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In their pedagogical projects, health management courses focus on multidisciplinarity, interdisciplinarity, comprehensiveness and transversality, whose main merit is to question health issues from different theoretical perspectives. Analyzing these issues under many perspectives does not necessarily mean the development of transversal competences. The development and application of these competences suppose going beyond integrating curricular contents and theory/practice. They depend on how the knowledge will be articulated to changes at organizational, sectorial and institutional levels and on the coevolution between these competences and changes. It is understood that health services manager role is effectively transversal when he/she: (i) acts at organizational boundaries, fostering interaction between organizations and other actors in the system; (ii) provides (and receives) feedback to (and from) these actors; and (iii) these feedbacks help decision makers to undertake organizational changes to respond to the environment and shape it.

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ABSTRACT In their pedagogical projects, health management courses focus on multidisciplinarity, interdisciplinarity, comprehensiveness and transversality, whose main merit is to question health issues from different theoretical perspectives. Analyzing these issues under many perspectives does not necessarily mean the development of transversal competences. The development and application of these competences suppose going beyond integrating curricular contents and theory/practice. They depend on how the knowledge will be articulated to changes at organizational, sectorial and institutional levels and on the coevolution between these competences and changes. It is understood that health services manager role is effectively transversal when he/she: (i) acts at organizational boundaries, fostering interaction between organizations and other actors in the system; (ii) provides (and receives) feedback to (and from) these actors; and (iii) these feedbacks help decision makers to undertake organizational changes to respond to the environment and shape it.

RESUMO Em seus projetos pedagógicos, os cursos de gestão de saúde privilegiam a multidisciplinaridade, interdisciplinaridade, integralidade e transversalidade, cujo principal mérito é problematizar as questões da saúde sob diferentes perspectivas teóricas. Analisar as questões da área da saúde a partir de diversos prismas não implica necessariamente no desenvolvimento de competências transversais. O desenvolvimento e a aplicação dessas competências pressupõem ir além da integração entre conteúdos curriculares e entre teoria e prática. Dependem de como os conhecimentos serão articulados às mudanças nos níveis organizacional, setorial e institucional e da coevolução entre essas competências e essas mudanças. Entende-se que a atuação do gestor de serviços de saúde é efetivamente transversal quando: (i) atua nas fronteiras organizacionais, fomentando a interação entre as organizações e outros atores do sistema; (ii) provê (e recebe) feedbacks para esses (desses) atores; e (iii) esses feedbacks auxiliam os tomadores de decisão a empreender mudanças organizacionais, de modo a responder ao ambiente e a moldá-lo.

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En este trabajo se analiza brevemente la importancia de la preparación y superación de los cuadros directivos y las reservas en Cuba. Asimismo, se recogen los criterios expresados al respecto por los principales dirigentes revolucionarios y el Estado cubano, y se plantean las condiciones que requieren los cuadros para que puedan estudiar e investigar, así como el objetivo general y los principios de su capacitación. Se examina otro elemento que caracteriza el proceso: su contenido, organizado en componentes, y por último se enuncian cuáles son las competencias directivas que precisa un cuadro revolucionario. Se concluye que la preparación y superación de cuadros y reservas es un proceso sistemático y continuo, de primordial importancia para el transcurso revolucionario(AU)

In this work the importance of preparation and occupational training of cadres and reserves in Cuba is briefly analyzed. Also, the approaches expressed in this respect by our main revolutionary leaders and the Cuban State are collected, and they think about the conditions required by cadres so that they can study and investigate, as well as the general objective and training principles of them. Another element that characterizes the process is examined: its content, organized in components, and lastly the managing competences needed by a revolutionary cadre are enunciated. It is concluded that the preparation and occupational training of cadres and reserves are a systematic and continuous process of essential importance for the revolutionary course(AU)

