Processo de trabalho do apoiador do Cosems-pr e os desafios e potencialidades do apoio nos territórios

Abstract

Since its implementation, the Unified Health System (SUS) assigns managers the responsibility of improving the administration of the system, in addition to providing better health conditions for the population. With decentralization, municipal managers started to actively participate in decision-making processes among federal entities, requiring the expansion of technical and financial cooperation strategies and instruments between governments, as well as the qualification to strengthen governance in health regions. The Cosems Support Strategy (EAC) emerges as an initiative to strengthen the municipal management of SUS, promoting the protagonism of managers in decision-making spaces. The Cosems supporter works on the democratization of management mechanisms and the strengthening of territorial governance, using Permanent Education as the main tool. This study aims to analyze the work process of the Cosems supporter in Paraná, as well as to identify the challenges and potential of this support in the territories. This is an exploratory and descriptive study, with a qualitative approach, developed in partnership with the State University of Londrina within the scope of the Research Project "Dimensions of Institutional Support in SUS." Data were extracted from the activity reports of Cosems- PR supporters. The data were organized in Microsoft Excel 2013 spreadsheets and presented in tables and graphs of absolute and relative frequencies, analyzed with the help of the IRAMUTEQ® software (Interface of R for Multidimensional Analysis of Texts and Questionnaires), which conducted lexicographical analyses, Correspondence Factor Analysis (CFA), Descending Hierarchical Classification (CHD), and created Text Segments. Then, 30% of the text segments were submitted for analysis with the support of ChatGPT. The results indicate a shift in focus in the supporters' work, from management issues to topics related to education and politics over time. The study reveals that the supporters face internal challenges, such as self- evaluation and reflection on their role, and external challenges related to health managers and the territories in which they operate. Despite these challenges, supporters recognize their potential to promote improvements, collaborate with managers and municipal teams, and implement their support in the territories with strategic planning and execution. Competencies such as empowerment promotion, critical analysis skills, result orientation, teamwork, and resilience were highlighted. The research results can contribute to the institutionalization process of support and the strengthening of public health policies, enhancing public health management.