This paper employs implementation theory and the political literature on performance measurement to understand how frontline health workers know, participate and evaluate the Brazilian National Program for Improving Access and Quality of Primary Care (PMAQ, 2nd round).
This paper develops an implementation theory-driven qualitative analysis. The research is developed in the city of Goiania (Brazil): a challenging organizational context in primary care (PHC). Interviews were carried out with 25 frontliners – managers, doctors, nurses and community health workers. Data were thematically and hierarchically analysed according to theoretical concepts such as policy knowledge, policy adherence, forms of accountability, alternative logics, organizational capacity and policy feedback.
Results show the need to foster organizational capacity, knowledge, participation and policy feedback at the frontline. Successful implementation would require those adaptations to counteract policy challenges/failures or the emergence of alternative logics.
The study was conducted in only one setting, however, our sample includes different types of professionals working in units with different levels of organization capacity, located in distinct HDs, expressing well the implementation of PMAQ/P4P. Qualitative researches need to be developed for further exploring the same/other factors.
Findings can be used to improve discussions/planning and design of P4P programs in the city and State of Goias.
The majority of analysis of PMAQ are of a quantitative or results-based nature. This article focuses on politically significant and unanswered questions regarding the implementation of PMAQ.
A first version of this paper was presented at the 3rd International Conference on Public Policy (ICPP3) of the International Public Policy Association (IPPA), in Singapore, June 2017, http://www.ippapublicpolicy.org/conference/icpp-3-singapore-2017/7. This paper presents the results of Dr. Fabiana Cunha Saddi's PNPD CAPES Postdoctoral Fellowship. We thank Maria Barretos for revising the English language.FCS was British Academy Newton Advanced Fellow during the development of this paper (2018-2020). MH is supported in part by the NW London NIHR Applied Research Collaboration. Imperial College London is grateful for support from the NW London NIHR Applied Research Collaboration and the Imperial NIHR Biomedical Research Centre. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.Funding: Brazilian Ministry of Education, CAPES, National Post-Doctoral Program (PNPD-CAPES Fellowship).
Saddi, F.d.C., Harris, M., Parreira, F.R., Pêgo, R.A., Coelho, G.A., Lozano, R.B., Mundim, P.d.S. and Peckham, S. (2021), "Exploring frontliners' knowledge, participation and evaluation in the implementation of a pay-for-performance program (PMAQ) in primary health care in Brazil", Journal of Health Organization and Management, Vol. 35 No. 3, pp. 327-343. https://doi.org/10.1108/JHOM-04-2020-0154
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