[The Integrar Project: an evaluation of comprehensive health care services in Vitória, Espírito Santo, Brazil].
This article describes an experience with the integration of various healthcare services, called the Integrar Project, in Vitória, capital of the State of Espírito Santo, Brazil, and analyzes the project's contribution to the development of comprehensive healthcare practices. The case study used a qualitative approach and covered the period from 2000 to 2003, identifying the project's potential in the areas of maternal and child health, continuing health education, and the family health strategy, but also identified difficulties in establishing integrated treatment projects involving both the Family Health Program teams and the various medical specialties. To a major extent the work proposal failed to materialize, highlighting the need to review the strategy to include new forms of communications and developing greater formal cooperation, beyond the existing informal coordination between individuals, teams, or services, based on a contractual logic in public healthcare services. Standards and norms that are negotiated through dialogue and a management contract would allow the involvement of professionals in sharing common goals and changing work processes. Such changes would involve management tools and new values to ensure accountability.
Costa-e-Silva
Vanessa
V
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ 21041-210, Brazil. vanessa@ensp.fiocruz.br
Rivera
Francisco Javier Uribe
FJ
Hortale
Virginia Alonso
VA
D001938:Brazil; D003695:Delivery of Health Care / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D015397:Program Evaluation; D036301:Qualitative Research; D012040:Regional Health Planning / Q000458:organization & administration / Q000592:standards*