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This paper analyzed the Burnout Syndrome (BS) among the managers of the Family Health Strategy (ESF) in the city of Rio de Janeiro and its associations with factors that influence the presence/absence of BS among these professionals. This is a descriptive study that used data from a questionnaire consisting of two parts: 1) manager profile and factors that could influence the presence of Burnout; 2) Maslach Burnout Inventory. The return rate was 63.5% (143) of the 225 questionnaires sent. The ESF managers are generally nurses (68.6%), young (63.6% under 39 years) female (76.9%), who have acted as managers for less than 5 years (85.2%). A BS presence was identified in 11.2% of the managers. The factors of an organizational nature were those that obtained the highest number of variables with an association. These data point to the need to make changes in the organizational practices of services and changes in work processes. Further studies on these issues can contribute to this.

Este artigo analisou a Síndrome de Burnout (SB) entre os gerentes da Estratégia de Saúde da Família (ESF) no Município do Rio de Janeiro e suas associações entre os fatores que influenciam a presença/ausência da SB nesses profissionais. Com natureza descritiva, ele utilizou um questionário, composto de duas partes: 1) perfil do gerente e fatores que possam influenciar a presença de Burnout; 2) Inventário Maslach Burnout Inventory. A taxa percentual de retorno foi de 63,5% (143) dos 225 enviados. Os gerentes da ESF são em geral, enfermeiros (68,6%), jovens (74,5% até 39 anos), do sexo feminino (76,9%) e que atuam na gerência há menos de 5 anos (85,2%). A presença da SB foi identificada em 11,2% dos gerentes. Os fatores de natureza organizacional foram os que obtiveram maior número de variáveis com associação. Esses dados apontam para necessidade de realização de mudanças nas práticas organizativas de serviços e de mudanças nos processos de trabalho. A realização de outros estudos, que aprofundem estas questões, pode contribuir neste sentido.

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Resumo Este artigo analisou a Síndrome de Burnout (SB) entre os gerentes da Estratégia de Saúde da Família (ESF) no Município do Rio de Janeiro e suas associações entre os fatores que influenciam a presença/ausência da SB nesses profissionais. Com natureza descritiva, ele utilizou um questionário, composto de duas partes: 1) perfil do gerente e fatores que possam influenciar a presença de Burnout; 2) Inventário Maslach Burnout Inventory. A taxa percentual de retorno foi de 63,5% (143) dos 225 enviados. Os gerentes da ESF são em geral, enfermeiros (68,6%), jovens (74,5% até 39 anos), do sexo feminino (76,9%) e que atuam na gerência há menos de 5 anos (85,2%). A presença da SB foi identificada em 11,2% dos gerentes. Os fatores de natureza organizacional foram os que obtiveram maior número de variáveis com associação. Esses dados apontam para necessidade de realização de mudanças nas práticas organizativas de serviços e de mudanças nos processos de trabalho. A realização de outros estudos, que aprofundem estas questões, pode contribuir neste sentido.

Abstract This paper analyzed the Burnout Syndrome (BS) among the managers of the Family Health Strategy (ESF) in the city of Rio de Janeiro and its associations with factors that influence the presence/absence of BS among these professionals. This is a descriptive study that used data from a questionnaire consisting of two parts: 1) manager profile and factors that could influence the presence of Burnout; 2) Maslach Burnout Inventory. The return rate was 63.5% (143) of the 225 questionnaires sent. The ESF managers are generally nurses (68.6%), young (63.6% under 39 years) female (76.9%), who have acted as managers for less than 5 years (85.2%). A BS presence was identified in 11.2% of the managers. The factors of an organizational nature were those that obtained the highest number of variables with an association. These data point to the need to make changes in the organizational practices of services and changes in work processes. Further studies on these issues can contribute to this.

