deve, desta forma, ser vista como vector de desenvolvimento,
o que pressupõe que a mesma seja parte integrante
de uma estratégia de intervenção multisectorial,
com projectos que tenham características de sustentabilidade.
Num processo de desenvolvimento, os projectos a considerar
devem proporcionar uma análise integrada das necessidades
da população, com novas perspectivas de acção,
uma concentração de esforços e melhor aproveitamento
dos recursos, fomentando sinergias e a promoção da capacidade,
motivação e autonomia da comunidade. Uma
resposta de qualidade que dê satisfação às necessidades
pressupõe também que os recursos humanos sejam considerados
o capital mais importante no seio de uma organização,
pelo que os profissionais devem ser possuidores de
um bom nível de informação, adequada às funções, formação
contínua e empowerment.
A actuação integrada só pode ser desenvolvida em parceria,
onde se envolvam não só os serviços estatais, mas
outros da sociedade civil, de forma a contribuir para o
desenvolvimento humano, do qual a saúde faz parte integrante.
ABSTRACT - Traditional planning forecasts based on parameter quantification must be substituted by a prospective opinion that uses the scenario method to examine parameters of quality. Among other characteristics, the latter describes the development of the system under study by taking into account the most likely evolution of the key variables by playing with hypothetical behaviours of the actors. Planning must weigh the context in which one is acting, the multiple interests and the relationships of power, influence or conflict that may exist between the several social actors. At the health care system level, the planning process must be based on a decentralised structure that appraises suitable solutions for each territory and the acceptability, from a market viewpoint, of different approaches; there must be a form of give and take, within a context of change, so as to make it easier to attain one’s objectives and increase the actors’ ability to learn and innovate. One must stress the notion of the close relationship that binds health care centres, hospitals and continuous care, both at the public sector level and at the community level, as these health care providers, in the space in which they act, have a more allembracing approach to health, where wellbeing is directly associated to an individual’s quality of life and where, in addition to traditional aspects, they also examine the relational, cultural, environmental and spiritual dimensions of the issues. Accordingly, health care must be seen as a vector of development, by which one presumes that it is an integral part of a strategy for multisectorial intervention, with projects that are likely to be sustainable. Within a development process, projects under consideration must produce an integrated analysis of the needs of the population, new courses of action, congregate efforts and make best use of the resources, inspire synergies and promote the community’s proficiency, motivation and independence. A quality response that meets the needs also presumes that human resources are the most important capital within the heart of an organization; the staff must possess a goodly amount of information that is appropriate to their position, engage in continuous learning and be empowered. Integrated action can only be successful if it is a partnership involving both public services and others provided by the civil society, particularly if it intends to contribute to human development of which health is an integral part.
ABSTRACT - Traditional planning forecasts based on parameter quantification must be substituted by a prospective opinion that uses the scenario method to examine parameters of quality. Among other characteristics, the latter describes the development of the system under study by taking into account the most likely evolution of the key variables by playing with hypothetical behaviours of the actors. Planning must weigh the context in which one is acting, the multiple interests and the relationships of power, influence or conflict that may exist between the several social actors. At the health care system level, the planning process must be based on a decentralised structure that appraises suitable solutions for each territory and the acceptability, from a market viewpoint, of different approaches; there must be a form of give and take, within a context of change, so as to make it easier to attain one’s objectives and increase the actors’ ability to learn and innovate. One must stress the notion of the close relationship that binds health care centres, hospitals and continuous care, both at the public sector level and at the community level, as these health care providers, in the space in which they act, have a more allembracing approach to health, where wellbeing is directly associated to an individual’s quality of life and where, in addition to traditional aspects, they also examine the relational, cultural, environmental and spiritual dimensions of the issues. Accordingly, health care must be seen as a vector of development, by which one presumes that it is an integral part of a strategy for multisectorial intervention, with projects that are likely to be sustainable. Within a development process, projects under consideration must produce an integrated analysis of the needs of the population, new courses of action, congregate efforts and make best use of the resources, inspire synergies and promote the community’s proficiency, motivation and independence. A quality response that meets the needs also presumes that human resources are the most important capital within the heart of an organization; the staff must possess a goodly amount of information that is appropriate to their position, engage in continuous learning and be empowered. Integrated action can only be successful if it is a partnership involving both public services and others provided by the civil society, particularly if it intends to contribute to human development of which health is an integral part.
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Citação
Brissos, Maria Adelaide - O planeamento no contexto da imprevisibilidade : algumas reflexões relativas ao sector da saúde = Planning in a context of imprevisibility : some considerations related to the health care sector. Revista Portuguesa de Saúde Pública. ISSN 0870-9025. Vol. 22, Nº 1 (Janeiro/Junho 2004), p. 43-55
Editora
Universidade Nova de Lisboa, Escola Nacional de Saúde Pública