Recursos humanos e gestão do trabalho em saúde: da teoria para a ...

51

Recursos humanos e gestão do trabalho em saúde:da teoria para a prática

Célia Regina Pierantoni, Thereza Christina Varella e Tania França

Introdução� A0*.'((* %' ,/#%$&+$9&:G* %&( '.*#*,$&(1 .*#-0&0$&#%* * /?&#$(,*

%' ,'+4*0$& #& 0'A&0-$:G* %&( 0$O/'9&( ' %' /, ,/#%* ,&$( 4*,*8Q#'*1&.$00*/ & &(($,'-0$& '#-0' *( A&Y('(1 '+')&#%* *( A&-&,&0'( %' A*30'9& %'/, .*#I/#-* ,&I*0$-F0$* %' #&:Z'( O/' .*#.'#-0&, %*$( -'0:*( %& A*A/+&:G*,/#%$&+ ' '(-&3'+'.'#%* #*)&( ?*0,&( %' *08&#$9&:G* %* �(-&%* ' %'0''(-0/-/0&:G* A0*%/-$)&H �((&( (G* &(('#-&%&( ', -0Q( 80&#%'( '$@*(� #*)&(-'.#*+*8$&(1 #*)&( ?*0,&( %' *08&#$9&:G* %* -0&3&+4* ' %& A0*%/:G* ' #*)&(?*0,&( %' 8'0'#.$&,'#-*H

�((& 8+*3&+$9&:G* .*#-*0#*/ /,& #*)& %$)$(G* $#-'0#&.$*#&+ %*-0&3&+4*1 '(-&3'+'.'#%* /,& .*#.*00Q#.$& %'(+'&+ '#-0' A&Y('( .'#-0&$(1(',$A'0$?70$.*( ' A'0$?70$.*(H� ( ?*0:&( %* ,'0.&%* #G* *A'0&, #* ('#-$%*%& $8/&+%&%'1 ,&( A*0 '(-Y,/+* & A&%0Z'( .*#.*00'#.$&$( %' '?$.$Q#.$&%'?$#$%*( A'+& 0&.$*#&+$%&%' %* ,*%'+* '.*#K,$.* .&A$-&+$(-&H �((',*)$,'#-* 0'?*0:& /,& %$(A*#$3$+$%&%' %' A*(-*( %' -0&3&+4* ,'#*(O/&+$?$.&%*( ' ,&$( ,&+ 0',/#'0&%*( #*( A&Y('( A*30'( W�*.4,&##1 ��X�

�� %DCCF'� �� (�� *�5 � �� * ��5 �� 6�� (�� *�5 � �� <�� 5�� "��* ��/

(($,1 &( ,/%&#:&( #* ,/#%* %* -0&3&+4* &A0'('#-&, 0'?+'@*(($8#$?$.&-$)*( #& *08&#$9&:G* (*.$'-F0$& ' #* %'(+*.&,'#-* %& .'#-0&+$%&%'

��@��L)�99�#,--4%��F��0�� +��0��0�(��0��$��(��2��0+��0�(��0��Q��+5�0 +�L��+�6��H��+�8��+��$�@�(��0�� +�1��F��+�@��+!��+��+��+�Q��*�+��$�@�(��0��I��+�9��+�)��+�5��+��+8��+�@��+�!�0��G��+��$

Gestão

52

Observatório de Recursos Humanos em Saúde no Brasil. Estudos e Análises – Volume 2

%* -0&3&+4* .*,* '(-0/-/0&#-' %& (*.$&3$+$%&%' 4/,&#&H � ('#-$%* %*-0&3&+4* A0'.$(& ('0 W0'X($8#$?$.&%* ', (/& ?*0,& .*#-',A*0N#'& .*,* -0&3&�+4* (*.$&+ O/' (' .*,A+'@$?$.& ' $#-'#($?$.& 0$-,*( ' A0*.'((*(H (*.$'%&%'%* .&A$-&+ #'.'(($-& .&%& )'9 ,'#*( %* -0&3&+4* '(-F)'+ ' /-$+$9&�(' .&%& )'9,&$( %' ?*0,&( %$)'0($?$.&%&( W#-/#'(1 ��XH

(($,1 &( A*+Y-$.&( .'#-0&%&( ', A0*.'((*( %' 0'?*0,&1 #&( E+-$,&(%7.&%&(1 .*, &( A0*A*($:Z'( 0'+&.$*#&%&( .*, ̂ %$,$#/$:G*^ %* �(-&%*1 A'0%&%& A0*-':G* (*.$&+ %* -0&3&+4* ' %*( -0&3&+4&%*0'(1 8+*3&+$9&:G* ?$#&#.'$0&.*, 4'8',*#$& %* .&A$-&+ ?$#&#.'$0* (*30' * .&A$-&+ A0*%/-$)*1 &80&)&0&, &($-/&:G* %' ',A0'8&3$+$%&%'H � �(-&%* ,Y#$,* 0'-$0&�(' %& '(?'0& A0*%/-$)&A&0& ./,A0$0 ,'+4*0 &( ?/#:Z'( (*.$&$( (', #* '#-&#-* .&,$#4&0 #'((&%$0':G*1 A*$(1 &+7, %' ',A0'8&0 .&%& )'9 ,'#*(1 &80'8& ,'#*( 0'./0(*(A&0& &(('8/0&0 %$0'$-*( &%O/$0$%*(1 A&0-$./+&0,'#-' A&0& %'(',A0'8&%*( ''@.+/Y%*(H

( ?*0,&( )'0-$.&+$9&%&( %& 8'0Q#.$& (G* (/3(-$-/Y%&( A*0 8'0Q#.$&4*0$9*#-&+1 .*, /,& %$,$#/$:G* %&( ?/#:Z'( %' .4'?$& ' & $#-0*%/:G* %'($(-',&( ,&$( A&0-$.$A&-$)*( ' &3'0-*( %' %'.$(G*H ,*-$)&:G* ' *'#)*+)$,'#-* %* -0&3&+4&%*0 .*, *( $#-'0'(('( %& ',A0'(& A&((&, &$#.*0A*0&0 & &8'#%& %& ^#*)& &%,$#$(-0&:G*^H ^?*0:& %' -0&3&+4*^ 7(/3(-$-/Y%& A'+& ̂ $#-'+$8Q#.$& %* -0&3&+4&%*0^1 O/' &((/,' A*($:G* 8'0'#.$&+' %' ,*#$-*0&,'#-*1 &3%$.&#%* %& (/& A*($:G* %' ̂ A0*%/-*0^H �*07,1 '((&(?*0,&( %' 8'0Q#.$& (G* &((/,$%&( (', & #'.'((F0$& &/-*#*,$& A&0&$,A+','#-&:G* %&( &-$)$%&%'( 8'(-*0&(1 (/3,'-$%&( & $#-'0'(('( 0'+&.$*#&%*(1A0$*0$-&0$&,'#-'1 .*, & *0%', '.*#K,$.&H

�*0 */-0& )$&1 &( ',A0'(&( A&((&, & '@$8$0 #*)*( A&-&,&0'( %'O/&+$?$.&:G* A&0& * -0&3&+4&%*01 O/'1 A&0& .*#('8/$0 /, A*(-* %' -0&3&+4*1A0'.$(& %' ,&$( '(.*+&0$%&%' ' ,&$*0 A*+$)&+Q#.$&� #G* 4F .*#('#(* ', -*0#*%& A0*.+&,&%& ̂ 0')&+*0$9&:G* %*( 0'./0(*( 4/,&#*(^ %'.*00'#-' %* A0*.'((*%' ,*%'0#$9&:G* ',A0'(&0$&+H �' A*0 /, +&%* *( -0&3&+4&%*0'( (' )Q',*30$8&%*( & $#-'#-&0 '(?*0:*( &%&A-&-$)*( [( '@$8Q#.$&( %'((& #*)&.*#?*0,&:G* %& A0*%/:G*1 A*0 */-0* /, #E,'0* .&%& )'9 ,&$*0 %' '@.'%'#-'%' ,G*�%'�*30& '#.*#-0&�(' #&( )$&( $#?*0,&$( */ (/3,'-$%&( & ?*0,&(A0'.F0$&( %' -0&3&+4*H

�* .&(* %* ('-*0 (&E%'1 & %'(A'$-* %& A&0-$.$A&:G* %* A&8&,'#-* %'A'((*&+ #*( ./(-*( %*( ($(-',&( %' (&E%'1 .&/(& A'0A+'@$%&%' & 4$(-P0$.&#'8+$8Q#.$& ' ,'(,* & &/(Q#.$& %' A*+Y-$.&( A&0& ��H &+ ?&-* A*%' *.*00'0', 0&9G* %'�

53

Recursos humanos e gestão do trabalho em saúde: da teoria para a prática

� &3*0%&8'#( ,&.0*'.*#K,$.&( O/' ?*.&+$9&, &(A'.-*( O/&#-$-&-$)*(%& ?*0:& %' -0&3&+4* %* ('-*0 (&E%'1 ', %'-0$,'#-* %' /,& &3*0%&8',.*#-',A*0N#'&1 ', #Y)'+ ,$.0*1 O/' (' .*#.'#-0& #& ,*-$)&:G* ' #*%'(',A'#4*]

� A*+Y-$.&( AE3+$.&( .'#-0&+$9&%&( %' 0'8/+&:G* %* ',A0'8*1 %$-&%&(A*0 ('-*0'( ?$#&#.'$0*( %*( 8*)'0#*( ', O/' &( A*+Y-$.&( ('-*0$&$( '(-G*.*#?$#&%&( & /, A&A'+ %' $,A+','#-&:G* ' $#-'0A0'-&:G* %' %$0'-0$9'(#&.$*#&$(]

� #G* )&+*0$9&:G* %* A&A'+ %*( A0*?$(($*#&$(1 '(A'.$&+,'#-' *( ,7%$.*(1./I& ?*0,&:G* '#?&-$9& )&+*0'( 0'+&.$*#&%*( .*, &/-*#*,$& ' 0'8/+&:G*A0*?$(($*#&+ A0PA0$&(1 ,&$( %* O/' .*, ,'-&( A*+Y-$.&( ' *A'0&.$*#&$(%* ($(-',& %' (&E%'H�((& A&/-& 7 %$(-$#-& %* ?*.* %&( 0'?*0,&( ('-*0$&$( ' ('8/0&,'#-'

$#?+/'#.$& & '?$.$Q#.$&1 & '?$.F.$& ' & 'O_$%&%' W�&.41 ��JXH ( .*#('O_Q#.$&(%* #*)* 3&+&#:* (*.$&+ A0*%/9$%* A'+& %$#N,$.& '.*#K,$.& ' & ^-0&#O_$�+$%&%' (*.$&+^ '(-G* #& &8'#%& %*( %'3&-'(H

Agenda global, saúde e recursos humanos� .*#('#(/&+ O/' &( %'($8/&+%&%'( #& %$(-0$3/$:G* %& 0$O/'9& #*

,/#%* &-$#8$0&, &-/&+,'#-' A0*A*0:Z'( )'0%&%'$0&,'#-' &+&0,&#-'(H� #E,'0* %' A*30'( 7 .0'(.'#-' ' IF .4'8& & J�= ,$+4Z'( %' A'((*&( #*,/#%*H �&0& & �08&#$9&:G* %&( �&:Z'( �#$%&( W��X1 * %&%* ,&$(A0'*./A&#-' 7 & -'#%Q#.$& %' O/' '((' #E,'0* &/,'#-' &-7 ��"1 O/&#%* *(A&Y('( ,'#*( %'('#)*+)$%*( A*%'0G* A&((&0 & -'0 �� ,$+4Z'( %' A'((*&()$)'#%* &3&$@* %& +$#4& %' A*30'9&H�

� ?*.* %* -0&3&+4* %' ,/$-&( &8Q#.$&( 3$+&-'0&$( ' ,/+-$+&-'0&$( )',('#%* 0'%/9$0 & A*30'9& %'(('( A&Y('(1 O/' (' '#.*#-0&, .*, &+-* 80&/ %''#%$)$%&,'#-*1 ' &+.&#:&0 /, .*#I/#-* %' ,'-&( $#-'0#&.$*#&$( %'%'('#)*+)$,'#-*H � .*,A*#'#-' ��,-�. A&0& * &+.&#.' %'((&( ,'-&(1 -',*./A&%* A*($:G* %' %'(-&O/' A'+* .*#('#(* $#-'0#&.$*#&+ %&( 0'+&:Z'( '#-0'

��G��4>>-+��0��0�(��0�� .C�0�(��0��D��F�� #��0�(��Q��%J��,/�0�(��+��0�� F��?��4>>-J��8GL��0�(��+��+��7��Q��$��20��0��F��0�(�� #��+�!�0��;��+�A��+�)?��F��+�*��A��+�*��7�R��I�� %$��0��0��0��L83;��$�6��S��*��7�R��+�0��"��0��4/��.>�� #@9HG+�,--.%$

54


A*30'9&1 3&$@* .0'(.$,'#-* '.*#K,$.* ' A7(($,&( .*#%$:Z'( %' (&E%'�

W�&0-$#'9 ' �&0-$#'&/1 ��XH�( A&Y('( A*30'( *#%' &( %*'#:&( -0&#(,$((Y)'$( &((/,', $#%$.&%*0'(

%0&,F-$.*( (G* *( O/' A*((/', 3&$@& .&A&.$%&%' $#(-$-/.$*#&+1 A&0-$./+&0�,'#-' A&0& $,A+','#-&:G* %& A*+Y-$.& ('-*0$&+H &$( A&Y('( -Q, %',*#(-0&%*0'.*00'#-'( ?0&.&((*( #& A0'(-&:G* %' ('0)$:*( O/' &-'#%&, &*( *3I'-$)*( %*('-*0H � A+&#'I&,'#-* ' * 8'0'#.$&,'#-* %' 0'./0(*( 4/,&#*( %& (&E%'.*#?$8/0&,�(' .*,* A*#-*( #*%&$( A&0& * 'O/&.$*#&,'#-* %*( A0*?/#%*(A0*3+',&( 0'+&.$*#&%*( & '((& 3&$@& .&A&.$%&%'H