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CONTEXT AND OBJECTIVES: The health technology assessment (HTA) process has been developed locally. The aim of this study was to describe, analyze and compare the opinions of participants in international health economics symposia about the HTA process used in Brazil. DESIGN AND SETTING: Observational cross-sectional study at the 2006 and 2008 International Health Economics Symposia, in São Paulo. METHODS: A structured questionnaire was applied. For the statistical analysis, the percentage distribution for each category was calculated, and variables were compared using tests for two-sample proportion hypotheses. RESULTS: Totals of 153 and 74 participants answered the 2006 and 2008 surveys, respectively. The response rate was better for the 2006 survey (67.1%) than for the 2008 survey (31.8%). Most interviewees were between the ages of 30 and 49 years and were managers in the healthcare system. Most of them considered that the current HTA process was incomplete and unable to meet the needs of the healthcare system. They mentioned the government, academia and experts as the three main groups of people who should be involved in the process, and selected efficiency/effectiveness, safety and disease relevance as the three main criteria to be considered in the HTA process. There is a trend towards developing decentralized regionalized HTA processes, with separate assessment and decision-making for the public and private systems. CONCLUSIONS: The HTA concept is well known. Healthcare system players feel that the process has methodological limitations. Additional surveys are needed to track the HTA process and its application in Brazil.

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CONTEXT AND OBJECTIVES: The health technology assessment (HTA) process has been developed locally. The aim of this study was to describe, analyze and compare the opinions of participants in international health economics symposia about the HTA process used in Brazil. DESIGN AND SETTING: Observational cross-sectional study at the 2006 and 2008 International Health Economics Symposia, in São Paulo. METHODS: A structured questionnaire was applied. For the statistical analysis, the percentage distribution for each category was calculated, and variables were compared using tests for two-sample proportion hypotheses. RESULTS: Totals of 153 and 74 participants answered the 2006 and 2008 surveys, respectively. The response rate was better for the 2006 survey (67.1 percent) than for the 2008 survey (31.8 percent). Most interviewees were between the ages of 30 and 49 years and were managers in the healthcare system. Most of them considered that the current HTA process was incomplete and unable to meet the needs of the healthcare system. They mentioned the government, academia and experts as the three main groups of people who should be involved in the process, and selected efficiency/effectiveness, safety and disease relevance as the three main criteria to be considered in the HTA process. There is a trend towards developing decentralized regionalized HTA processes, with separate assessment and decision-making for the public and private systems. CONCLUSIONS: The HTA concept is well known. Healthcare system players feel that the process has methodological limitations. Additional surveys are needed to track the HTA process and its application in Brazil.

CONTEXTO E OBJETIVOS: O processo de avaliação de tecnologias em saúde (ATS) tem sido desenvolvido localmente. O objetivo deste estudo foi descrever, analisar e comparar as opiniões dos participantes dos simpósios internacionais de economia da saúde sobre o processo de ATS utilizado no Brasil. TIPO DE ESTUDO E LOCAL: Estudo observacional transversal, realizado nos Simpósios Internacionais de Economia da Saúde de 2006 e 2008, em São Paulo. MÉTODOS: Um questionário estruturado foi aplicado. A análise estatística calculou a distribuição percentual de cada categoria e comparou as variáveis com teste de hipóteses de proporções de duas amostras. RESULTADOS: Um total de 153 e 74 participantes responderam às pesquisas de 2006 e 2008, respectivamente. A taxa de resposta foi melhor na pesquisa de 2006 (67,1 por cento) do que na pesquisa de 2008 (31,8 por cento). A maioria dos entrevistados estava entre 30 e 49 anos e era composta de gestores do sistema de saúde. A maioria considerou o atual processo de ATS incompleto e incapaz de satisfazer as necessidades do sistema de saúde. Entrevistados mencionaram o governo, academia e especialistas como os três principais grupos de pessoas que deveriam estar envolvidos no processo, e eficiência/efetividade, segurança e relevância da doença como os três principais critérios a serem considerados no processo de ATS. Existe a tendência de desenvolvimento de um processo de ATS descentralizado e regionalizado com avaliações e decisões separadas para o sistema público e privado. CONCLUSÕES: O conceito ATS é conhecido. Os atores do sistema de saúde acham que o processo tem limitações metodológicas. Pesquisas adicionais são necessárias para acompanhar o processo de ATS e sua aplicação no Brasil.