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Introducción: el entrenamiento es una figura académica del posgrado, utilizada en el sistema de preparación y superación de los directivos. Objetivo: evaluar el impacto del entrenamiento a equipos de dirección de la provincia de Santiago de Cuba, luego de 2 años de realizado. Métodos: se realizó una investigación en sistemas y servicios de salud, cuya muestra se seleccionó por conveniencia y consistió en 120 cuadros y reservas, quienes cursaron el entrenamiento y se mantenían en el cargo o fueron promovidos a otro durante ese período. A tales efectos se utilizó la metodología establecida por la Escuela Nacional de Salud Pública, y se trazaron criterios, indicadores y estándares a partir de las temáticas de algunas habilidades que fueron impartidas en el entrenamiento. Asimismo se aplicaron encuestas a los entrenados y a sus colaboradores y se efectuó una revisión documental. Resultados: en la serie predominaron los directivos del grupo etario de 41-55 años y del sexo femenino; de igual modo, más de la tercera parte de los directivos presentaban de 1-3 años en el cargo y otra cantidad similar, más de 6 años. Los médicos representaron la profesión más frecuente (46,0 por ciento), cuya mayoría (60,0 por ciento) provenía de la reserva o había sido promovida de otros cargos. Al triangular los datos, el criterio reunión", con los subcriterios tiempo de duración, el no nombramiento de un facilitador y la presencia del directivo no era necesaria, fueron los de mayor desviación con el estándar trazado. Conclusiones: la evaluación resultó inadecuada, pues 82,6 por ciento de los criterios y 81,1 por ciento de los subcriterios obtuvieron calificación de inadecuada(AU)

Introduction: training is an academic element of postdegree, used in the preparation and training system for cadres. Objective: to evaluate the impact from the training management teams from Santiago de Cuba province, after 2 years. Methods: an investigation in systems and services of health was carried out whose sample was selected by convenience and it consisted on 120 cadres and substitutes who studied the training and they stayed in their responsabilities or they were promoted to another one during that period. For this purpose, the methodology established by the National School of Public Health was used, and criteria, indicators and standards were traced based on the thematic of some skills that were delivered during training. Also surveys were applied those trained and to their collaborators and a literature review was carried out. Results: in the series, cadres of the group 41-55 years and female sex prevailed; in the same way, more than the third part of the cadres had of 1-3 years in the responsability and other similar quantity, more than 6 years. The doctors represented the most frequent profession (46.0 percent), whose majority (60.0 percent) came from the substitutes or had been promoted from other responsability. When triangulating data, the criterium meeting", with the subcriterium duration time, the non designation of a facilitator and the cadres presence was not necessary, were those of greater deviation with the standard. Conclusions: the evaluation was inadequate, because 82.6 percent of the criteria and 81.1 percent of the subcriteria obtained qualification of inadequate(AU)

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Decentralization in Brazil's Unified National Health System is challenging the management capability at the local level. Municipalities are required to operate health teams, provide infrastructure, technology, and supplies for the health services, and organize the work process. An epidemiological survey assessed the management of work, education, information, and communication in primary care services in 41 municipalities with more than 100,000 inhabitants each in the Northeast and South of the country. Health professionals and administrators were insufficiently trained for their daily responsibilities, and the infrastructure and management tools were deficient. Precarious work contracts (lack of formal job stability) for health workers is a serious problem in Brazil's primary care system. The work supervision was weakly linked to health care and planning. Continuing education for the health team was limited, and health information focused only on collection of data to send to the State and Federal management levels. Thus far health communication has been ineffective as a tool to connect primary care managers and professionals to the population and society.

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A descentralização das ações no Sistema Único de Saúde requer competências específicas para a gestão municipal. As demandas incluem o gerenciamento de equipes de trabalho, estrutura física e tecnológica, e organização de insumos e estratégias. Por meio de inquérito epidemiológico estudou-se a gestão do trabalho, da educação, da informação e da comunicação na atenção básica à saúde de 41 municípios com mais de 100 mil habitantes das regiões Sul e Nordeste do Brasil. Evidenciou-se uma escassa profissionalização dos gestores e limitações importantes das estruturas e instrumentos de gestão. A precarização do trabalho é um problema relevante na atenção básica. A supervisão do trabalho está pouco direcionada ao planejamento e às práticas de saúde. A educação permanente de trabalhadores se limita a particularidades das ações de saúde. Geralmente, a informação em saúde no âmbito municipal se restringe à coleta e transferência de dados às esferas estadual e federal. Já a comunicação não se constitui em uma estratégia efetiva de vinculação entre gestores, trabalhadores, população e controle social.