�*0 */-0& )$&1 &( &3*0%&8'#( .*#.'$-/&$( %* -'0,* ��'/�� 0/1��

(*?0', /,& ')*+/:G*1 ('#%* W0'X($8#$?$.&%* & A&0-$0 %' (/& %'?$#$:G* .+F(($.&1*0$/#%& %& .$Q#.$& %& &%,$#$(-0&:G*1 '(-&#%* (/3*0%$#&%* [ P-$.& %' O/','@'0.' &+8/,& ?/#:G* %' 8'0Q#.$& */ %' A+&#'I&,'#-* W8'0Q#.$& %' .&A&.$%&%'%&( A'((*&(1 &(($, .*,* %*( 0'./0(*( ,&-'0$&$( ' ?$#&#.'$0*( .*, )$(-&( &/,& /-$+$9&:G* ,&$( 0&.$*#&+ ' '?$.$'#-'XH 3(*0)' * .*#.'$-* %' ?*0:& %'-0&3&+4* %& '.*#*,$& A*+Y-$.& .*, * /(* %'(.0$-$)* ' &#&+Y-$.* %*( ?'#K,'#*(%* ,'0.&%* %' -0&3&+4* � ',A0'8*U%'(',A0'8*1 A0*%/:G*1 0'#%&1&((&+&0$&,'#-* ' .*#?$8/0&�(' #& 8'(-G* %* -0&3&+4* � ' %& (*.$*+*8$& %*-0&3&+4*1 ', /, ,$@ O/' '#)*+)' * -0&3&+4*1 * -0&3&+4&%*0 .*,* ̂ ('0 (*.$&+^' & (*.$'%&%'H

� .'#F0$* $#-'0#&.$*#&+ &A*#-& /,& (70$' %' %'(&?$*( #* O/' (' 0'?'0' [(O/'(-Z'( %& 2�� -� ��3�40�H +8/#( IF (' &./,/+&, &* +*#8* %*( &#*(1.*, %'(-&O/'( A&0& & 3&$@& 0',/#'0&:G* ' & ,*-$)&:G* %&( 'O/$A'(1 &$#$O_$%&%' %$(-0$3/-$)& %& ?*0:& %' -0&3&+4*1 %'(',A'#4* ' �� %$#(&-$(?&-P0$*( %*( A0*?$(($*#&$(H �*,&,�(' & '(-'( %'(&?$*( ','08'#-'( .*,*& ,$80&:G* '#-0' A&Y('(1 & 3&$@& .&A&.$%&%' %' A0'A&0&:G* ' ?$@&:G* %'0'./0(*( 4/,&#*( ' * $,A&.-* %&( 'A$%',$&( #& ?*0:& %' -0&3&+4* %& (&E%'10'(/+-&#%* ', &3('#-'Y(,* ' (*30'.&08& %' -0&3&+4* W�&0-$#'9 ' �&0-$#'&/1��XH ($-/&:G* 7 &$#%& &80&)&%& O/&#%* *( A0*80&,&( %' &I/%&$#-'0#&.$*#&+1 &+7, %' &A*#-&0', & #'.'(($%&%' %* '(-&3'+'.$,'#-* %'A*+Y-$.&( ,&.0*'.*#K,$.&( (P+$%&(1 (' 0'?'0', &* O/&%0* %' 0'./0(*(4/,&#*( ', (&E%' &A0'('#-&%* .*,* ̂ 0$(.* */ A0'((/A*(-*^1 .*#%$.$*#&#-'(A&0& & &I/%& ?$#&#.'$0& ' #G* .*,* A0*AP($-* ' *3I'-$)*( ', #Y)'+ %' 0'(/+-&%*H

��)�� 0��?��(��+��0��(��0��0�(��0��+�0��L83��+�� $�*��;��F��0��7��$

��T��T��7��+�� 2��U��? �� $

55


(($,1 #& &8'#%& $#-'0#&.$*#&+ %$)'0($?$.&%*( &-*0'( .*#?+/', '(?*0:*(A&0& & (/A'0&:G* %*( %'(&?$*( 0'+&-$)*( [( O/'(-Z'( %' �� #& F0'& %& (&E%'10'(/,$%*( ', O/&-0* 80&#%'( *3I'-$)*(�� &/,'#-&0 & .*3'0-/0& ' & ?$@&:G* %&( 'O/$A'( %' A0*?$(($*#&$( A&0&

&(('8/0&0 & A0'(-&:G* %' ('0)$:*( %' (&E%' %' ?*0,& &%'O/&%& ''O_$-&-$)&]

� 8&0&#-$0 .*,A'-Q#.$&( ' 4&3$+$%&%'( .4&)'( A&0& & ?*0:& %' -0&3&+4*', (&E%']

� &/,'#-&0 * %'(',A'#4* %& 'O/$A' %' A0*?$(($*#&$( %$&#-' %*( *3I'-$)*(%'?$#$%*(]

� ?*0-&+'.'0 & .&A&.$%&%' %' A+&#'I&,'#-* ' 8'0'#.$&,'#-* %' �� #*('-*0 (&E%'H �08&#$9&:G* �/#%$&+ %& �&E%' W��X &A*#-& '(-0&-78$&( ?*.&+$9&%&(

A&0& & F0'& %' 0'./0(*( 4/,&#*( & ('0', $,A+','#-&%&( & ./0-*1 & ,7%$* '& +*#8* A0&9*(1 O/' $#.+/',�

� '/��5 ?*0-&+'.$,'#-* %' A0F-$.&( 8'0'#.$&$(] &%)*.&.V] %'('#)*+�)$,'#-* %' A*+Y-$.&( A&0& $#.'#-$)*( ' ?$@&:G* %' 0'./0(*( 4/,&#*(]&A*$* &* -0'$#&,'#-* ', ('0)$:*] %$((',$#&:G* %&( #*)&( A0F-$.&(]

� 16-(�5 '(-/%*( %& $,A+','#-&:G* ' %* $,A&.-* %&( A*+Y-$.&( W./(-*(%& ,$80&:G*1 %& ?*0,&:G* ' %* -0'$#&,'#-*1 %& ,*-$)&:G* ' %*($#.'#-$)*(1 %&( .*#%$:Z'( %' -0&3&+4*X] %'('#)*+)$,'#-* %' ($(-',&(%' $#?*0,&:G* %' ��(]

� 4��2�5 ?*0-&+'.$,'#-* %& .&A&.$%&%' %' ?*0,/+&%*0'( %' A*+Y-$.&0'8$*#&+ ' #&.$*#&+] .*#(-0/:G* %' $#?0&�'(-0/-/0&H� O/&%0* ('8/$#-' 0'-0&-& ' '(-&3'+'.' &( $#-'0�0'+&:Z'( '#-0' *( %$)'0(*(

&(A'.-*( '#)*+)$%*(1 &A*#-&#%* & $#-'0('-*0$&+$%&%' ' & .*,A+'@$%&%' %&(&:Z'( O/' '#)*+)', &( A*+Y-$.&( %' 0'./0(*( 4/,&#*( A&0& & (&E%' W�'0.'0'- &+H1 ��JXH

56


Figura 1 – Recursos humanos em saúde: aspectos estruturais

Fonte: MERCER et al. (2003). Adaptação livre.

O sistema de saúde brasileiro e recursos humanos� ('-*0 (&E%' #* �0&($+ #G* '(-')' $,/#' [( ,/%&#:&( %'.*00'#-'( %&

#*)& *0%', %' *08&#$9&:G* A0*%/-$)& #', -&,A*/.* %*( 0'?+'@*( %&0'?*0,/+&:G* %* A&A'+ %* �(-&%* O/' #G* %$?'0', %&( &A*#-&%&( A*0 �&.4W��JX #& .*#I/#-/0& $#-'0#&.$*#&+ ' '(-G* 0'+&-&%&( A*0 �$'0&#-*#$ W��XH�((&( %G* .*#-& %' &(A'.-*( 0'+&-$)*( [( %$,'#(Z'( '(-0/-/0&$( W.*,*1 A*0'@',A+*1 .*,A*($:G* ' %$(-0$3/$:G* %& ?*0:& %' -0&3&+4*X1 0'8/+&-P0$&(W0'A0'('#-&%&( A*0 %$?'0'#-'( &-*0'( ' 80/A*( %' $#-'0'(('( #& F0'& %& (&E%'' O/' '#)*+)', ($(-',& ?*0,&%*01 .*0A*0&:Z'(1 '#-0' */-0*(X ' 8'0'#.$&$(W($(-',&( .'#-0&+$9&%*( %' ?$#&#.$&,'#-*1 +'8$(+&:G* ' -0&3&+4* '#-0' '(?'0&(%' 8*)'0#*XH

�*0 */-0& )$&1 * A0*.'((* %' $,A+&#-&:G* %* �$(-',& �#$.* %' �&E%'W��X ' & -0&I'-P0$& %& %'(.'#-0&+$9&:G* -Q, #* ?$#&#.$&,'#-*1 #&0'(A*#(&3$+$%&%' %' 8'(-G* ' #* A&.-* $#-'08'(-*0'( ('/ ?*.* A0$)$+'8$&%*H�((& %'(.'#-0&+$9&:G* A0')Q & *08&#$9&:G* +*.&+ %' '(-0/-/0&( A*+Y-$.*�&%,$#$(-0&-$)&( .&A&9'( %' &((/,$0 0'(A*#(&3$+$%&%'( $#'0'#-'( [ 8'(-G* %'

57


A*+Y-$.&( AE3+$.&( -0&%/9$%&( ', &/-*#*,$&1 .*,A'-Q#.$&( ' 0'(A*#(&3$+$�%&%'( .*#?'0$%&( A'+& +'8$(+&:G* ' +'8$-$,&%&( (*.$&+,'#-'H

�,3*0& * A0$#.YA$* %' .*,&#%* E#$.* ', .&%& '(?'0& %' A*%'0 ?'%'0&-$)*A0')'I& 0'(A*#(&3$+$%&%'( ' A0'00*8&-$)&( #& ?*0,/+&:G* %& A*+Y-$.& ('-*0$&+A&0& * �$#$(-70$* %& �&E%'1 ('.0'-&0$&( '(-&%/&$( ' ,/#$.$A&$(1 .*#%$:Z'(+*.&$( '(-0/-/0&$( ' .*#I/#-/0&$( -Q, .*#?'0$%* &(A'.-*( ($#8/+&0'(1$#?+/'#.$&#%* &( ,*%&+$%&%'( %' $,A+&#-&:G* ' (/(-'#-&3$+$%&%' %* ��H�& *0$8', %'((& ��'��() � A*%', ('0 %'(-&.&%*( -0Q( 80&#%'( 80/A*( %'?&-*0'(1 (/,&0$9&%*( A*0 L/'$0*9 W��JX ' 4$(-*0$.&,'#-' &./,/+&%*(H

�* A0$,'$0* 80/A*1 & &/-*0& %'(-&.& ̂ & 4'-'0*8'#'$%&%' 8'*80F?$.&1 &(%$,'#(Z'( .*#-$#'#-&$( ' A*A/+&:G* #/,'0*(&1 $00'8/+&0,'#-' %$(-0$3/Y%&#* -'00$-P0$* #&.$*#&+^ O/' $#?+/'#.$&, A'0?$( 'A$%',$*+P8$.*(1 &%&A-&:Z'(+*.&$( A&0& $,A+','#-&:G* ' 8'(-G* %& &(($(-Q#.$& [ (&E%'] ̂ & 4'-'0*8'#'$%&%'(*.$*'.*#K,$.& ' & .*#.'#-0&:G* %' 0'#%&^1 &.'#-/&%& #&( E+-$,&( %7.&%&(.*, ?*0-' .*#.'#-0&:G* %' 0'#%& ' 0'%/9$%& .&A&.$%&%' %$(-0$3/-$)& �%$,'#(Z'( O/' �� %'A'#%', ,&$( %' &:Z'( &,A+$&%&( %' %'('#)*+)$,'#-*(*.$&+ ' '.*#K,$.* $#.+/%'#-' ', /, A+&#* ,&0.&%* A*0 %$)'0($?$.&%&(.&A&.$%&%'( &%,$#$(-0&-$)&( ' ?$(.&$(] ' ̂ *( -0&:*( A&0-$./+&0'( %& *08&#$9&:G*A*+Y-$.& ?'%'0&-$)&^1 %$(-0$3/Y%*( A*0 -0Q( #Y)'$( %' 8*)'0#* W�= '(-&%*( '"H"M� ,/#$.YA$*( � ==1�` %'+'( .*, A*A/+&:G* &3&$@* %' �" ,$+ 4&3$-&#-'(1#*( O/&$( 0'($%', �J1=` %& A*A/+&:G* -*-&+ %* A&Y(X1 .*, &/-*#*,$&&%,$#$(-0&-$)& ' (', )$#./+&:Z'( 4$'0F0O/$.&( '#-0' ($H�

(($,1 #& '.*#*,$& 30&($+'$0& &( '(-0/-/0&( A0*%/-$)&(1 &( 0'+&:Z'( %'-0&3&+4*1 &( .*#%$:Z'( %' )$%& ' &( A*(($3$+$%&%'( %' &.'((* %& A*A/+&:G*&*( 3'#( ' &*( ('0)$:*( 3F($.*( .&0&.-'0$9&,�(' A'+&( %'($8/&+%&%'( 0'8$*#&$(-&#-* #& A'0(A'.-$)& A'((*&+ O/&#-* #& '(A&.$&+H ( 0'8$Z'( 30&($+'$0&(1 �*0-'1�*0%'(-'1 �/%'(-'1 �/+ ' �'#-0*��'(-'1 #* O/' (' 0'?'0', &*( $#%$.&%*0'((*.$&$(1 &A*#-&, %'($8/&+%&%'( O/' A*%', ('0 ')$%'#.$&%&( #&( $#?*0,&:Z'(0'.'#-'( 0'A0*%/9$%&( #* �'+&-P0$* (*30' * �'('#)*+)$,'#-* �/,&#* #*�0&($+ W��X W��JX�

�� *�5 �� LC�� W�� <��(� ��<�� 7� �� 1��/��,��

��G��)��+��F��,-V��,/��7��F��,-V��0��+��0�(��L��W��7 �� 0��/�#��)��+�,--4%$

�� 2��(��0��F��8�K6+��@9�G�#@��F��9��0��G��(��%+�F��+�� 9��+��U�� $

58


DCCG��*�� 3��+ �� <�� (�� *�5 �� DCFI/�-�3�� ;�� (�� *�5 ��GEX��FLLC�� JJX��DCCF/�-�Y�� %#��'�� 3��;��6�� <��(��#��3�� 2��/�� 3�� * �2��;��+�� /

�(('( %&%*( &A*#-&, O/'1 A&0& &+7, %* ?*0-&+'.$,'#-* %& .&A&.$%&%'8'(-*0& %&( -0Q( '(?'0&( %' 8*)'0#*1 7 A0'.$(* %'('#)*+)'0 &:Z'( 0'+&-$)&(1#G* (*,'#-' A&0& & ��,-�. ,&( -&,37, &:Z'( $#-'0('-*0$&$( O/' $#%$O/',#*)*( A&-&,&0'( %' %'('#)*+)$,'#-* '.*#K,$.* ' (*.$&+1 *3'%'.'#%* [(%'($8/&+%&%'( ' [( '(A'.$?$.$%&%'( 0'8$*#&$( ' +*.&$(H

�* .&,A* %& .&A&.$%&%' 8'(-*0&1 7 .*#('#(/&+ O/'1 & %'(A'$-* %' /,&0'.'#-' A0*?$(($*#&+$9&:G* %& 8'(-G* $,A/+($*#&%& A'+& #'.'(($%&%' %'O/&+$?$.&:G* A&0& &( #*)&( ?/#:Z'(1 & 4'0&#:& .*#('0)&%*0& ' A&-0$,*#$&+$(-&(' .*#-0&AZ' & /,& &%,$#$(-0&:G* AE3+$.& A0*?$(($*#&+$9&%& O/' /-$+$9' &)&+*0$9&:G* %* -0&3&+4&%*01 (/& A0*?$(($*#&+$9&:G* .*, %'('#)*+)$,'#-*%' 4&3$+$%&%'( ' 0'(A*#(&3$+$%&%'(1 ,'%$%&( %' &)&+$&:G* %' %'(',A'#4*1'#-0' */-0&(H �&$( &$#%&1 A'0,&#'.' & A0F-$.& %' ̂ $#%$.&:G* A*+Y-$.&^ ' ?/#:Z'(8'(-*0&( .*,* %' ̂ 8*)'0#*^ ', %'-0$,'#-* %* .&0F-'0 -7.#$.* A&0& O/&+$?$.&:G*%& 8'(-G*H

�* .&,A* %& 8'(-G* %' �� ' %&( 0'+&:Z'( $#-'0('-*0$&$(1 7 .*#4'.$%*O/' *( -0&3&+4&%*0'( ', (&E%' #* �0&($+ .*,AZ', /, .*#-$#8'#-' %'A0*?$(($*#&$( $#?+/'#.$&%*( A*0 %$?'0'#-'( ($(-',&( %' ?*0,/+&:G* %' A*+Y-$.&(.*, &/-*#*,$&1 %$0'.$*#&+$%&%' ' .'#-0&+$9&:G* A0PA0$&( #G* 0'8/+&%*( A'+&A*+Y-$.& ('-*0$&+1 ,&( %$0'-&,'#-' &?'-&%*( A'+& 0'8/+&:G* '(-&-&+%$)'0($?$.&%&H �(('( ($(-',&( $#.+/', ($(-',& '%/.&.$*#&+ ' (/& .*#?*0,&:G*A'./+$&01 *( ($(-',&( &%,$#$(-0&-$)*( .'#-0&+$9&%*( ', A*+Y-$.&( 8'0&$( '&,A+$&%*( A&0& 0'./0(*( 4/,&#*(1 #* &A&0&-* I/0Y%$.*�+'8&+ ' +'8$(+&-$)*O/' (/(-'#-& &( 0'+&:Z'( %' -0&3&+4* %'(%' & 0'8/+&,'#-&:G* %&( A0*?$((Z'([ #*0,&-$9&:G* %&( 0'+&:Z'( %' ',A0'8*1 ', (/&( ,&$( )&0$&%&( '@A0'((Z'(W�$'0&#-*#$1 ��XH

��8GL��(��0��0��F��F��0��0�(��"��O��T�� +��0�� T$

59


�&$( &$#%&1 ', /, A+&#* 0'.'#-'1 & .*,3$#&:G* %&( -0&#(?*0,&:Z'( #*,/#%* %* -0&3&+4*1 A*0 /, +&%*1 ' & $,A+','#-&:G* %& A*+Y-$.& ('-*0$&+1 O/''#)*+)'/ ,/%&#:&( '@A&#($*#$(-&( %' .*3'0-/0&1 .*, A0$*0$9&:G* %& &-'#:G*3F($.& ' &3'0-/0& %' A*(-*( %' -0&3&+4* W)$& $,A+&#-&:G* %* �&E%' %& !&,Y+$&1#* .&(* %* �0&($+X1 A*0 */-0*1 &A0*?/#%&, -'#(Z'( ' O/'(-Z'( A0''@$(-'#-'(H�#-0' '((&( A*%',*( %'(-&.&0�� %'($8/&+%&%'( %' *?'0-&( %* ,'0.&%* '%/.&-$)* A&0& ?*0,&:G*

A0*?$(($*#&+ #& F0'& %& (&E%'1 -&#-* O/&#-$-&-$)&( W.*#.'#-0&:Z'(0'8$*#&$(1 A*0 '@',A+*X .*,* O/&+$-&-$)&( WA0*+$?'0&:G* %'(*0%'#&%&%' ./0(*( ', %'-'0,$#&%&( F0'&( %' ?*0,&:G* ' %'A'#%Q#.$&(&%,$#$(-0&-$)&(1 A0F-$.&( A'%&8P8$.&( '@.+/%'#-'( %' /,& )$(G* %'$#-'80&+$%&%' ' %' -0&3&+4* ', 'O/$A'1 A*0 '@',A+*X]

� $#-'#($?$.&:G* ' A0$)$+'8$&,'#-* %&( ,*%&+$%&%'( %' .*#-0&-&:G* #*�$(-',& �#$.* %' �&E%' (', &,A&0* +'8&+1 8'0&#%* /, &+-* Y#%$.' %'A0'.&0$9&:G* ', -*%* * A&Y(]

� A0'.F0$& '(-0/-/0& ' .&A&.$%&%' 8'(-*0& -&#-* %* ('-*0 '%/.&-$)* .*,*%' A0'(-&:G* %' ('0)$:*( %& F0'& %& (&E%'1�'�*+*'� & )'+*.$%&%' ' &O/&+$%&%' %&( ,/%&#:&( %* ($(-',&1 .*,*1 A*0 '@',A+*1 $#.0','#-*%' ,'.&#$(,*( %' A&0-$.$A&:G* (*.$&+1 '#-0' */-0*(H

Gestão do trabalho: construindo capacidades nacionais e locais 8'(-G* %* -0&3&+4* #& (&E%' 0'O/'01 ', /, A+&#*1 * 0'.*#4'.$,'#-*

%&( %$,'#(Z'( O/' '#)*+)', * -0&3&+4* ' *( -0&3&+4&%*0'( ', (&E%'H �(-&(1.*,* IF )$(-* &#-'0$*0,'#-'1 '(-G* 0'+&.$*#&%&( .*, *( A0*.'((*( %' 8'(-G*1& .*#?$8/0&:G* '(-0/-/0&+ %* ('-*0 ' & .*#(-0/:G* ' & 0'-*,&%& %' ,'.&#$(,*(%' 0'8/+&:G* A*0 A&0-' %* �(-&%* & A&0-$0 %' &+8/,&( %&( .&0&.-'0Y(-$.&(.*,/#( #* A+&#* %' 0'./0(*( 4/,&#*( ' %& 8'(-G* %* -0&3&+4* *3('0)&%&(#&( E+-$,&( %7.&%&(H �&0& -&#-*1 %')' A&0-$0 %' /, A0'((/A*(-* 3F($.* O/'%'?$#& /,& &8'#%& %' -0&3&+4* .*,* A*+Y-$.& %' �(-&%* ' #G* %' 8*)'0#*1'#)*+)'#%* &( %$?'0'#-'( '(?'0&( O/' .&0&.-'0$9&, * �(-&%* �&.$*#&+1 )$(&#%*[ .*#(*+$%&:G* &,A+$&%& %' ,/%&#:&( ,&$( .*#($(-'#-'( -&#-* A&0& * ($(-',&%' (&E%' .*,* A&0& * %'('#)*+)$,'#-* %& (*.$'%&%'H �,A+$.& & %'?$#$:G* ' *.*#4'.$,'#-* %& .&A&.$%&%' 8'(-*0& %* -0&3&+4* ', (&E%' .*, *0'.*#4'.$,'#-* %' .*,A'-Q#.$&( ' $#(-N#.$&( %' A*%'0 )$(&#%* & /, ,*%'+*%' 8'(-G* A&0-$.$A&-$)* $#-'08'(-*0'( %&( %$?'0'#-'( $#(-N#.$&( &%,$#$(-0&-$)&(%& !'%'0&:G* ' &0-$./+&%*0 $#-'0('-*0$&+ %*( A*%'0'( �@'./-$)*1 �'8$(+&-$)* '>/%$.$F0$*H

60


�'(('( &(A'.-*(1 %'(-&.&,�(' * ,*%'+* %' ?$#&#.$&,'#-* ('-*0$&+ ' *(+$,$-'( $,A*(-*( &*( #Y)'$( #&.$*#&$( ' (/3#&.$*#&$(1 A'+& +'8$(+&:G* )$8'#-'1A&0& 8&(-*( .*, .*#-0&-&:G* %' -0&3&+4&%*0'( %* ('-*0 AE3+$.* ', 8'0&+H�

�*,* A*#-*( & ('0', .*#($%'0&%*( A&0& /,& &8'#%&1 ', /, A+&#*,&$( 8'0&+1 %'(-&.&,�('�� ,'.&#$(,*( %' 8'(-G* #& A'0(A'.-$)& %& .*#(-0/:G* (*.$&+ '#)*+)'#%*

#*)*( A&.-*( '#-0' /(/F0$*(1 A0*?$(($*#&$( ' 8'(-*0'( 0'?'0$%*( & A&0N�,'-0*( %' O/&+$%&%'1 7-$.& ' %' A0*-':G* %' -0&3&+4&%*0'( ' /(/F0$*(]

� A*+Y-$.& %' ',A0'8* O/' .*#-',A+' %$0'$-*( (*.$&$( %*( -0&3&+4&%*0'(%& (&E%'1 -&#-* %* ('-*0 AE3+$.* .*,* %* A0$)&%*1 %'?$#$#%*A0*?$(($*#&$( ' ($(-',& %' A0*,*:G* ' %' A0'(-&:G* %' ('0)$:*( #&(&E%' )$& ,'.&#$(,*( %' *?'0-&1 %$(-0$3/$:G* ' ?$@&:G* %' -0&3&+4&%*0'(A&0& * ($(-',&]

� 0'8/+&:G* %& ?*0,&:G*1 %& O/&+$?$.&:G* A0*?$(($*#&+1 %& '%/.&:G*A'0,&#'#-'1 %* -0&3&+4* ' %* '@'0.Y.$* A0*?$(($*#&+1 .*#?$8/0&#%*A0*.'((*( O/' '#)*+)&, * ($(-',& '%/.&.$*#&+1 &( .*0A*0&:Z'( ' &(&((*.$&:Z'( A0*?$(($*#&$(1 * ($(-',& %' (&E%' ' & (*.$'%&%'H�* A+&#* '(A'.Y?$.*1 7 .*#('#(/&+ O/' & %'(.'#-0&+$9&:G* %& 8'(-G* %*(

('0)$:*( %' (&E%' #* A&Y( #G* 0'(/+-*/1 &/-*,&-$.&,'#-'1 #& -0&#(?'0Q#.$&%' .&A&.$%&%' 8'(-*0& A&0& &( '(?'0&( ,/#$.$A&$(H �&$( &$#%&1 A*-'#.$&+$9*/A0*3+',&( .0K#$.*( ' %'('#.&%'*/ (*+/:Z'( ' &00&#I*( *( ,&$( %$)'0(*( A&0&O/' * 8'(-*0 ,/#$.$A&+1 ', ?&.' %&( %',&#%&( %& A*+Y-$.& ' %&( 0'(-0$:Z'(&,A+$&%&( %& '(?'0& I/0Y%$.*�+'8&+1 A/%'((' '@'./-&0 &( A0*A*(-&( %'0'?*0,/+&:G* %* ($(-',&H

�* .&(* %* �0&($+1 ', O/' '((& F0'& (' $#(-$-/.$*#&+$9& #* N,3$-* %&A*+Y-$.& #&.$*#&+ %' (&E%'1 )$& .0$&:G* %& �'.0'-&0$& %' 2'(-G* %* 0&3&+4* '%& �%/.&:G* #& �&E%' %* �$#$(-70$* %& �&E%'1 & &)&+$&:G* ' * &.*,A&#4&�,'#-* %*( A0*.'((*( %' 8'(-G* %'('#)*+)$%*( #&( $#(-N#.$&( +*.&$( '*08&#$9&.$*#&$( ', O/'1 #& �,-��'(('( A0*.'((*( '(-G* ('#%* %'('#)*+�)$%*(1 -*0#&,�(' $,A'0&-$)*(H � ?/#%&,'#-&+ $%'#-$?$.&0 ?0&8$+$%&%'( 'A*-'#.$&+$%&%'( O/' A*((&, *0$'#-&0 -&#-* & %'?$#$:G* %' %$0'-0$9'( A*+Y-$.&(O/&#-* *?'0'.'0 ,'.&#$(,*( %' &A*$* &*( ($(-',&( +*.&$( A&0& $,A+','#-&:G*%&( A*+Y-$.&(1 .*, &/-*#*,$&1 $#%'A'#%Q#.$& ' 8*)'0#&#:&H

�A��F��0��0��F��0��0��U��(F��?O��+��0��+�� 2��C-V��0��(0��/-V��(F��+��?O��0��7�? ��0��0��?$�@��+��A��0��:,��,=��?��4>>/�'�A��4$