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OBJETIVO: Analisar as mudanças decorrentes do processo de descentralização do Sistema Único de Saúde na governança do setor saúde no âmbito do poder local entre 1996 e 2006. MÉTODOS: Um questionário foi aplicado aos gestores municipais de saúde de todo o Brasil em 1996 e novamente em 2006. Foram coletadas informações sobre as características de inovação da gestão em três dimensões: social, gerencial e assistencial. O presente artigo analisa resultados referentes à dimensão social da gestão (relação entre a gestão municipal e os diferentes atores da sociedade) a partir de quatro atributos: elaboração do orçamento (qual o grau de influência de atores variados), estabelecimento de prioridades, prestação de contas e fluxo de informações para a sociedade. RESULTADOS: Aumentou a influência dos secretários e dos conselhos municipais de saúde na elaboração do orçamento, em detrimento da influência dos políticos locais. Na definição de prioridades em saúde, reduziu-se a solicitação dos políticos locais e a demanda espontânea e fortaleceram-se o parecer do corpo técnico e as propostas dos conselhos e das conferências de saúde. Observa-se a institucionalização da prática de prestação de contas em virtude da diversificação do conjunto de atores a que se direciona (especialmente câmara de vereadores e conselho de saúde) e dos mecanismos utilizados, embora continue prevalecendo o uso de balancete periódico (que implica em conhecimento técnico para interpretação dos resultados). Por fim, as informações oferecidas à população ainda se referem acima de tudo às ações e campanhas de saúde e ao funcionamento de serviços, embora tenha crescido a divulgação de informações inovadoras à sociedade. Esse padrão se observa em todas as regiões e portes populacionais, com tendências mais progressivas na região Sul. CONCLUSÕES: A relação entre estado e sociedade modificou-se em direção a um padrão mais democrático de governança local, embora tenham sido mantidas práticas governamentais concentradoras de poder na tomada de decisão. O processo de descentralização ainda encontra obstáculos importantes para a concretização de um modelo de maior participação, controle social, responsabilização e interação entre Estado e sociedade.

OBJECTIVE: To analyze the changes in local health care governance resulting from the decentralization process associated with the Unified Health System (SUS) in Brazil between 1996 and 2006. METHODS: A questionnaire was answered in 1996 and again in 2006 by all city officials involved in health care management in Brazil. Information was collected on the innovative characteristics of administrative practices in terms of three dimensions: social, management, and care. The present article analyzes the results relating to the social dimension (relationship between municipal officials and the various community actors) according to four attributes: preparing the budget (degree of influence of various actors), establishing priorities, accountability, and flow of information to the community. RESULTS: The influence of municipal secretaries of health and health councils on budget preparation has increased, with a decrease of local politician influence. In prioritizing health issues, local politicians and spontaneous demands have also become less influential, with strengthening of the influence of technical opinions and proposals by health councils and conferences. Public disclosure of results has become institutionalized as a result of the diversification of stakeholders (especially municipal secretaries and health councils) and of the methods available for disclosure, even though balance sheets are still the most common type of information disclosed (which imply technical knowledge for interpretation of results). Finally, the information conveyed to the community still mainly refers to health actions and campaigns and functioning of health services, even though a larger amount of innovative information is being communicated. This was observed in all regions and in cities of all sizes, with a more progressive trend in the South of Brazil. CONCLUSIONS: The relationship between government and society has changed toward a more democratic standard of local governance, despite the maintenance of centralized government decision-making practices. The process of decentralization still faces important obstacles to the establishment of a more participative model, with enhanced social control, accountability and interaction between government and society.

