Municipal managers’ perceptions of the PMAQ: Experience in the Crato Health Region, Ceará, Brazil

Abstract

The institutionalization of evaluation processes as a central mechanism for improving primary care is a challenge for universal health systems. The National Program for Improving Access and Quality of Primary Care established a performance-based evaluation framework, assessing the implementation and development of elements aligned with defined quality standards. This study analyzed the understanding of the program from the perspective of municipal health managers in the Crato Health Region, Ceará, in northeastern Brazil. Participants were municipal health secretaries and primary health care coordinators. Data were collected through semi-structured interviews in June 2020, and the analysis was based on the principles of content analysis. Three empirical categories were identified: (1) Understanding PMAQ as a policy for improving the work environment and incentives; (2) Scope of the program in managing primary care: contributions and challenges; and (3) The role of managers: commitment and integration. The findings highlighted the program’s difficulties in institutionalizing evaluation and team management processes. Divergent perceptions were observed regarding its capacity to reorganize work in primary care management and the impact of competitive processes, overburdening workers, and causing psychological strain.