61


�(-/%* 0'&+$9&%* A&0& &)&+$&0 & .&A&.$%&%' 8'(-*0& %' ,/#$.YA$*( .*,,&$( %' �� ,$+ 4&3$-&#-'(� A*(($3$+$-*/ & $%'#-$?$.&:G* %' 0'&+$%&%'( +*.&$(' & %$(.0$,$#&:G* %' $%'#-$%&%'( 0'8$*#&$( ' #&.$*#&$(H �&0& -&#-*1 &+7, %'/,& &3*0%&8', -0&%$.$*#&+1 )*+-&%& &A'#&( A&0& * &+.&#.' %' ,'-&( '0'(/+-&%*( O/&#-$-&-$)*(1 * ,*%'+* %' &#F+$(' %*( 0'(/+-&%*( A0*./0*/'(-&3'+'.'0 .*00'+&:Z'( '#-0' &( )&0$F)'$( '(-&3'+'.$%&( #* '(-/%* ' *%'(',A'#4* ' &( A'0.'A:Z'( %*( &8'#-'( '#)*+)$%*(H

( ('.0'-&0$&( ,/#$.$A&$( %' (&E%' W��X ?*0&, &#&+$(&%&( ', /,&A0$,'$0& '-&A& #* ('/ .*#I/#-* ' A*(-'0$*0,'#-' &80/A&%&( ('8/#%* *(.0$-70$*( O/' %'?$#$&,�� $#(-N#.$&( +*.&$( '�1 P08G* '(A'.Y?$.* %' 0'./0(*( 4/,&#*( #&

'(-0/-/0& %& ('.0'-&0$& ,/#$.$A&+ W�"�X]� $#(-N#.$&( +*.&$( ��1 P08G* '(A'.Y?$.* %' 0'./0(*( 4/,&#*( #&

'(-0/-/0& %& ('.0'-&0$& ,/#$.$A&+ W"MX]� �� +*.&+$9&%&( #&( '��(��(� W��XH�'((& ?*0,&1 * O/' (' O/$( .&0&.-'0$9&0 .*, & A'(O/$(& .*,AZ' /,&

('O_Q#.$& %' A'08/#-&( 8'0&%&( O/' )G* ('#%* ?*0,/+&%&( [ ,'%$%& O/' ('&)&#:& #* A0*.'((* %' &#F+$(' %*( %&%*( O/' &3*0%&,1 '#-0' */-0&(�� .&A&.$%&%' 8'(-*0& )$& A0*.'((*( %' 8'(-G* ' ,'.&#$(,*( /-$+$9&%*(]

O/&+$?$.&:G*] A*%'0 %'.$(P0$* ' A&0-$.$A&-$)* %* 8'(-*0 %' ��H� A'0.'A:G* %*( 8'(-*0'( %' �� (*30' O/'(-Z'( 0'+&-$)&( [ &/-*#*,$&1 [

/-$+$9&:G* %' $#(-0/,'#-*( %' 8'(-G* ' [( ?*0,&( %' .*#-0&-&:G*H�'(-&.&,*(1 #'(-' -'@-*1 &.4&%*( 0'+')&#-'( O/' .*,AZ', * ̂ '(-&%* %&

&0-'^ %& 8'(-G* %' �� ', (&E%' ' A*%', ($#&+$9&0 $#-'0)'#:Z'( %' ./0-*1,7%$* ' +*#8* A0&9*( A&0& * .&,$#4* %& 8'(-G* %* -0&3&+4* #& F0'&H

.&0&.-'0$9&:G* %' ̂ '@A'0$Q#.$&^ %* 8'(-*0 %' ��1 .*#?*0,' &A*#-&%&#* 80F?$.* & ('8/$01 %',*#(-0*/ /,& -'#%Q#.$& W4'0&#:&X A&0& .&A&.$%&%'(0'+&-$)&( [ ^&%,$#$(-0&:G* %' A'((*&+^ ', &-$)$%&%'( 0'+&.$*#&%&( .*,($(-',&( %' .*#-0*+' %' A&8&,'#-*1 3'#'?Y.$*(1 '#-0' */-0&(H

��0��K��!��L��8��R��A��*��)��(0��@0��? *�0��4--��L��+�0��F��7��0��6��? ��1��8)*�H��D��9��H�)K��!��!��L��*��#!��%�,--.$��0��0��D��0��F��7��0�� 0��7��0(��0�� $��0��F��,,<��(0��,C��0��+��D��00��? ��0��/-V��00��? ��#��00��0��,--<%$�G��D��+�,-C�*)*��0��F��+��,.��0��$�SSS$��$��$��D$��$

62


Gráfico 1 – Avaliação da experiência/qualificação do gestor de RH. Brasil, 2004

Fonte: Rorehs/IMS-Uerj/Nescon-UFMG. Capacidade Gestora de Recursos Humanos em Instâncias Locais de Saúde em Municípioscom População Superior a 100 mil Habitantes. Brasil, 2004.

� A+&#'I&,'#-* %&( &:Z'( %' 0'./0(*( 4/,&#*( #G* '(-F $#.*0A*0&%*#& A0F-$.& %*( %$0$8'#-'( %& F0'&1 * O/' A*%' ('0 *3('0)&%* #G* (P A'+&0'(A*(-& %$0'-& [ A'08/#-& W=�1J` &?$0,&, -'0 A*/.& */ #'#4/,&'@A'0$Q#.$&X1 ,&( A'+& &#F+$(' %* .*#I/#-* %*( 0'(/+-&%*(H �'(-&.&�(' &O/$O/' & ?*+4& %' A&8&,'#-* (' .*#(-$-/$ #& A0$#.$A&+ ?*#-' %' %&%*( A&0& '((&&-$)$%&%'1 .&/(&#%* (/0A0'(& & #G*�/-$+$9&:G*1 A'+&( ��1 %' ($(-',&( %'$#?*0,&:G* %' 0'./0(*( 4/,&#*( .*, &A*0-' O/&+$-&-$)*H �((' .'#F0$* A*%'$#%$.&0 & #'.'(($%&%' %' %'?$#$0 A*+Y-$.&( ' &%*-&0 '(-0&-78$&( O/' A*((&,&A*$&0 &( ('.0'-&0$&( A&0& * /(* %' ($(-',&( %' $#?*0,&:G* .*,* ?'00&,'#-&%' A+&#'I&,'#-* ' 8'(-G*H

�' &.*0%* .*, &( %$0'-0$9'( A*+Y-$.&( A&0& & F0'& %' 0'./0(*( 4/,&#*('@A0'((& #& ��U��1� * A+&#* %' .&08*(1 .&00'$0& ' (&+F0$*( W��X 7.*#($%'0&%* /, $#(-0/,'#-* %' *0%'#&:G* %* -0&3&+4* O/' %')' ('0$#.*0A*0&%* & .&%& #Y)'+ %' 8'(-G* %* ��H

�, 0'+&:G* &* ��1 %*( �"� ,/#$.YA$*( O/' %'.+&0&0&, '(-0/-/0& %'�� #& ��1 .'0.& %' �=` &A*#-&, & '@$(-Q#.$& %' A+&#* '(A'.Y?$.* A&0& &(&E%'1 ' #&( .&A$-&$(1 "�1�`H �*( ,/#$.YA$*( ', O/' & &-$)$%&%' %' �� 7

��9��!L;*H*� #9��0�� !��L��0�� *H*%� ��7�0��? ��9��*��0�� ? ��*H*$

63


.'#-0&+$9&%& #& &%,$#$(-0&:G* W"MX1 D�1�` &?$0,&0&, A*((/$0 A+&#* .*,'(A'.$?$.$%&%' A&0& & (&E%'H �(('( 0'(/+-&%*( ,'0'.', ('0 ,&$( 3',O/&+$?$.&%*( .*, 0'+&:G* [ '(A'.$?$.$%&%' A&0& & (&E%'1 & &-/&+$%&%' %*A+&#*1 & $,A+&#-&:G*1 '#-0' */-0&( .*$(&(H �*0 */-0& )$&1 4F /, 0'.*#4'.$,'#-*%'.+&0&%* ', .'0.& %' M�` %&( �� %*( 80/A&,'#-*( '(-/%&%*( %&A'0-$#Q#.$& %' /-$+$9&:G* %* �� .*,* $#(-0/,'#-* ?&.$+$-&%*0 %& 8'(-G*H

Gráfico 2 – Plano de cargos, carreira e salários específico para os trabalhadores da SMS.Brasil, 2004


/-$+$9&:G* %' $#.'#-$)*( .*,* ?*0,& %' 0'-0$3/$:G* %$0'-& */ $#%$0'-&A&0& *( -0&3&+4&%*0'( %& (&E%' ?*$ $#%$.&%& A*0 .'0.& M�` %*( ,/#$.YA$*(1('#%* *( ,&$( /-$+$9&%*( ?70$&(�A0Q,$*1 ?*+8&( ' $#.'#-$)*( ?$#&#.'$0*(H

�F %' (' A'#(&0 ', A+&#*( %' .&08*( O/' .*#-',A+', -$A*( %' )Y#./+*(',A0'8&-Y.$*( ' ?*0,&( %' 0',/#'0&:G* .*,A&-Y)'$( .*, &( ?/#:Z'( -YA$.&(%' .&00'$0& %& (&E%' ' A0*,*)&,1 '#-0' */-0&(1 & ?$@&:G* %* -0&3&+4&%*0W$#.+/$#%* /,& A*+Y-$.& %' $#.'#-$)*(X ' & '(A'.$?$.&:G* %' )Y#./+*( ?+'@Y)'$(' &%&A-F)'$( & .*#%$:Z'( +*.&$( ' '(A'.$&$(1 #G* %$0'-&,'#-' 0'+&.$*#&%&(.*, * -0&3&+4* ', (&E%'1 A&.-/&%*( '#-0' -0&3&+4&%*0'(1 8'(-*0'( ' &(*.$'%&%'H

� A0*.'((* %' #'8*.$&:G* %* -0&3&+4* )$& $#(-&+&:G* %' ,'(& %'#'8*.$&:G* A&0& & (&E%' ?*$ %'.+&0&%* ', ��` %*( ,/#$.YA$*( .*, '(-0/-/0&

64


A0PA0$&1 J=1"` %&( .&A$-&$( ' ', &A'#&( /, ,/#$.YA$* %* 80/A* O/' #G*A*((/$ '(-0/-/0& A0PA0$& #& ��H �&( .&A$-&$(1 M�` &A*#-&, & ,'(& .*,*$#(-0/,'#-* ?&.$+$-&%*0 %& 8'(-G*1 I/#-* .*, �D1=` ' J�1�` %*( ('8,'#-*(.*, '(-0/-/0& #& �� ' .'#-0&+$9&%&1 0'(A'.-$)&,'#-'H

Gráfico 3 – Mesa de negociação coletiva instalada na SMS. Brasil, 2004


�(('( &.4&%*( A*%', %&0 A$(-&( %& #'.'(($%&%' %* ?*0-&+'.$,'#-* %&$,A+&#-&:G* ' %& 8'(-G* %' .&00'$0& ' %' ,'(& %' #'8*.$&:G*1 $#?*0,&#%* &A'0-$#Q#.$& %* '(-&3'+'.$,'#-* %' A*+Y-$.&( $#%/-$)&( ' $#(-0/,'#-&$( A&0& &$,A+','#-&:G* %'((&( ?*0,&( %' 0'8/+&,'#-&:G* ' %' 8'(-G* %* -0&3&+4*A&0& & (&E%'H ( ,'(&( %' #'8*.$&:G* A'0,&#'#-' %' -0&3&+4&%*0'(1 ','(A'.$&+ %* ��1 A*%', ('0 .&0&.-'0$9&%&( .*,* ^A0*I'-* .*+'-$)* *#%' &%',*.0&-$9&:G* %&( 0'+&:Z'( %' -0&3&+4* #& (&E%' (/08' .*,* )&+*0?/#%&,'#-&+^H �Q, ('#%* %'('#)*+)$%&( .*, & A&0-$.$A&:G*1 #& 3/(.& %*.*#('#(*1 %' -0&3&+4&%*0'(1 *08&#$9&:Z'( ($#%$.&$(1 8'(-*0'( %&( %$)'0(&($#(-N#.$&( %& (&E%'1 A&0& (*+/:Z'( %' .*#?+$-*( ','08'#-'( %&( 0'+&:Z'(+&3*0&$( W�0&($+1 ��XH

�( %&%*( .*+'-&%*( (*30' -$A*( %' )Y#./+* 0')'+&0&, O/' * ',A0'8*?*0,&+ ' '(-F)'+ &$#%& 7 * A0'%*,$#&#-' #& (&E%'1 )&0$&#%* %' D"` & �"`#*( 80/A&,'#-*( &#&+$(&%*(] %'(-&.&�(' & ,*%&+$%&%' .**A'0&-$)& #&(.&A$-&$(H

�(-' O/&%0* 7 .*00*3*0&%* A'+& %&-& %' 0'&+$9&:G* %* E+-$,* .*#./0(*AE3+$.*� *3('0)*/�(' O/'1 & A&0-$0 %* &#* %' ��1 D�` %*( 8'(-*0'(

65


'#-0')$(-&%*( %'.+&0&0&, -'0 0'&+$9&%* .*#./0(* AE3+$.* .*,* ?*0,& %'0'.0/-&,'#-* ' ('+':G* %' A'((*&+H

Gráfico 4 – Ano de realização do último concurso público segundo a região do país. Brasil, 2004


�( $#%$.&%*0'( ('+'.$*#&%*( A&0& &)&+$&:G* %' &/-*#*,$& %' 8'(-G*W.*#-0&-&:G* %' A'((*&+1 ($(-',& %' &)&+$&:G* %' %'(',A'#4*1 /-$+$9&:G* %'0'./0(*( ?$#&#.'$0*( ' %' A0*.'((*( %' .&A&.$-&:G*X %',*#(-0&, O/' * #Y)'+%' &/-*#*,$& %* 8'(-*0 7 +$,$-&%* [( O/'(-Z'( 0'+&.$*#&%&( [ ^3/0*.0&.$&$#-'0#&^ � ($(-',& %' &)&+$&:G* %' %'(',A'#4* ' .&A&.$-&:G*H�� &0& &O/'+&(O/' '@$8', A*%'0 %'.$(P0$*1 .*,* /-$+$9&:G* %' 0'./0(*( *0:&,'#-F0$*( '.*#-0&-&:G* %' A'((*&+1 & &/-*#*,$& %'.+&0&%& 7 ̂ ,/$-* 3&$@& */ #'#4/,&^H

