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Planeamento estratégico em saúde no contexto da Agenda 2030 para o desenvolvimento sustentável
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A necessidade de aprofundar o conhecimento quanto à potencial contribuição do planeamento estratégico em saúde para o aumento do nível de saúde das populações e o fortalecimento dos sistemas de saúde no paradigma do desenvolvimento sustentável e quadro concetual e operacional da Agenda 2030 para o Desenvolvimento Sustentável, tem sido expressa em Portugal e no mundo. Ciente desse potencial, mas, também, da complexidade em ajustar o planeamento ao modelo de desenvolvimento humano vigente e, simultaneamente, aos desafios crescentes que se têm colocado à saúde nas últimas décadas, com particular atenção para os inerentes à pandemia de COVID-19, foi desenhada esta investigação com o objetivo geral de contribuir para a construção de um modelo de planeamento estratégico em saúde aos níveis nacional e internacional, em conformidade com o modelo conceptual do desenvolvimento sustentável e os princípios, valores e objetivos da Agenda 2030 para o Desenvolvimento Sustentável.
Optando-se por uma abordagem metodológica de métodos mistos com dominância qualitativa, procurou-se responder à pergunta de investigação recorrendo à estratégia de estudo de caso, centrada no planeamento estratégico em saúde enquanto caso. Os resultados globais da investigação emergiram da integração dos resultados de quatro estudos específicos – um estudo qualitativo, dois estudos quali-quantitativos e um estudo quantitativo -, desenvolvidos para dar resposta a quatro objetivos específicos. Foram utilizados dados primários recolhidos por observação participativa, análise documental e questionários, e secundários recolhidos por revisão da literatura e análise documental. Analiticamente, recorreu-se a análise documental, análise temática, análise estatística univariada, análise estatística para cálculo do coeficiente alfa de Cronbach e análise da materialidade.
Os resultados mostraram de forma convergente que a mobilização social e das comunidades no processo de planeamento em saúde parece ser facilitador da seleção e implementação de estratégias de saúde no contexto do desenvolvimento sustentável, o que foi reforçado pela pandemia de COVID-19, parecendo urgente a consensualização da nomenclatura inerente ao planeamento em saúde sustentável. O modelo GAPFRAME, um dos instrumentos de apoio à operacionalização do processo de planeamento, foi adaptado para Portugal e avaliado quanto à consistência interna das suas dimensões através do coeficiente alfa de Cronbach, que se mostrou entre alta e muito alta. Sendo utilizado como referencial de uma análise da materialidade, foi possível priorizar questões de sustentabilidade percecionadas como de elevada relevância para a elaboração e implementação de planos de saúde sustentável por todos os setores da sociedade em Portugal. A análise da materialidade revelou, ainda, um potencial interessante na mobilização de toda a sociedade na priorização estratégica. Por outro lado, os profissionais de saúde pública expressaram uma perceção favorável quanto à aceitação do processo de planeamento em saúde sustentável por profissionais, sociedade civil e população, mas menos favorável em relação à capacitação, tempo dedicado e disponibilidade de recursos humanos e financeiros para a prática ao nível subnacional, comprometendo a sua exequibilidade, embora com possibilidade de reversão. Conclui-se que com desenvolvimentos metodológicos adequados, o planeamento em saúde adaptado à Agenda 2030 para o Desenvolvimento Sustentável é aceitável, exequível e desejável para garantir o contributo do setor da saúde para a consecução dessa Agenda.