Decentralization in Brazil's Unified National Health System is challenging the management capability at the local level. Municipalities are required to operate health teams, provide infrastructure, technology, and supplies for the health services, and organize the work process. An epidemiological survey assessed the management of work, education, information, and communication in primary care services in 41 municipalities with more than 100,000 inhabitants each in the Northeast and South of the country. Health professionals and administrators were insufficiently trained for their daily responsibilities, and the infrastructure and management tools were deficient. Precarious work contracts (lack of formal job stability) for health workers is a serious problem in Brazil's primary care system. The work supervision was weakly linked to health care and planning. Continuing education for the health team was limited, and health information focused only on collection of data to send to the State and Federal management levels. Thus far health communication has been ineffective as a tool to connect primary care managers and professionals to the population and society.

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Objective. The evaluation of a reading skill to critically read theoretical texts, interpretation; at different groups linked to investigation and, explore if a closer, longer experience with this, can influence this skill development. Material and methods. An instrument that comprises a text on epistemologic aspects and the relation of science with society, was validated. It was applied on four natural groups, selected by a degree of involvement they had shown in health research: students at "pre-degree" (n = 23); students at post-degree (n = 19), academic administrative assessors (n = 17), and professional researchers (n = 20). Results. Reliability coeficients of the instrument were 0.91 y 0.94. From 74 as maximum score expected, medians of groups were 19 for pre-grade and post-grade students, 17 for assessors, and 21 for researchers (p = 0.50). Conclusions. The not sufficient ability to critically read a text, that we supposed was more or lest related to all studied groups, come to be highly relevant, when a need for the researcher to acquire plain understanding, of the importance of his actions is acknowledged. And on the other hand, the fact that students on upper levels, be conscious of the reason why science is beforehand included in their education.

Objetivo. Valorar una habilidad propia de la lectura crítica de textos teóricos, la interpretación; en distintos grupos vinculados con la investigación y explorar si una experiencia más cercana y prolongada con ésta, se relaciona con el desarrollo de esa habilidad. Material y métodos. Se validó un instrumento que contiene un texto sobre aspectos epistemológicos y la relación de la ciencia con la sociedad. Se aplicó en cuatro grupos naturales, escogidos por el grado en que aparentemente se habían involucrado con la investigación en salud: estudiantes de pregrado (n = 23); estudiantes de posgrado (n = 19), asesores académico-administrativos (n = 17) e investigadores profesionales (n = 20). Resultados. Los coeficientes de confiabilidad del instrumento fueron de 0.91 y 0.94. De una puntuación máxima esperada de 74, las medianas de los grupos fueron: 19 para los estudiantes de pregrado y de posgrado, 17 para los asesores y 21 para los investigadores (p = 0.50). Conclusiones. La insuficiente habilidad para interpretar un texto con una temática que supusimos más o menos de interés para los grupos estudiados, toma gran relevancia cuando se reconoce la necesidad de que el investigador adquiera plena conciencia de la trascendencia de sus acciones. Y, por otra parte, el que los estudiantes de nivel superior también sean conscientes del porqué se antepone la ciencia en su formación.

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OBJECTIVE: The evaluation of a reading skill to critically read theoretical texts, interpretation; at different groups linked to investigation and, explore if a closer, longer experience with this, can influence this skill development. MATERIAL AND METHODS: An instrument that comprises a text on epistemologic aspects and the relation of science with society, was validated. It was applied on four natural groups, selected by a degree of involvement they had shown in health research: students at "pre-degree" (n = 23); students at post-degree (n = 19), academic administrative assessors (n = 17), and professional researchers (n = 20). RESULTS: Reliability coeficients of the instrument were 0.91 y 0.94. From 74 as maximum score expected, medians of groups were 19 for pre-grade and post-grade students, 17 for assessors, and 21 for researchers (p = 0.50). CONCLUSIONS: The not sufficient ability to critically read a text, that we supposed was more or lest related to all studied groups, come to be highly relevant, when a need for the researcher to acquire plain understanding, of the importance of his actions is acknowledged. And on the other hand, the fact that students on upper levels, be conscious of the reason why science is beforehand included in their education.

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In Brazil, in recent years, as a result of the increasing participation of county authorities in health care, a need for tools which would contribute to the better preparation of local administrators, complementary to the activities of a more academic nature, has been recognized. One of the possible alternatives is the exploitation of experiences, regarded as successful, in local health care planning and administration, by using them as material for "case studies" in activities with selected groups of health care administrators thus, stimulating the identification of those elements which contributed to the favorable results attained, and their interactions, in the quest for analogies which would facilitate the identification of new perspectives for their own situations. In this article an experience of a "case studies" development, in response to a demand from UNICEF, based on 8 counties in from the North and Northeast, which were successful in using a "focus approach" in their organization of data and their utilisation in a seminar with 21 local managers from both regions, is presented. During the seminar the local health managers attained greater knowledge of the strategies implemented and identified feasible intervention alternatives. The methodological proposition of teaching on the basis of case studies, using a conceptual strategy of grouping experiences according to specific dimensions enabled local health managers to learn from their practical experiences.

