Performance of the local health system and contingent influences in Northeast-Brazil: breaking vicious and virtuous circles
Performance do sistema de saúde local e influências contingentes no Nordeste do Brasil: quebrando círculos viciosos e virtuosos
Ciênc. Saúde Colet. (Impr.); 18 (11), 2013
Publication year: 2013
INTRODUCTION:
Organizational theory has long emphasized the importance of contingent, environmental influences on organizational performance. Similarly, research has demonstrated the importance of local political culture and informal management on the performance of the local health system, establishing vicious and virtuous circles of influence that contribute to increasing inequalities in performance among decentralized local health systems.OBJECTIVE:
A longitudinal ethnography studied the relationship between these elements in the same rural municipality in Northeast Brazil after a four-year interval. The second study found the local health system performance much improved.Two main factors appear to have interacted to bring this about:
leadership vision and power to implement of one individual; professionalization of the local health system by hiring a significant number of senior health staff.CONCLUSION:
The origins of these influences combine initiatives at local, state and federal levels.
A teoria organizacional tem enfatizado por muito tempo a importância de influências contingentes e ambientais na performance e desempenho organizacional. Igualmente, pesquisas também demonstram a importância da cultura política local e de fatores informais na gerência e desempenho do sistema local de saúde, estabelecendo círculos viciosos e virtuosos que influenciam e contribuem para aumentar as desigualdades nos sistemas descentralizados da saúde.