��9��0��+��0��?O��;��U��0��0��0��0��)��*��$

66


Gráfico 5 – Grau de autonomia do gestor de RH das SMS. Brasil, 2004


�#-0' &( O/'(-Z'( *A$#&-$)&(1 *( 8'(-*0'( &A*#-&, $#?*0,&:Z'(%$?'0'#.$&%&( ', 0'+&:G* [( ?*0,&( %' .*#-0&-&:G* %' A'((*&+ A&0& & (&E%'��

', ?/#:G* %& #&-/0'9& %* ('0)$:*H ( ?*0,&( $#%$0'-&( ' ,$(-&( W%'A'#%'#%*%& .&-'8*0$& */ A*0 O/&+O/'0 ?*0,& %' )$#./+&:G*X %' .*#-0&-&:G* %' A'((*&+A*%', ('0 &A*#-&%&( .*,* /,& -'#%Q#.$& #& A0'?'0Q#.$& %*( 8'(-*0'( A&0&4*(A$-&$( ' ('0)$:*( '(A'.$&+$9&%*(1 #G* ('#%* *3('0)&%& %$?'0'#:& '#-0'�� .*, ' (', '(-0/-/0& %' ��H

�&( .&A$-&$(1 ', 0'+&:G* [( /#$%&%'( 4*(A$-&+&0'(1 &A'#&( %/&(&(($#&+&0&, & ,*%&+$%&%' %$0'-&U'(-&-/-F0$& .*,* A0'?'0'#.$&+1 '#O/&#-*4F A0'%*,$#N#.$& %&( .*#-0&-&:Z'( )$& ?*0,&( $#%$0'-&( ' ,$(-&(H

>F A&0& * ��!U&-'#:G* 3F($.&1 * '(-/%* %$(.0$,$#*/ O/' &( ?*0,&( %$0'-&(' ,&$( '(-F)'$( %' .*#-0&-&:G* (' .&0&.-'0$9&, .*,* /,& -'#%Q#.$& #& *A:G*%*( 8'(-*0'(H �&( .&A$-&$(1 '#-0'-&#-*1 #'#4/, 8'(-*0 &(($#&+*/ &( ?*0,&(%$0'-&( '(-F)'$( A&0& ��!U&-'#:G* 3F($.&] (' &80'8F((',*( &( &?$0,&-$)&(0'+&-$)&( [( ?*0,&( %' )$#./+&:G* $#%$0'-&( ' ,$(-&(1 -'0Y&,*( D�1�` %&A0'?'0Q#.$& #&( .$-&:Z'( %'((' 80/A&,'#-*H

��0?O��2��0��? �� J��2��0��#�0��7��%J�0��0��? �� +��? J�0��F��F��? +��0��0��$

67


�( 0'(/+-&%*( %* '(-/%* &O/$ %'(-&.&%*( #G* '(8*-&, -*%&( &(A*(($3$+$%&%'( %' .&0&.-'0$9&0 & .&A&.$%&%' 8'(-*0& %&( ��H �* '#-&#-*1 *(&.4&%*( %& A'(O/$(& ('0)',1 ('8/0&,'#-'1 .*,* 3&(' A&0& %'?$#$0 '(-0&-78$&(-&#-* A&0& ?*0-&+'.$,'#-* %' A0*.'((*( O/' '#)*+)', & 8'(-G* %* -0&3&+4* '%& '%/.&:G* A&0& & (&E%' � $#%$.&#%* -'#%Q#.$&( A&0& A0$*0$%&%'( %'$#-'0)'#:G* O/&+$?$.&%& � .*,* A&0& * ?*0#'.$,'#-* %' $,A*0-&#-'( (/3(Y%$*(A&0& -*,&%& %' %'.$(Z'( A*0 A&0-' %*( 8'(-*0'( %* ($(-',& %' (&E%'30&($+'$0*H��

%',&$(1 * -0&:* .*,/, *3('0)&%* #*( -0Q( 80/A&,'#-*( ('+'.$*#&%*(A&0& A'(O/$(& 0',*#-& [ ?0&8$+$%&%' %' O/'(-Z'( ,&$( &,A+&( 0'?'0$%&( .*,& &/-*#*,$& %& 8'(-G* ?$#&#.'$0& ' %*( A0*.'((*( O/' '#)*+)', * -0&3&+4*WA+&#'I&,'#-*1 .*#-0&-&:G* %' A'((*&+1 .&00'$0&1 '-.HX ' & '%/.&:G*W%'('#)*+)$,'#-* ' &A+$.&:G* %' &-$)$%&%'( %' ?*0,&:G* ' %' '%/.&:G*A'0,&#'#-' 0'+&.$*#&%&( [ *A'0&.$*#&+$9&:G* %*( ($(-',&( +*.&$(XH

Considerações finais( O/'(-Z'( 0'+&-$)&( &* -0&3&+4* ' &*( -0&3&+4&%*0'(1 ', '(A'.$&+ %&

F0'& %& (&E%'1 ('8/0&,'#-' '(-G* #& &8'#%& ,/#%$&+ ', &(A'.-*( -G* %$)'0(*(O/&#-* *( 0'+&-$)*( &* A0PA0$* -0&3&+4&%*0 W.*,* '@.+/(G*1 %'(',A0'8*A0*+*#8&%*1 $#('8/0&#:&1 ?&+-& %' O/&+$?$.&:G* A&0& * -0&3&+4*X ' [ (&E%'10'+&.$*#&%& .*, .*#%$:Z'( %' )$%& ' %' %'('#)*+)$,'#-* %' /,& (*.$'%&%'H�1 ,&$( &$#%&1 '(('( ̂ ,&+'(^ &-',*0$9&, ' &A0*@$,&,�(' %' A&Y('( .'#-0&$(1O/' )Q', (/&( .*#%$:Z'( %' )$%& ' -0&3&+4* & .&,$#4* %* 3+*.* %*( '@.+/Y%*(H

�F /, .*#('#(* %' O/'1 A&0& &+7, %' A*+Y-$.&( A*#-/&$(1 %')', ('0'(-&3'+'.$%&( &:Z'( O/' $#.+/&, &(A'.-*( 8'*80F?$.*(1 (*.$*%',*80F?$.*(1./+-/0&$(1 '.*#K,$.*( ' A*+Y-$.*(H %',&$(1 &:Z'( O/' &A*#-',1 A*0 /, +&%*1A&0& (*+/:Z'( ?*.&+$9&%&(1 '1 A*0 */-0*1 A&0& (*+/:Z'( $#-'0('-*0$&$( O/'A*-'#.$&+$9', &( A*+Y-$.&( %' �� ', (&E%'H

� .*#('#(/&+ -&,37, O/' &( A*+Y-$.&( .'#-0&+$9&%&( O/' %$(.0$,$#&,?$#&#.$&,'#-* ' $#(-$-/', * &A&0&-* I/0Y%$.* +'8&+ %* �(-&%* A*%', &A0'('#-&0%$(-N#.$&( */ ,'(,* .*#(-$-/$0 $,A'%$-$)*( A&0& &:Z'( '?'-$)&( #& F0'& %&(&E%'1 ?&)*0'.'#%* $#$O_$%&%'( ' A0'I/%$.&#%* &( ,'-&( %' O/&+$%&%' '$#.+/(G* (*.$&+H (($,1 *( .0$-70$*( %' ?$#&#.$&,'#-* .&+.&%*( ', &)&+$&:G*O/&+$-&-$)& %' 0'(/+-&%*( %')', ('0 A0'?'0Y)'$( &*( O/' (' ?/#%&,'#-&,1'@.+/($)&,'#-'1 ', 3&('( A*A/+&.$*#&$( ' O/&#-$-&-$)&(H

��SSS$��$��$��D$��0�� 0��F��$

68


)&+*0$9&:G* %& .$Q#.$& ' %& -'.#*+*8$& ,*%$?$.& * -0&3&+4* &+-'0&#%*A0*%/-*(1 A0*.'((*( */ & 8'(-G*1 '1 A&0& &+7, %& $#.*0A*0&:G* %' -'.#*+*8$&&0,&%&1 %*( -0&3&+4&%*0'( '@$8',�(' #*)*( A'0?$( &%&A-&-$)*(H �(-'(%',&#%&, #*)& .*#?*0,&:G* %& .&A&.$%&%' +&3*0&+ %' %$)'0(*( ('-*0'( %&'.*#*,$&1 %$-&%& A*0 -'#%Q#.$&(1 [( )'9'( .*#-0&%$-P0$&(1 0'+&.$*#&%&( .*,& A*+$)&+Q#.$&1 & &/(Q#.$& %' '(A'.$&+$9&:G*1 & .&A&.$%&%' %' $#*)&01 & Q#?&('%* -0&3&+4* ', 'O/$A'1 & O/&+$?$.&:G*1 & &/-*#*,$&1 & 0'(A*#(&3$+$9&:G* ' *%'('#)*+)$,'#-* %' 4&3$+$%&%'( .*8#$-$)&( ' %' #*)&( .*,A'-Q#.$&(H

)'+*.$%&%' .*, O/' '(('( #*)*( A'0?$( (G* %',&#%&%*(1 &+$&%& &A0*A*($:Z'( $#*)&%*0&( &A+$.&%&( ', '(-0/-/0&( *08&#$9&.$*#&$( 0Y8$%&( */.*, ,'-*%*+*8$&( -0&%$.$*#&$(1 ?&9 .*#)$)'0 4*I' ?*0,&( 4Y30$%&( %'*08&#$9&:G* %* -0&3&+4*H (($,1 A'0($(-', A0*.'((*( %' -0&3&+4* .*,&/(Q#.$& %' A&0-$.$A&:G* '?'-$)& %*( -0&3&+4&%*0'(1 0*-&-$)$%&%' %& *./A&:G*%*( A*(-*( %' -0&3&+4*1 -0'$#&,'#-*( */ '(A'.$&+$9&:Z'( O/' )$(&, &,/%&#:&( .*,A*0-&,'#-&$( ' #G* [ ?*0,&:G* '(A'.Y?$.& ,&$( O/&+$?$.&%&1'#-0' */-0&(H �*0 */-0& )$&1 7 $#-0*%/9$%& & #*0,&+$9&:G* %' ?*0,&( %' .*#-0&-*(-',A*0F0$*(1 ')'#-/&$(1 .*, A'0%& A0*80'(($)& %& A0*-':G* (*.$&+H

� ̂ #*)*^ .&,A* %' &-/&:G* %& 2�� -� ��3�40� �1 ��,-� ' %* 8'(-*0%' �� A*%' ('0 .*#?$8/0&%* ', /, .*#I/#-* %' &-$)$%&%'( O/' '#)*+)',� *A+&#'I&,'#-*1 & .&A-&:G*1 & %$(-0$3/$:G* ' & &+*.&:G* %' A'((*&( ', A*(-*(%' -0&3&+4*1 .*, & O/&+$?$.&:G* 0'O/'0$%& ' .*, ,'%$%&( O/' ?*0-&+':&, &?$@&:G* %'(('( A0*?$(($*#&$(] & *?'0-& %' A*(($3$+$%&%'( %' ?*0,&:G* '.&A&.$-&:G* O/' &-'#%&, [( #'.'(($%&%'( %' %'('#)*+)$,'#-* %'.*,A'-Q#.$&( A&0& &-'#:G* [ (&E%' %' O/&+$%&%'] ' ,'%$%&( #* .&,A* %&0'8/+&:G* %* -0&3&+4* .*, $#-'0?&.'(U$#-'0,'%$&:Z'( .*, &( .*0A*0&:Z'(A0*?$(($*#&$(1 * ,'0.&%* '%/.&-$)* ' & (*.$'%&%'H

(($,1 & &8'#%& A&0& & 8'(-G* %* -0&3&+4* ', (&E%' %')' $#.+/$0 *?*0-&+'.$,'#-* %' A0F-$.&( 8'0'#.$&$( O/' 3/(O/', .*#('#(*( ' &.*0%*( A&0&&-'#%'0 &*( .*#?+$-*( '#-0' *( $#-'0'(('( .*0A*0&-$)*( ' (*.$&$( '#)*+)$%*(1*3I'-$)&#%* /,& )$(G* &,A+$&%& %* %$0'$-* [ (&E%' 8&0&#-$%* .*#(-$-/.$*#&+�,'#-'1 .*,* #* .&(* %* �0&($+] & $#.*0A*0&:G* %& A0F-$.& %& &)&+$&:G* .*,*$#(-0/,'#-* %' ?*0-&+'.$,'#-* ' -0&#(?*0,&:G* -&#-* %& A0PA0$& 8'(-G* .*,*%' .*#(-0/:G* %' .&A&.$%&%'( A&0& ?*0,/+&:G* %' A*+Y-$.&( AE3+$.&(H �&$(&$#%&1 & )&+*0$9&:G* %* .&A$-&+ 4/,&#* ' %* .*#4'.$,'#-* .*,* ?*0:&(A0*%/-$)&( ' ,'%$&%*0&(1 #G* (P %* %$0'$-* [ (&E%'1 ,&( -&,37, %'%'('#)*+)$,'#-* (*.$&+H

69


Referências bibliográficas�3)�3$�� ,�� /�� )��8/� $� �� *�� 6�� * �+�/�� H��5�$�� $�� DCCD/�DCC�/

7�� +/� �� 4� �� +�� *�� H��+�� :/�#H��$,,#3�-�� M��B�-Z��<��%-��/'�3�9�� '��)��9��&�� '��9[�H-��DCCG/��/�FCI�FJE/

7�3�-��3�#�B/�6��#�� DCCF/

7,��#B/�� /��+��3 �� /�7��/�� :� ��;<�="$>�(�/�7� �;�� H�� DCCD/�� ) ��/�FFD�/

7,��#B/�� /�� 9��)� * �+�� $�� /� ��+��3 �� /�%� �� '��0�� (�� 5 �� "�� * �+�� \�� W��/�7� �;�� H�� DCCG/�� /�,��"��6�1�� /�GJ�/