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OBJECTIVE: To analyze the changes in local health care governance resulting from the decentralization process associated with the Unified Health System (SUS) in Brazil between 1996 and 2006. METHODS: A questionnaire was answered in 1996 and again in 2006 by all city officials involved in health care management in Brazil. Information was collected on the innovative characteristics of administrative practices in terms of three dimensions: social, management, and care. The present article analyzes the results relating to the social dimension (relationship between municipal officials and the various community actors) according to four attributes: preparing the budget (degree of influence of various actors), establishing priorities, accountability, and flow of information to the community. RESULTS: The influence of municipal secretaries of health and health councils on budget preparation has increased, with a decrease of local politician influence. In prioritizing health issues, local politicians and spontaneous demands have also become less influential, with strengthening of the influence of technical opinions and proposals by health councils and conferences. Public disclosure of results has become institutionalized as a result of the diversification of stakeholders (especially municipal secretaries and health councils) and of the methods available for disclosure, even though balance sheets are still the most common type of information disclosed (which imply technical knowledge for interpretation of results). Finally, the information conveyed to the community still mainly refers to health actions and campaigns and functioning of health services, even though a larger amount of innovative information is being communicated. This was observed in all regions and in cities of all sizes, with a more progressive trend in the South of Brazil. CONCLUSIONS: The relationship between government and society has changed toward a more democratic standard of local governance, despite the maintenance of centralized government decision-making practices. The process of decentralization still faces important obstacles to the establishment of a more participative model, with enhanced social control, accountability and interaction between government and society.

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OBJETIVO: Adaptar y evaluar una herramienta de autodiagnóstico de la capacidad de los equipos de gestión de salud para utilizar la investigación, con énfasis en su adquisición, análisis, adaptación y aplicación. MATERIAL Y MÉTODOS: La herramienta se tradujo al español y se elaboró un manual sometido a la autorización de la Comisión de Ética del Instituto Nacional de Salud Pública, antes de su aplicación durante el periodo de abril a noviembre del 2007 en 122 unidades (tasa de respuesta de 84.4 por ciento) para cubrir una amplia gama de instituciones en seis entidades contrastantes de México, según el índice de desarrollo humano (IDH). Se validó la herramienta de manera interna y externa con métodos estadísticos. RESULTADOS: Se observaron diferencias en la capacidad de los equipos para cada fase de utilización, sin importar cuáles fueran su composición por género, experiencia o estudios, pero sí la participación en la atención a los pacientes, de acuerdo con el IDH de los estados. CONCLUSIONES: La herramienta se validó de modo interno y externo para su aplicación en diversas condiciones de México. Puede aplicarse en cualquier país de habla hispana.

OBJECTIVE: A tool was adapted and evaluated for the self-assessment by health management teams of their capacity to utilize research, distinguishing between its acquisition, analysis, adaptation and application. MATERIAL AND METHODS: The tool was translated into Spanish and a manual was created. The manual was submitted for authorization to the Ethics Committee of the National Public Health Institute of Mexico. The kit was sent to 122 units (response rate of 84.4 percent), covering a wide range of institutions in six contrasting states of Mexico according to the Human Development Index (HDI). The tool was validated internally and externally using statistical methods. RESULTS: Differences were observed in the teams' research utilization capacity within each phase, regardless of their composition by gender, experience or academic level but with differences according to the extent of involvement in patient care and to the states' HDI. CONCLUSIONS: The tool was validated both internally and externally for its application under widely varying conditions in Mexico. The tool can be applied in any Spanish speaking country.