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A universidade tem uma grande responsabilidade no esforço para superar a ineficiência e a baixa qualidade dos serviços de saúde hoje oferecidos à populaçäo. Se faz necessário construir um novo espaço assistencial voltado para a preservaçäo da saúde e para a melhoria da qualidade de vida. Para atender a este modelo, é preciso formar gerentes com profundo compromisso social, capacidade inovadora e disposiçäo para agir nas fronteiras do conhecimento, independentemente do setor que atuam. A formaçäo desse novo gerente de saúde exigirá da universidade a construçäo de um novo paradigma.

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Apresenta e discute um arcabouço teórico sobre o papel da administraçäo de saúde e dos programas de educaçäo para profissionalizar os recursos humanos nesta área. Revisa a literatura sobre o ensino de administraçäo de saúde, com ênfase para a evoluçäo histórica desse campo de interesse acadêmico e profissional. Apresenta os achados do estudo de oito programas PROASAs que ilustram a busca de um paradigma para o ensino de administraçäo de saúde e, a seguir, as conclusöes

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O programa de Administraçäo de Enfermagem em Serviços Locais de Saúde está estruturado em cinco unidades didáticas. Seu conteúdo desenvolve-se a partir do estudo da organizaçäo e funcionamento, atual, dos serviços locais de saúde com destaque para as atividades realizadas pelos Serviços e sua relaçäo com problemas e necessidades de saúde da populaçäo de referência. As bases conceituais dos modelos clássicos e psico-sociais da administraçäo se ampliam na configuraçäo da assistência de saúde e de enfermagem como processo de trabalho onde a definiçäo de base territorial, a populaçäo adscrita, os problemas de saúde desta populaçäo e, as medidas de intervençäo compöem o eixo da programaçäo a ser implementada. O sistema de informaçäo, nesta abordagem, é tratado como expressäo desta realidade dinâmica a ser analisado como unidade de programaçäo e de avaliaçäo do trabalho

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Se realizó un estudio acerca del proceso de preparación y desarrollo del personal de dirección. Se presenta un enfoque donde se determina que éste es diferente al resto de los subsistemas de enseñanza y que el aspecto que caracteriza la enseñanza a dirigentes es la práctica de estos en dirección, con la divisa permanente de aprender haciendo como concepción básica; se plantea además, que este proceso requiere de un enfoque sistémico diferenciado y se señala el estudio de las tendencias actuales de este tipo de capacitación en otros países. Se hace referencia a la necesidad de precisar el carácter cibernético del sistema objeto de estudio (AU)

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Este trabalho tem como objetivo estudar as possíveis bases de um paradigma para a educaçäo em administraçäo de serviços de Saúde na América Latina, utilizando as experiências PROASAs como evidências empíricas para um arcabouço teórico proposto e baseado no papel do desempenho esperado de um administrador de serviços de saúde e nos conceitos de conhecimento formal para a profissionalizaçäo, que podem e devem ser transmitidos por um programa acadêmico de ensino. No Capítulo 1 é apresentado e discutido o papel da Administraçäo de Serviço de Saúde, e dos programas de educaçäo para profissionalizar os recursos humanos. No Capítulo 2 é revista a literatura sobre o ensino de administraçäo de saúde, dando ênfase para a evoluçäo histórica desse campo. No Capítulo 3 é descrita a metodologia utilizada para estudar as experiências PROASAs, dando especial atençäo para a discussäo dos problemas que afetam um estudo transnacional, e a importância de um enfoque "iluminativo" para superá-los. No Capítulo 4 säo apresentados, de maneira sistemática, os 8 programas PROASAs estudados e que ilustram a busca de um paradigma para o ensino de administraçäo de serviços de saúde, bem como os principais achados do estudo. No Capítulo 5 säo discutidos esses achados, bem como säo apresentadas conclusöes que representam a contribuiçäo do autor para o desenvolvimento desse campo de estudo

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