�3)��&��)/�"�� (��;�� H�+��H&&444/��/��/*�&�+/��/��H�DE�� DCCJ/

��,)#3$Z�� 8 ��M��,)#3$��)��/�$�� /��;��H�+��H&&444/+ ��+��/��/��H�K�� DCCJ/

�$,�$,��M��B�-Z��<��M�-,?#BB�� M��)#BS$BB��7<�* � M�8��$��7��+ M��,$$��3��*��M� ��B��Z��M� 7$�9B$�-B$��,�*��/�� 6��+ ��+H��:��6��+ �/�#H��$,,#3�-�� M��B�-Z��<��%-��/'/�3�9�� '��)��9��&�� '��9[�H�-��DCCG/��/�JIF��JKD/

�#$,�3)-3#�� /��6�� $�� +�� H��*�� /�-��-��#� ��7,��-�E�%D'��/�GJF�GEF��DCCF/

�#$,�3)-3#�� /�,��+�� 1�� /� #H�3$9,#��7 �! �M?#�3�� B��5 �%-��/'/�<�� ?��:�� H��*� ��DCCD/��/�ECL�EGC/

�3��/�� @A��'��&�'��,�$��DC� ;��FLLC/�3�� ;��M�� B� � �� /��;��H�+��H&&+��/��/��&DCCJ&/��H�DJ�� DCCJ/

7 0


�-��33��<��/�<��'��'��)��:��0�� * �+�� +��(��7� ��+�/�� H�7��$�� DCCD/FIF�/

P�$#,-Z��B�� /�)2�� 2�� H�� *�� /� #H��#$,�3)-3#��/M��3�-��/2� �0�� ,��8 ��H�� DCCG/��/�LG�FGF/

��3)-��/�7��'��)��:��0�� =��1�� /�,��8 ��H�,��DCCF/�FQJ�/

7 1

Assistência domiciliar – instrumento parapotencializar processos de trabalho na

assistência e na formação

Maria José Bistafa Pereira, Silvana Martins Mishima, Cinira Magali Fortuna,

Silvia Matumoto, Rafaela Azenha Teixeira, Clarice Aparecida Ferraz,

Janete Rodrigues da Silva Nakao, Marcia Regina Antonietto da Costa Melo e Maria Luiza Anselmi

0'?*0,& (&#$-F0$& 30&($+'$0&1 $#$.$&%& IF #& %7.&%& %' ��=�1 -0&9 A&0&* .'#F0$* %&( A*+Y-$.&( %' (&E%'1 %*( ($(-',&( ' %*( ('0)$:*( %' (&E%' ' %&(A0F-$.&( &(($(-'#.$&$( #*)&( %',&#%&( ' %'(&?$*( O/' #'.'(($-&, ('0'#?0'#-&%*( ' .*#(-0/Y%*( #* #Y)'+ %& ,&.0*A*+Y-$.& ' %& ,$.0*A*+Y-$.&H .*#(-0/:G* %' ?'00&,'#-&(1 ' (/& *A'0&:G* .*-$%$&#&1 A&0& & A0*%/:G* %'&:Z'( ./$%&%*0&( 7 /, %'(('( %'(&?$*(H

�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�'/ A*-'#.$&+ ', A0*,*)'0 ,&$*0.*+&3*0&:G* '#-0' *( ('0)$:*( 4*(A$-&+&0'( ' #G* 4*(A$-&+&0'( A*%' &/,'#-&0& A*(($3$+$%&%' %' %&0 .*#-$#/$%&%' ' ,&$*0 '?$.F.$& [ &(($(-Q#.$&H &0-$./�+&:G* '#-0' '(('( ('0)$:*( A*0 ,'$* %& &(($(-Q#.$& %*,$.$+$&0 .*#?'0'�+4' /,.&0F-'0 ?&.$+$-&%*0 A&0& * -0&3&+4* .*,A&0-$+4&%* ' $#-'80&%* ', %$?'0'#-'(#Y)'$( %' &-'#:G*H /,'#-& &( ^.4&#.'(^ %' %$,$#/$0 &( *A*($:Z'( ' *(?0'O_'#-'( &-&O/'( '#-0' *( ('0)$:*( 4*(A$-&+&0'( ' %& 0'%' 3F($.&1 A'0,$-$#%*1&(($,1 /, '(A&:* A0$)$+'8$&%* A&0& * '(-&3'+'.$,'#-* %' '(-0&-78$&( %''%/.&:G* A'0,&#'#-'1 )$(&#%* '?'-$)&0 & $#-'80&+$%&%' %& &(($(-Q#.$& &*&0-$./+&0 * ,/#%* %* -0&3&+4* &* ,/#%* %& '%/.&:G*H

Gestão

72


Resgatando conceitos�&0& $#$.$&0,*( #*((& &3*0%&8', (*30' & -',F-$.&1 ?&9�(' #'.'((F0$*

'(-&3'+'.'0 &+8/,&( %'?$#$:Z'( 4&3$-/&+,'#-' /(&%&( #& '+&3*0&:G* %'A0*I'-*( O/' '#)*+)', & A0'(-&:G* %' &(($(-Q#.$& #* %*,$.Y+$* %*( /(/F0$*(*/ A*-'#.$&+,'#-' /(/F0$*( %*( ('0)$:*( %' (&E%'H �(-&,*( ?&+&#%* %&#'.'(($%&%' %' '(.+&0'.'0 *( .*#.'$-*( %' )$($-& %*,$.$+$&0 W��X1 &(($(-Q#.$&%*,$.$+$&0 W�X ' � ��H �$,/+-&#'&,'#-' [ .*#.'$-/&:G*1 '(-&0',*(&A0'('#-&#%* .*#($%'0&:Z'( %&( .&0&.-'0Y(-$.&( %& � ', .*#?*0,&:G* &*,*%'+* &(($(-'#.$&+H

� 7(�(�� -�1('(4(�� 7 -*,&%& .*,* /, $,A*0-&#-' $#(-0/,'#-*1 '#-0'*/-0*(1 A&0& *A'0&.$*#&+$9&0 A&0-' %' /, A0*80&,& %' (&E%' */ A&0-' %'/,& A*+Y-$.& %' &(($(-Q#.$& [ (&E%' A0'('#-' ', /,& (*.$'%&%' #/, %&%*,*,'#-* 4$(-P0$.*H

�'((' ('#-$%*1 & )$($-& %*,$.$+$&0 7 /-$+$9&%& A&0& 0'&+$9&0 $#O/70$-*(1.&%&(-0&,'#-*(1 .*#-0*+' %' /(/F0$*( ?&+-*(*(1 .*#-0*+' %' ?*.*( 'A$%Q,$.*(1', 0'(/,*1 &:Z'( A*#-/&$( ' ?*.&+$9&%&(H 2'0&+,'#-'1 '((&( &:Z'( (G*0'&+$9&%&( A*0 /, &8'#-' %' (&E%' -0'$#&%* A0')$&,'#-' A&0& %'('#)*+)'0 &&-$)$%&%' ', ?*.*H

�&00'$0& W��X1 ', ('/ '(-/%* (*30' * .*#-0*+' %& -/3'0./+*(' #* �0&($+1#* .*,':* %* (7./+*1 &80/A*/ &( &-$)$%&%'( %& )$($-& %*,$.$+$&0 A&0&A*0-&%*0'( %'((' &80&)* ', ?/#:Z'(1 %'#-0' &( O/&$( (' %'(-&.&,�

�8 9/�� :�('� � A'#'-0&0 #& $#-$,$%&%' %* -'.$%* (*.$&+ A&0& %'-'.-&0A0'.*.','#-'1 #* .&(*1 -/3'0./+*(']

�8 9/�� -� �� 0'?*0:&0 & *0%', ,7%$.& ' & &/-*0$%&%'(&#$-F0$&]

�8 9/�� -� '��4� � )'0$?$.&0 * ./,A0$,'#-* %&( #*0,&( (&#$-F0$&(%' A0*?$+&@$& %& -/3'0./+*('H

� ��(��;�'(� -�1('(4(�� .&0&.-'0$9&�(' A*0 %'('#)*+)'0 &:Z'( %'A0*,*:G*1 A0')'#:G* ' 0'&3$+$-&:G* [ (&E%' %* $#%$)Y%/* ' %& ?&,Y+$&H�*0-&#-*1 '(-F A0')$(-& #& � /,& 'O/$A' ,/+-$%$(.$A+$#&01 .*, &-/&:G*$#-'0%$(.$A+$#&01 $,A+$.&#%* &(($, & &8+/-$#&:G* %' /, .*#I/#-* %' (&3'0'(A&0& &+7, %* 3$*+P8$.*H �((& ,*%&+$%&%' %' &-'#:G* -&,37, -', '(-0'$-&0'+&:G* .*, & *08&#$9&:G* %*( ('0)$:*( %' (&E%' '1 A*0 .*#('8/$#-'1 .*, &.*#?*0,&:G* %* ,*%'+* &(($(-'#.$&+H

73

Assistência domiciliar – instrumento para potencializar processos de trabalho na assistência e na formação

�'((& ,&#'$0&1 )&,*( '#.*#-0&0 & � .*#?$8/0&#%*�(' %' ?*0,&(%$?'0'#-'(H �*( A&Y('( O/' &A0'('#-&, & *08&#$9&:G* %*( ('0)$:*( %' (&E%'.*, .&0&.-'0Y(-$.&( %' %$.*-*,$& '#-0' *( ('0)$:*(1 #G* (' -', '(-&3'+'.$%* &.*#-$#/$%&%' %& &-'#:G* '#-0' * #Y)'+ A0$,F0$* %' &-'#:G* ' *( 4*(A$-&$(1 ')$.'�)'0(&] & � *.*00' ('8/$#%* '((& ,'(,& +P8$.& � 7 ,&$( /, ('0)$:*A0'(-&%*H �(-F %'(-$#&%& [O/'+'( A&.$'#-'( .0K#$.*( */ [O/'+'( $#.+/Y%*( ',&+8/, -$A* %' A0*80&,&1 O/'1 A*0 (/&( A0'.F0$&( .*#%$:Z'( %' (&E%'1 0'O/'0',&(($(-Q#.$& -&,37, #* %*,$.Y+$*1 A&0& *( O/&$(1 #* '#-&#-*1 #G* '(-G*A0')$(-*( ./$%&%*( ' -0&-&,'#-*( .*,A+'@*(H

L/&#%* -',*( & � $,A+&#-&%& ', /, ,*%'+* %' &-'#:G* ', O/' &&-'#:G* A0$,F0$& [ (&E%' 7 '(-0/-/0&#-' %& *08&#$9&:G* %* ($(-',& %' (&E%'1'+& (' .&0&.-'0$9& A*0 $#-'80&:G*1 &0-$./+&:G* ' .*#-$#/$%&%' '#-0' *( ('0)$:*(1A*(($3$+$-&#%* & .*#.0'-$9&:G* %& +*#8$-/%$#&+$%&%'1 & $#-'80&+$%&%'1 &&.'(($3$+$%&%' ' & $#-'0&:G* '#-0' * A0*?$(($*#&+ ' * /(/F0$*U?&,Y+$&H�

.&0&.-'0Y(-$.& %'((' -$A* %' � 7 A&/-&%& A'+& 0'&+$9&:G* 0'8/+&0 %'./$%&%*( A'+& 'O/$A' ,/+-$%$(.$A+$#&0 %& (&E%'1 .*, &-/&:G* $#-'0%$(.$A+$#&01A0'(-&#%* ./$%&%*( &*( A0*3+',&( %' *0%', 3$*+P8$.& O/' '(-$)'0 &?'-&#%** $#%$)Y%/*U?&,$+$&0'(1 ,&( -&,37, .*,3$#&#%* & '((& -'0&AQ/-$.& &( &:Z'(O/' -0&3&+4&, .*, & %$,'#(G* (/3I'-$)& ' &$#%& .*, *( &(A'.-*( %& %$,'#(G*%& ',&#.$A&:G* ' %& .$%&%&#$&H �((& &-'#:G* A0'.$(& ('0 0'&+$9&%& %' ?*0,&.*#($(-'#-' &* +*#8* %* -',A*1 A0'((/A*#%* &(($, & ,&$*0 A*(($3$+$%&%' %*'(-&3'+'.$,'#-* %' /,& 0'+&:G* %' )Y#./+* ' 4/,&#$9&%&H

�*0 ,'$* %& &0-$./+&:G* ' %& $#-'80&:G* '#-0' *( ('0)$:*(1 & 'O/$A' %&&-'#:G* A0$,F0$& A&0-$.$A& A0')$&,'#-' %* A+&#'I&,'#-* %& &+-& 4*(A$-&+&0%* A&.$'#-' I/#-* .*, & 'O/$A' %*( A0*?$(($*#&$( %* 4*(A$-&+1 &((/,$#%* &.*�0'(A*#(&3$+$%&%' #& .*#-$#/$%&%' %* -0&-&,'#-* #* %*,$.Y+$*H �/ ('I&1'(-&3'+'.'�(' /, )Y#./+* 3&(-&#-' '(-0'$-* '#-0' *( A0*?$(($*#&$( %& &-'#:G*A0$,F0$& ' *( %* 4*(A$-&+H �&0& -&#-*1 ?&9�(' #'.'((F0$* '(-&3'+'.'0 .0$-70$*(%' $#.+/(G* #& &-'#:G* %*,$.$+$&0 3', .*,* A0*-*.*+*( %' ('8/$,'#-*1.*,A0''#%$%*( .*,* 3&+$9&( A&0& & .*#(-0/:G* %*( A0*I'-*( -'0&AQ/-$.*($#%$)$%/&$(1 /,& )'9 O/' &( #'.'(($%&%'( &A0'('#-&%&( A*0 .&%& /(/F0$*('0G* (',A0' ($#8/+&0'(1 E#$.&(1 ,*)$%&( A*0 (/&( %*0'(1 (*?0$,'#-*( '%'('I*(1 */ ('I&1 A'+& (/& (/3I'-$)$%&%'H