ABSTRACT, The need to deepen knowledge regarding the potential contribution of strategic health planning to increasing the health level of populations and strengthening health systems in the paradigm of sustainable development and the conceptual and operational framework of the 2030 Agenda for Sustainable Development, has been expressed in Portugal and around the world. Aware of this potential, but also of the complexity of adjusting planning to the current human development model and, simultaneously, to the growing challenges that have faced health over the decades, with particular attention to those inherent to the COVID-19 pandemic, this research project was designed with the general objective of contributing to the construction of a strategic health planning model at national and international levels, in accordance with the conceptual model of sustainable development and the principles, values and objectives of the 2030 Agenda for Sustainable Development. Opting for a methodological approach of mixed methods with qualitative dominance, we sought to answer the research question using the case study strategy, centred on strategic health planning as a case. The overall research results emerged from the integration of the results of four specific studies – one qualitative study, two qualitative-quantitative studies and one quantitative study -, developed to meet four specific objectives. Primary data collected through participatory observation, document analysis and questionnaires were used, and secondary data collected through literature review and document analysis. Analytically, document analysis, thematic analysis, univariate statistical analysis, statistical analysis to calculate Cronbach's alpha coefficient and materiality analysis were used. The results convergently showed that social and community mobilization in the health planning process appears to facilitate the selection and implementation of health strategies in the context of sustainable development, which was reinforced by the COVID-19 pandemic, making it urgent to consensus on the nomenclature inherent to sustainable health planning. The GAPFRAME model, one of the instruments to support the operationalization of the planning process, was adapted for Portugal and evaluated for the internal consistency of its dimensions using Cronbach's alpha coefficient, which was found to be between high and very high. Being used as a framework for a materiality analysis, it was possible to prioritize sustainability issues perceived as highly relevant for the development and implementation of sustainable health plans by all sectors of society in Portugal. The analysis of materiality also revealed an interesting potential in mobilizing the entire society in strategic prioritization. On the other hand, public health professionals expressed a favourable perception regarding the acceptance of the sustainable health planning process by professionals, civil society and the population, but less favourable in relation to training, dedicated time and availability of human and financial resources for the practice at the subnational level, compromising its viability, although with the possibility of reversal. It is concluded that with adequate methodological developments, health planning adapted to the 2030 Agenda for Sustainable Development is acceptable, viable and desirable to guarantee the contribution of the health sector to the achievement of this Agenda.
ABSTRACT, The need to deepen knowledge regarding the potential contribution of strategic health planning to increasing the health level of populations and strengthening health systems in the paradigm of sustainable development and the conceptual and operational framework of the 2030 Agenda for Sustainable Development, has been expressed in Portugal and around the world. Aware of this potential, but also of the complexity of adjusting planning to the current human development model and, simultaneously, to the growing challenges that have faced health over the decades, with particular attention to those inherent to the COVID-19 pandemic, this research project was designed with the general objective of contributing to the construction of a strategic health planning model at national and international levels, in accordance with the conceptual model of sustainable development and the principles, values and objectives of the 2030 Agenda for Sustainable Development. Opting for a methodological approach of mixed methods with qualitative dominance, we sought to answer the research question using the case study strategy, centred on strategic health planning as a case. The overall research results emerged from the integration of the results of four specific studies – one qualitative study, two qualitative-quantitative studies and one quantitative study -, developed to meet four specific objectives. Primary data collected through participatory observation, document analysis and questionnaires were used, and secondary data collected through literature review and document analysis. Analytically, document analysis, thematic analysis, univariate statistical analysis, statistical analysis to calculate Cronbach's alpha coefficient and materiality analysis were used. The results convergently showed that social and community mobilization in the health planning process appears to facilitate the selection and implementation of health strategies in the context of sustainable development, which was reinforced by the COVID-19 pandemic, making it urgent to consensus on the nomenclature inherent to sustainable health planning. The GAPFRAME model, one of the instruments to support the operationalization of the planning process, was adapted for Portugal and evaluated for the internal consistency of its dimensions using Cronbach's alpha coefficient, which was found to be between high and very high. Being used as a framework for a materiality analysis, it was possible to prioritize sustainability issues perceived as highly relevant for the development and implementation of sustainable health plans by all sectors of society in Portugal. The analysis of materiality also revealed an interesting potential in mobilizing the entire society in strategic prioritization. On the other hand, public health professionals expressed a favourable perception regarding the acceptance of the sustainable health planning process by professionals, civil society and the population, but less favourable in relation to training, dedicated time and availability of human and financial resources for the practice at the subnational level, compromising its viability, although with the possibility of reversal. It is concluded that with adequate methodological developments, health planning adapted to the 2030 Agenda for Sustainable Development is acceptable, viable and desirable to guarantee the contribution of the health sector to the achievement of this Agenda.
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Saúde pública Planeamento estratégico Desenvolvimento suscentável