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OBJETIVO: La capacidad de los gestores de servicios de salud para utilizar la investigación en salud es una habilidad fundamental para su desempeño. Se describe y analiza dicha habilidad en relación con cuatro componentes: adquisición del conocimiento, análisis de su calidad y pertinencia, adaptación a las necesidades del proceso de gestión y aplicación en el contexto de la planeación estratégica y la toma de decisiones. Se describen y analizan asimismo las propuestas para fortalecer la capacidad. MATERIAL Y MÉTODOS: Se aplicaron una herramienta de autodiagnóstico y una guía de discusión, sometidas para su autorización a la Comisión de Ética del Instituto Nacional de Salud Pública antes de su aplicación. El trabajo se llevó a cabo durante los meses de abril a noviembre del año 2007 en 122 equipos de gestión en unidades locales de servicio y programación (84.4 por ciento de tasa de respuesta) de instituciones públicas y privadas no lucrativas, en seis entidades contrastantes y representativas de México. RESULTADOS: Se observó un gradiente en la capacidad de utilización entre las entidades. La adquisición del conocimiento es inversamente proporcional al índice de desarrollo humano (IDH). No se detectaron diferencias significativas entre instituciones públicas ni entre el sector público y el privado. La principal necesidad detectada de fortalecimiento radica en la adquisición de investigación. La principal prioridad percibida consiste en incrementar la calificación del personal en investigación en salud. Las entidades con menor IDH tienen necesidades más inmediatas de fortalecimiento. Las medidas de fortalecimiento propuestas a través de los estados varían de acuerdo con su IDH y la sensibilización sobre las bondades de la investigación entre tomadores de decisión es la de mayor mención en las entidades con menor IDH. CONCLUSIONES: Debe impulsarse el autodiagnóstico de la capacidad en las unidades de servicio y programas institucionales...

OBJECTIVE: The perceived capacity of health management teams to utilize research for decision making is assessed, as well as proposals for strengthening such capacity. MATERIALS AND METHODS: A total of 103 management teams (84.4 percent response rate) from a wide range of institutions in six contrasting and representative states in Mexico were asked to assess their perceived capacity for utilizing research and to propose strategies to strengthen that capacity. Qualitative and statistical techniques were used from April to November 2007, after approval by the Mexico National Institute of Public Health (INSP) Ethics Commission. RESULTS: Significant differences across states were found. Only the acquisition of knowledge is significantly correlated with the human development index. The acquisition of research is identified as the priority for strengthening capacity, through increasing the qualifications of personnel in public health research. States with a lower human development index have more immediate needs for strengthening capacity. Proposals for strengthening capacity also depend on whether decision makers are aware of the importance of research. CONCLUSIONS: The use of self-assessment should be encouraged at the state and institutional levels. Different strategies should be used to address differences among states.

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OBJECTIVE: A tool was adapted and evaluated for the self-assessment by health management teams of their capacity to utilize research, distinguishing between its acquisition, analysis, adaptation and application. MATERIAL AND METHODS: The tool was translated into Spanish and a manual was created. The manual was submitted for authorization to the Ethics Committee of the National Public Health Institute of Mexico. The kit was sent to 122 units (response rate of 84.4%), covering a wide range of institutions in six contrasting states of Mexico according to the Human Development Index (HDI). The tool was validated internally and externally using statistical methods. RESULTS: Differences were observed in the teams' research utilization capacity within each phase, regardless of their composition by gender, experience or academic level but with differences according to the extent of involvement in patient care and to the states' HDI. CONCLUSIONS: The tool was validated both internally and externally for its application under widely varying conditions in Mexico. The tool can be applied in any Spanish speaking country.

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OBJECTIVE: The perceived capacity of health management teams to utilize research for decision making is assessed, as well as proposals for strengthening such capacity. MATERIALS AND METHODS: A total of 103 management teams (84.4% response rate) from a wide range of institutions in six contrasting and representative states in Mexico were asked to assess their perceived capacity for utilizing research and to propose strategies to strengthen that capacity. Qualitative and statistical techniques were used from April to November 2007, after approval by the Mexico National Institute of Public Health (INSP) Ethics Commission. RESULTS: Significant differences across states were found. Only the acquisition of knowledge is significantly correlated with the human development index. The acquisition of research is identified as the priority for strengthening capacity, through increasing the qualifications of personnel in public health research. States with a lower human development index have more immediate needs for strengthening capacity. Proposals for strengthening capacity also depend on whether decision makers are aware of the importance of research. CONCLUSIONS: The use of self-assessment should be encouraged at the state and institutional levels. Different strategies should be used to address differences among states.

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