��@��?O��"��+��*1�!�86AG$�� #$��!%��&��F��(��+��?��$��(��H��+)��*��+�,--,$

74


� � ��7 /,& &+-'0#&-$)& &(($(-'#.$&+ %* ('-*0 (&E%' O/' .*#($(-'', /,& '(-0&-78$& .&A&9 %' %$(A'#(&0 /, .*#I/#-* %' ./$%&%*( ,7%$.*( '%' '#?'0,&8', %' N,3$-* 4*(A$-&+&01 -&#-* ', O/&#-$%&%' .*,* ',O/&+$%&%'1 & A&.$'#-'( ', ('/ %*,$.Y+$*1 O/&#%* '(-'( IF #G* #'.'(($-&, %'$#?0&�'(-0/-/0& 4*(A$-&+&01 ,&( A0'.$(&, %' )$8$+N#.$& &-$)& ' %' &(($(-Q#.$&%' ,&$*0 %'#($%&%' -'.#*+P8$.& O/' %& &-'#:G* A0$,F0$& W�*--& '- &+H1 ��XH�� -&,37, A*%' ('0 .*,A0''#%$%* A*0 ./$%&%*( (',$�$#-'#($)*(H

�&+' %'(-&.&0 O/' &+7, %*( A0*?$(($*#&$( O/' '(-G* %$0'-&,'#-' &-/&#%*#* %*,$.Y+$* '(-G* '#)*+)$%*( ?&0,&.Q/-$.*(1 #/-0$.$*#$(-&( ' *( 0'(A*#(F)'$(A'+* .*#-0*+' %' ,&-'0$&$(1 ,'%$.&,'#-*( ' 'O/$A&,'#-*(H

�* � ��-&,37, '(-G* A0')$(-*( * '(-&3'+'.$,'#-* %' .0$-70$*( %'$#.+/(G*1 3', .*,* A0*-*.*+*( %' ('8/$,'#-* ' &)&+$&:G* %*( ('0)$:*( �A0*-*.*+*( %' &-'#%$,'#-*1 'O/$A' A0*?$(($*#&+ '(A'.$&+$9&%&1 0'./0(*( .*,%'#($%&%' -'.#*+P8$.& &%'O/&%& A&0& .&%& A&.$'#-'1 &)&+$&:G* %&( .*#%$:Z'(%* %*,$.Y+$* ' %*( ?&,$+$&0'( A&0& ./$%&0 */ %$(A*0 %' /, ./$%&%*0 #*(&(A'.-*( 8'0&$( %* ./$%&%*H ( .&0&.-'0Y(-$.&( A&/-&%&( #& (/3I'-$)$%&%' %*/(/F0$* ' %* -0&3&+4&%*0 O/' A0'(-& & &(($(-Q#.$& #* � ��-&,37, '(-G*A0'('#-'( ' (G* %'?$#$%*0&( %* A0*I'-* -'0&AQ/-$.* A0*A*(-*H

�0&9 W��1 AH JX &+'0-& ̂ HHH* ./$%&%* A0'(-&%* #* %*,$.Y+$* #G* %')' ('0/,& &-$)$%&%' ,*)$%& & $,A0*)$(&:Z'( ' $#?*0,&+$%&%'(^H

�& $#-'0#&:G* %*,$.$+$&0 A0')$(-& #* � �� /,& .&0&.-'0Y(-$.&?/#%&,'#-&+ 7 * .&0F-'0 -0&#($-P0$*H �$9'#%* %' */-0& ,&#'$0&1 & $#-'0#&:G*%*,$.$+$&0 %')' -'0 & %/0&:G* +$,$-&%&1 '(-&3'+'.$%& A'+&( .$0./#(-N#.$&( %&&+-&1 A*%'#%* ('0 A0')$(-& & &+-& %*,$.$+$&01 .*, A'0(A'.-$)& A&0& & ./0& ' */& ,*0-'1 ��-�� %* +&-$,1 (&Y%&X '(-&3$+$9&:G* %* O/&%0* A&-*+P8$.*10'$#-'0#&:G* #* 4*(A$-&+ */ -0&#(?'0Q#.$& A&0& * ('0)$:* %' &-'#:G* A0$,F0$&H�&(* #G* (' -0&3&+4' .*, '((' .&0F-'0 %' -0&#($-*0$'%&%'1 &( $#&%'O/&:Z'( %'(/& &A+$.&:G* $0G* &A&0'.'01 -&$( .*,*� .*00'�(' * 0$(.* %' %/A+$.&0 *-0&-&,'#-*1 IF O/' & )$8$+N#.$& ' * ('8/$,'#-* %' A&.$'#-'( .0K#$.*( #*%*,$.Y+$* %')', ('0 %' 0'(A*#(&3$+$%&%' %*( ('0)$:*( %' &-'#:G* A0$,F0$&1(&+)* 0&0&( '@.':Z'(H

�*, '((&( .*#($%'0&:Z'(1 (G* A&.$'#-'( $#%$.&%*( A&0& & $#-'0#&:G*%*,$.$+$&0 &O/'+'( O/' #G* #'.'(($-&, %' -*%& & $#?0&�'(-0/-/0& 4*(A$-&+&0A&0& * -0&-&,'#-* $#%$.&%*1 #* '#-&#-* 0'O/'0', ./$%&%*( O/' '@$8', /,&%'#($%&%' -'.#*+P8$.& ,&$( '+')&%& O/' & %& &-'#:G* A0$,F0$&H �G*1 A*0-&#-*1A&.$'#-'( O/' 0'O/'0', /,& 'O/$A' ?*0,&%& A*0 ,7%$.*(1 -0&3&+4&%*0'( %''#?'0,&8', ' */-0*(1 ' &$#%& %' 'O/$A&,'#-*( -'.#*+P8$.*( #'.'((F0$*( A&0&?&9'0 %$&8#P(-$.* ' A0*)'0 -0&-&,'#-* ' ./$%&%*H

75


�, �*--& '- &+H W��X1 '#.*#-0&,*( *( A&.$'#-'( O/' -Q, &A0'('#-&%*,&$*0 ?0'O_Q#.$& ', $#-'0#&:G* %*,$.$+$&0H �G* '+'( *( A*0-&%*0'( %'�

� ��'�� '�<�('�� 2/-(=�-�� W.&0%$*A&-$&(1 (Y#%0*,' %&$,/#*%'?$.$Q#.$& &%O/$0$%&1 4'A&-*A&-$&( .0K#$.&(1 #'*A+&($&(1%*'#:& A/+,*#&0 *3(-0/-$)& .0K#$.&1 .$00*(' 4'AF-$.&1 %*'#:&(-'0,$#&$(X]

> ��'(�� 1 ��'�� )�?'(�,�2('� $,'%$&-* %' .$0/08$& %' ,7%$* 'A'O/'#* A*0-'1 */ AP( .$0E08$.* -&0%$* %' .$0/08$&( %' 80&#%' A*0-'.*, .*,A+$.&:Z'(] AP(�*A'0&-P0$* %' .$0/08$& *0-*A7%$.& ' -0&/,&�-*+P8$.& ' &$#%& -0&-&,'#-* %' 80&#%'( '(.&0&(]

� ��'(�� 1 �(�/�@�� 2/-��5 A#'/,*#$&(1 A$'+*#'?0$-'(1 %*'#:&()&(./+&0'( ' #'/0*+P8$.&(1 A&.$'#-'( ', #/-0$:G* A&0'#-'0&+ ')'#-$+&:G* ,'.N#$.& ' &$#%& ', O/$,$*-'0&A$& ' &#-$3$*-$.*-'0&A$&$#-0&)'#*(& %*,$.$+$&0H�'+* '@A*(-*1 *( ('0)$:*( %' A0'(-&:G* %' ./$%&%*( #* %*,$.Y+$* %$?'0',1

3&($.&,'#-'1 ', %/&( 80&#%'( ,*%&+$%&%'(� (�� 0��(��4�� -�1('(4(�� -��7�47(-� ��4� �A/(�� -� �� (1:�(�8

�&( %/&( ,*%&+$%&%'(1 7 #'.'((F0$* O/' *( -0&3&+4&%*0'( $#-'80&#-'(%& 'O/$A' %& &-'#:G* A0$,F0$& ' %* 4*(A$-&+ &-/', %' ?*0,& $#-'80&%& '&0-$./+&%&1 %')'#%* '(-&0 &%'O/&%&,'#-' *08&#$9&%*( ' -'0 ?$#&#.$&,'#-*A&0& A0*)'0 & &(($(-Q#.$& #* %*,$.Y+$*H

�& �1 *( -0&3&+4&%*0'( #G* A'0,&#'.', #* %*,$.Y+$* &AP( 0'&+$9&0*( ./$%&%*(H $#%&1 (' 4F & *A:G* %' %$(A*#$3$+$9&0 & � [O/'+'( A&.$'#-'((', A*(($3$+$%&%'( -'0&AQ/-$.&(1 )$(&#%* &* ./$%&%* A&0& * &+Y)$* %& %*0 '%' (*?0$,'#-*( %' */-0& #&-/0'9&1 -&,37, (' '(A'0& O/' & 'O/$A' -0&3&+4'.*, & ?&,Y+$& & ',$#Q#.$& %& ('A&0&:G*UA'0%&H �'((& ($-/&:G*1 & � 7.*#4'.$%& .*, & %'#*,$#&:G* %' 4P(A$.'H

�& $#-'0#&:G* %*,$.$+$&01 A*%'�(' '#.*#-0&0 &( *A:Z'(U#'.'(($%&%'(%& A'0,&#Q#.$& %' A'((*&+ %' '#?'0,&8', A*0 M1 ��1 �� ' �� 4*0&(1 & %'A'#%'0%* O/&%0* A&-*+P8$.* ' %&( .$0./#(-N#.$&( %* A&.$'#-' ' %' ('/( ?&,$+$&0'(H

Importância da assistência no domicílio – (re)conhecendosuas potencialidades( -0&#(?*0,&:Z'( *.*00$%&( #& (*.$'%&%' ' &( 0'+&:Z'( '(-&3'+'.$%&(

'#-0' *( 4*,'#( ' #*( A0*.'((*( %' -0&3&+4*1 */ ('I&1 #& %$#N,$.& %&(*.$'%&%'1 8'0&, #'.'(($%&%'(1 ' A&0-$./+&0,'#-' #& (&E%' -',*( )$)$%*,*%$?$.&:Z'( #*( 4F3$-*( (&#$-F0$*(1 '(-&,*( )$)'#.$&#%* /,& -0&#($:G*

76


%',*80F?$.& O/' 0'(/+-& #* &/,'#-* %& '(A'0&#:& %' )$%& '1 .*#('O_'#�-','#-'1 %* .*#-$#8'#-' %& A*A/+&:G* $%*(&H $#%&1 &( .0'(.'#-'(#'.'(($%&%'( %' ./$%&%*( &#-' &( %*'#:&( $#?'..$*(&( W��1 -/3'0./+*('X1.*,* -&,37, &#-' &( %*'#:&( .0K#$.&( #G* -0&#(,$((Y)'$( ' &( .*#%$:Z'(.0K#$.&(1 -Q, ($#&+$9&%* & #'.'(($%&%' %& 0'*08&#$9&:G* %*( ('0)$:*( %'(&E%'H

.0$(' %& (&E%' &#&+$(&%& A*0 %$)'0(*( N#8/+*( � $#'?$.$Q#.$&1$#'?$.F.$&1 $#$O_$%&%' ' $#(&-$(?&:G* %& *A$#$G* AE3+$.& � $,A/+($*#& &'#.*#-0&0 #*)&( '(-0&-78$&( A&0& & *08&#$9&:G* ' & 8'(-G* %*( ('0)$:*( %'(&E%'1 .*, )$(-&( & .*#-0$3/$0 #& 0'*0$'#-&:G* %* ,*%'+* &(($(-'#.$&+ '1 &*,'(,* -',A*1 %* ,*%'+* %' '#($#* %&( A0*?$((Z'( %& F0'& %' (&E%' ' %*(A0*.'((*( %' '%/.&:G* A'0,&#'#-'H �'#-0' '((&( '(-0&-78$&(1 %'(-&.&,*( &&-'#:G* %*,$.$+$&0 ' & $#-'0#&:G* %*,$.$+$&0H

�08&#$9&:G* �/#%$&+ %& �&E%' -', .*#($%'0&%* .*,* /, %*(,&$*0'( %'(&?$*( A&0& *( ($(-',&( %' (&E%' %' -*%* * ,/#%* * 8'0'#.$&,'#-*%' .*#%$:Z'( .0K#$.&( &#-' &( A'0(A'.-$)&( ?/-/0&( O/' *( '(-/%*( (*30' '(-&(0')'+&,H

0')$(G* %& +$-'0&-/0& A'0,$-'�#*( )'0$?$.&0 #& %7.&%& %' �� & &%*:G*%& &(($(-Q#.$& ' %& $#-'0#&:G* %*,$.$+$&0 #/, .0'(.'#-' ($8#$?$.&-$)* A*0%$)'0(*( ('0)$:*( %' (&E%'1 A&/-&%& ', I/(-$?$.&-$)&( %' %$?'0'#-'( *0%'#( �,&$( )&8&( #*( 4*(A$-&$(1 0'%/:G* %*( 0$(.*( %' $#?'.:G* 4*(A$-&+&014/,&#$9&:G* %* &-'#%$,'#-* ' ('#(Y)'+ 0'%/:G* %*( ./(-*(H �*,&%* & '((&(I/(-$?$.&-$)&(1 '#.*#-0&,*( #& +$-'0&-/0& &O/'+'( O/' %'?'#%', & $,A+&#-&:G*%' ('0)$:*( %'((& #&-/0'9& A'+& #'.'(($%&%' %' A0*,*)'0 /,& ,&$*0$#-'80&:G* ' .*+&3*0&:G* '#-0' *( ('0)$:*( 4*(A$-&+&0'( ' *( '@-0&�4*(A$-&+&0'(1.*, )$(-&( [ .*#(-0/:G* %' /, #*)* ,*%'+* %' &-'#:G*1 A*(($3$+$-&#%* &(($,& &(($(-Q#.$& .*#-Y#/& ' #& A'0(A'.-$)& %& $#-'80&+$%&%'H

�', *.*00'#%* /, &/,'#-* #* #E,'0* %' ('0)$:*( %' &(($(-Q#.$&%*,$.$+$&01 .*#?*0,' #*( $#?*0,& &)*+&0$ '- &+H W��1 AH �MX� ^�F .'0.& %'.$#.* &#*(1 4&)$& #* �0&($+ A*/.* ,&$( %' .$#.* ',A0'(&( O/' ?&9$&,&(($(-Q#.$& %*,$.$+$&0 #* ('-*0 A0$)&%* dHHHe1 * #E,'0* %' ',A0'(&( /+-0&A&((*/& ,&0.& %' �D� ', ��^H

�( &/-*0'( 0'?'0', -'0 4*I' #*( �� ̂ .'0.& %' �� ,$+ ',A0'(&( %' � ��'1 &$#%& #* ($(-',& & ,&$*0$& %*( &-'#%$,'#-*( .*,A*(-*'@.+/($)&,'#-' A*0 ./$%&%*( %' '#?'0,&8', %' 3&$@& .*,A+'@$%&%'1 .*,A*/.& A&0-$.$A&:G* ,7%$.& dHHHe^ W&)*+&0$ '- &+H1 ��1 AH �"XH

$#%&1 7 ?/#%&,'#-&+ (' .*#($%'0&0 & A*(($3$+$%&%' %' (' *3-'0 ,&$((&-$(?&:G* ' A&0-$.$A&:G* %* /(/F0$* ' %' ('/( ?&,$+$&0'(1 )'0$?$.&#%*�(' /,&

77


0'./A'0&:G* ,&$( A0*#-& %* A&.$'#-' ', ,/$-&( '#?'0,$%&%'(H 0'%/:G*%*( ./(-*( IF &A&0'.' A'+* A0PA0$* /(* ,&$( &%'O/&%* ' 0&.$*#&+ %*( 0'./0(*(H

�*--& '- &+H W��X &?$0,&, O/' & &(($(-Q#.$& %*,$.$+$&0 &/,'#-& &%$(A*#$3$+$%&%' %' +'$-*( 4*(A$-&+&0'( ' -&,37, %$,$#/$ * A'0Y*%* %'$#-'0#&:G*1 ('#%* *( ./(-*( A&0& & $#-'0#&:G* %*,$.$+$&0 ,'#*0'( O/' &,A+$&0' ,&#-'0 +'$-*( ', 4*(A$-&$(H &)*+&0$ '- &+H W��X &?$0,&, O/' & &(($(-Q#.$&%*,$.$+$&0 A'0,$-' /,& 0'%/:G* %*( ./(-*( ', (&E%' A0*A*0.$*#&+,'#-' #&*0%', %' "�` O/&#%* .*,A&0&%*( &*( %& &(($(-Q#.$& 4*(A$-&+&01 ('#%*'((& 0'%/:G* /, %*( 80&#%'( ,*-$)*( O/' $,A/+($*#&0&, * $#)'(-$,'#-*', ('0)$:*( %'((& #&-/0'9&H

( )&#-&8'#( &.'0.& %& $#-'0#&:G* %*,$.$+$&0 ?*0&, ($(-',&-$9&%&(A*0 �*--& '- &+H W��X ' '(-G* &(($#&+&%&( #* O/&%0* &3&$@*�

Quadro 1 – Vantagens da internação domiciliar

Pacientes e suas famílias

Melhor atenção, participaçãoe responsabilidade

Melhor qualidade de vida,intimidade e bem-estar

Assistência personalizadaemais humanizada

Educação para a saúde

Prevenção de desinserçãosocial e hospitalismopsíquico

Menor risco de iatrogenia

Hospital

Melhor rentabilidade deseus recursos disponíveis

Aumento em rotação edisponibilidade de camas

Redução de permanênciasdesnecessárias

Redução dos períodos deinternações

Pressuposição de reduçãode custos

Possibilidade de melhoraros Serviços

Sistema de saúde

Incremento da eficácia e daefetividade mediante umaassistência mais humanizada

Uso mais eficiente dos recursossanitários

Possibilidade de integrar emelhorar as relações entreosdiversos níveis assistenciais

Possibilidade de atenção:continuada, integral e multidis-ciplinar entre os profissionaisda atenção primária

Fonte: COTTA, R. M. M.; VARELA-SUÁREZ, M. M.; GONZÁLEZ, A. L.; COTTA FILHO, J. S.; REAL, E. R.; RICÓS, A. D. La hospitalizacióndomiciliaria: antecedentes, situación actual y perspectivas. Rev. Panam Salud Public, v. 10, n. 1, p. 45-55, 2001.

78


�(('( &(A'.-*( A*($-$)*( '+'#.&%*( A*0 �*--& '- &+H W��X (P ('0G*)$&3$+$9&%*( (' 4*/)'0 /, ,*)$,'#-* %*( -0&3&+4&%*0'( %' (&E%'1 %*(/(/F0$*(1 %*( 8'(-*0'( ' %&( $#(-$-/$:Z'( ?*0,&%*0&( #& %$0':G* %' 0'.*#(-0/$0* -0&3&+4* A&0& &+7, %*( .&,A*( '(A'.Y?$.*( %' .&%& F0'& A0*?$(($*#&+1&,A+$&#%* * .&,A* %' &-/&:G* A&0& & A0*%/:G* %' ./$%&%*(H

�, '(-/%* 0'&+$9&%* A*0 �'0'$0& W��X1 ?*$ ')$%'#.$&%* O/' & &(($(-Q#.$&#* %*,$.Y+$* -', A*-'#.$&+$%&%'( %' A0*,*)'0 #*( -0&3&+4&%*0'( %' (&E%'&/-*O/'(-$*#&,'#-*(1 0')$(G* %' .*#.'$-*(1 &,A+$&#%* & )$(G* (*30' *A0*.'((* (&E%'�%*'#:& A&0& &+7, %& %$,'#(G* 3$*+P8$.&H �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

�'((' ('#-$%*1 * '(A&:* %*,$.$+$&0 7 A*-'#-' A&0& A0*,*)'0 & 0'?+'@G*%&( 0'+&:Z'( /(/F0$*U-0&3&+4&%*0 %' (&E%' #* .*#-'@-* $#-0&�('0)$:*( %'(&E%' ' $#-0&%*,$.$+$&0H �*( ('0)$:*( %' (&E%'1 #& ,&$*0$& %&( )'9'(1 .*,0&0&( '@.':Z'(1 * /(/F0$* 7 -*,&%* .*,* *3I'-*1 ' * -0&3&+4&%*0 4$'0&0O/$.&�,'#-' (' .*+*.& #* -*A* %& 0'+&:G*1 '#O/&#-* #* %*,$.Y+$* '((& 0'+&:G* -'#%'& (' -*0#&0 ,&$( 4*0$9*#-&+ ' A'0,'&%& A*0 -0*.&( %' $#-'0(/3I'-$)$%&%'1 ',O/' * /(/F0$* (' .*+*.& ' 7 .*+*.&%* .*,* (/I'$-* %'((& 0'+&:G*H �&+' & A'#&%'(-&.&0 O/' * '(A&:* %*( ('0)$:*( %' (&E%' 7 %' %*,Y#$* %* -0&3&+4&%*01 '#* %*,$.Y+$*1 * '(A&:* 7 %' %*,Y#$* %* /(/F0$*1 * O/' &/,'#-& & A*(($3$+$%&%'%' 0'?+'@G* %*( -0&3&+4&%*0'( ', 0')'0 (/&( A*(-/0&(H

� '(-&3'+'.$,'#-* %' )Y#./+*1 %' /,& 0'+&:G* ,&$( A'0(*#&+$9&%& ',&$( 4/,&#$9&%& 7 )$(-* .*,* /, %*( &-0$3/-*( A0*A*0.$*#&%*( A'+&&(($(-Q#.$& #* %*,$.Y+$*H �$&#-' %* '@A*(-*1 & 4/,&#$9&:G* %* &-'#%$,'#-*#& A0'(-&:G* %' &-'#:G* [ (&E%' .*#?$0,&�(' .*,* /,& %&( .*#%$:Z'(?&)*0F)'$( A&0& * $#.'#-$)* %' (' $#)'(-$0 #'((& '(-0&-78$&H ?$0,&,*( O/'-*%*( '(('( &-0$3/-*( &O/$ '+'#.&%*( #*( A'0,$-', %'?'#%'0 & &(($(-Q#.$& #*%*,Y.$+$* .*,* /, %$(A*($-$)* A&0& & ,/%&#:& %* ,*%'+* &(($(-'#.$&+1 O/'1A*0 (/& )'91 A&((& & 0'O/'0'0 A0*.'((*( %$?'0'#.$&%*(U&,A+$&%*( %'

79


?*0,&:G* ' '%/.&:G* A'0,&#'#-' %*( -0&3&+4&%*0'(H �*(($3$+$-& -&,37,,/%&0 * ,*%'+* %' 8'(-G*1 4*I' A0'%*,$#&#-','#-' %$0'.$*#&%* A&0& ('0)$:*(%'($#-'80&%*( ' *08&#$9&%*( ,&$( ', ?/#:G* %&( .&0&.-'0Y(-$.&( '(-0/-/0&$(%*( ('0)$:*( O/' %&( #'.'(($%&%'( %& A*A/+&:G*H

�((' .'#F0$* 0','-' [ #'.'(($%&%' %* %'('#)*+)$,'#-* %' $#)'(-$8&:Z'(O/' $%'#-$?$O/', A0*A*(-&( A'%&8P8$.&( O/' )$&3$+$9', & &%'O/&:G* %' /,#*)* A'0?$+ A0*?$(($*#&+ [( #'.'(($%&%'( A0'('#-'(H

Desafios e apostas na construção de formas diferenciadasde produzir cuidado�*#-$#/& ('#%* * 80&#%' %'(&?$* -&#-* A&0& *( ?*0,/+&%*0'( %&(

A*+Y-$.&( %' (&E%' .*,* A&0& *( 8'(-*0'( %' (&E%' & -&0'?& %' .*#(-0/$0 /,#*)* ,*%'+* &(($(-'#.$&+1 #G* (' 0'(-0$#8$#%* * &-'#%$,'#-* [( %',&#%&(%& %*'#:&1 ,&( $#%* &+7,1 A0*./0&#%* %'('#)*+)'0 &:Z'( O/' )$(', [$#-'80&+$%&%' %& &(($(-Q#.$& ' %*( ('0)$:*( %' (&E%'1 -'#%* & (&-$(?&:G* %*(/(/F0$*( .*,* /, %*( $#%$.&%*0'( %' (&E%'H �&+' 0'((&+-&0 O/' * ,*%'+* %'?*0,&:G* ' %' &-'#:G* A0'%*,$#&#-'1 A&/-&%* A'+& ?0&8,'#-&:G* %*.*#4'.$,'#-* ' A'+& %'($#-'80&:G* %*( ('0)$:*(1 .*#(-$-/$ A*#-*( '(('#.$&$(%' 0')$(G* #* ('#-$%* %' W0'X.*#(-0/:G* %' /, */-0* ,*%* %' A0*%/9$0 ' &8$0', (&E%'H

&(($(-Q#.$& %*,$.$+$&0 7 -$%& .*,* /, %*( $#(-0/,'#-*( O/' A'0,$-'&*( -0&3&+4&%*0'( %* ('0)$:* ' %*( P08G*( ?*0,&%*0'( &A0''#%'0', &#'.'(($%&%' %& &0-$./+&:G* '#-0' *( ('0)$:*( A*0 ,'$* %' %$)'0(*( 0'./0(*(1'#-0' '+'( * %' (' $#)'(-$0 #& ,'+4*0$& %* 0'8$(-0* ' %& .*,/#$.&:G* � '#-0'-0&3&+4&%*0 ' /(/F0$* ' '#-0' *( ('0)$:*( � (*30' * A+&#* -'0&AQ/-$.* %*(/(/F0$*( O/' -0&#($-&, A'+*( %$?'0'#-'( ('0)$:*( O/' .*,AZ', * ($(-',& %'(&E%'H

f( $#(-$-/$:Z'( %' '#($#* .&3' * %'(&?$* %' '(-&3'+'.'0 '(-0&-78$&( #*A0*.'((* %' ?*0,&:G* O/' +')', [ .*#(-0/:G* %' /,& A0F-$.& ,/+-$A0*�?$(($*#&+1 $#-'0%$(.$A+$#&01 4/,&#&1 7-$.& ' .*,A&0-$+4&%& ' A*(($3$+$-', *%'('#)*+)$,'#-* %' &:Z'( ./$%&%*0&( #& A'0(A'.-$)& %& '%/.&:G*A'0,&#'#-' ', (&E%' A&/-&%&( A'+* �$(-',& �#$.* %' �&E%'H

8 0


Referências bibliográficas7�,,$#,��#/��/��/ �� *��/�,��8 ��FLLD/�GGI�/�)�� /�$�� $6�� 3�:/

7,�Z��/�9/� ,�� B�� (� �� +�/�444/��/��/*�&�!�&�� /��6/� �� DCCJ/

�-3�$B�-��$�$,�B��$��$�#�#3�/�#��6��1�� ; � H�6��* 6�� /�%��-�� 5��R#?��FFF��*��FLLL/�/�D/

�-))��,/��/��/M�?�,$B��],$Z��/��/M�9-3Z]B$Z��/�B/M��-))��#B�-��8/�/M� ,$�B�� $/� ,/M� ,#�^��/��/� B � +�� 5 ��.� �� H� �� .� �� :�� /�"�#��7��7�)�� /�FC��/�F��/�JI�II��DCCF/

-,9�3#Z�_`-��3�#�B��\�$/�-�� #�� C�� /�,� �.�� /�DCCD/

�$,$#,��/�8/�7/�<��)��#�� 1�� %�'�� <�� 6�� /�,�*��DCCF/�DIE�/�)�� /�$�� $6�� ,�*�� /

)�?-B�,#��/�$/�B/� �� -�� +�� 7� ��/"�# �� 0�� /�G��/�L��DCCC/

�)�,�#$B��7/��0��.��(��;*�� /�7� �;�� H�� DCCD/

Recursos humanos e gestão do trabalho em saúde: da teoria para a ...

Documents

Transcript of Recursos humanos e gestão do trabalho em saúde: da teoria para a ...