Health manager at SES Tocantins: Evaluation of knowledge and competencies

BARBOSA, César Martins. PINTO, Isabela Cardoso de Matos. Health manager at SES Tocantins: Evaluation of knowledge and competencies. Revista Científica Multidisciplinar Núcleo do Conhecimento. Year 05, Ed. 11, Vol. 02, pp. 26-44. November 2020. ISSN: 2448-0959, Access Link: https://www.nucleodoconhecimento.com.br/health/health-manager, DOI: 10.32749/nucleodoconhecimento.com.br/health/health-manager

and evaluation of government programs; expertise in research in public administration/ public health, formulation, analysis, monitoring and evaluation of programs and projects that confer efficiency, effectiveness and effectiveness to the management of public health policies. This professional also competes in the exercise of the functions of supervision, coordination, direction and advice for the articulation and integration of institutional projects and programs related to health policies implemented by the government, contributing to the three management spheres of the Unified Health System -SUS -at the National, State and Municipal levels, respecting the service regulations and the needs of the public health system.
To assume the position of health manager, law n o . 1,588/2005 defines some mandatory requirements: Being a holder of a higher education degree recognized by the Ministry of Education in any area of knowledge, plus a specialization course in: public health, collective health, health surveillance, hospital administration, auditing health services or management of public health services. In addition professional needs to be approved in public tender of evidence and titles to take possession of the position in question.
However, there was a failure with regard to higher education in any area of knowledge, because the practice of management involves a set of skills and abilities that often do not compose the curricula of any and all higher education, generating great challenges in relation to the knowledge and experience of professionals when they assume a position in the management of the health system.
Another mistake in the formulation of the requirements to assume the public position of health manager at the Tocantins Health Department was the non-requirement of experience / professional experience in public management / health management.
Based on the assumption that the health institution should know the profile of professionals to outline strategies that seek the quality of services provided by the Health Department of Tocantins (SES-TO), and the qualification of professionals working in the system was conducted this study, which points out relevant aspects for the qualification of management and identification of existing gaps for the performance of management functions performed by health managers of SES-TO.
Health manager at SES Tocantins: Evaluation of knowledge and competencies www.nucleodoconhecimento.com.br In addition, it is important to analyze the distances between knowledge and the experiences of professionals who have entered as managers seeking to relate to the attributions required by the position they occupy in the Health Secretariat. Thus, the questions that led to the present study were: Who is the health management professional in the state of Tocantins?
What knowledge and skills are required of them in the performance of their duties?
In view of the above, the objective of this study is to present the profile of the health manager in the state of Tocantins, contributing to the improvement of management, so that it can broaden the reflection on the management activities and characteristics of the health units where they operate.
HEALTH MANAGEMENT: DEFINITIONS AND ASSOCIATED COMPETENCES Several authors draw attention to the debate regarding the concepts of management and administration, considered by some as synonyms (MOTA, 1997;SOUZA and VIANA, 2014). For Mota (1997), the term management is related to the management of the Anglo-American private sector and to the publishing administration of the French line. Both management, management or even management are terms that can be understood as synonyms, although, depending on the situation or use of these terms, some may highlight the broader and more relevant meaning. Considering that currently, in the second decade of the 21st century the term management has been used, more precisely to explain the political and strategic dimension in the face of classical operational administration.
The classic definition of administration proposed by Henry Fayol in the early twentieth century was to plan, organize, direct and control resources with a view to achieving results.
For this author, planning consists of making decisions about objectives to be achieved, the organization of activities and monitoring of the resources used. Organizing refers to distributing authority and responsibility among people taking into account the allocation of physical, technological, financial and human resources. For this author to direct means mobilizing resources, especially people, to accomplish the tasks and achieve the objectives.
Finally, the control function is concerned with monitoring and supervising the use of resources in order to complete the tasks in order to ensure the achievement of the objectives outlined at the time of planning.
Health manager at SES Tocantins: Evaluation of knowledge and competencies www.nucleodoconhecimento.com.br From the perspective of the situational strategic planning of Carlos Matus (1996), much adopted by authors in the areas of collective health and public health such as Rivera (1989) and Teixeira (2002), management is seen as one of the main moments of strategic planning, the tactical-operational moment. According to Motta (1997), the term management suggests the idea of directing and deciding: "The primary purpose of health management is the production of decisions, this being a complex process that involves qualification, motivations, interests, intuition, knowledge, skills and skills" According to Fernandes;Machado and Anschau (2009) When explaining about the concept used by the World Health Organization -WHO in 1978, Souza and Viana (2014), reaffirm the concept of expanded management, which understands the administration as a set of techniques used for the operation of an organization, taking into account aspects related to planning, financing, accounting, resource allocation, personnel management, systems analysis, etc. , including the political decision-making process also as the objective of management. In this sense, the concept of management adopted by the World Health Assembly of 1978 is closer to the concept of planning created by Matus than to the concept of classical administration of Fayol. In this sense, the concept of management is perceived as an indirect activity and extremely fundamental for the control of the work of the professionals involved in the processes. It is part of the management control, in its authoritarian or democratic aspects, which are essential for the actions to be coordinated and integrated whose objective is the production of positive results that impact on the achievement of the organization's goals.
According to Fernandes;Machado and Anschau (2009), the reorientation of management functions can be seen as one of the strategies for the consolidation of the principles of the SUS and for the transformation and qualification of health practices, creating conditions for Health manager at SES Tocantins: Evaluation of knowledge and competencies www.nucleodoconhecimento.com.br the direction of the work process, for the development of technologies and services, for the better application of resources efficiently and effectively contributing to the problem solving of the problems faced by users of the public health system. The expansion of management functions in the public health system requires a new set of competencies that must be charged to the public manager and that will contribute very significantly to the best performance of the system.
Bergue (2011), cites the mission imposed on public managers, emphasizing the complexity and variety of knowledge and skills necessary for professionals working in management. For this author, the complexity and variety increase much more when applied to the management of the public health system. Souza (2009), when reflecting on management strategies that bring the SUS closer to the necessary SUS, takes into account the hierarchy in which it first seeks to understand the implementation of the SUS as a political struggle and then adopt an expanded concept of management, which covers the entire scope of the SUS. Only after these two steps is it possible to consider the actual activities performed by the health manager. The same author considers public health management as a complex activity, which requires a diverse set of skills and abilities, in addition to the continuous qualification of the actors involved. Public health management also involves a range of administrative, legal, financial, budgetary, relational and behavioral knowledge that directly influence the performance of the system.
Regarding the complexity of health management, Mintzberg (1995) states that health organizations are characterized as professional bureaucracies. According to this author, professionals are differentiated workers because the very exercise of their competencies requires them to have a high degree of autonomy in their work process. The professionals involved in the health system are aware of their singularities, being holders of privileged information that is not made available to either managers or to service users, who are thus in a situation of dependence, so decision-making power is not limited only to the manager who often does not make the right decisions due to lack of information / evidence that influence the decision-making that is more accurate to the context of the public health management system where it operates.
Fragelli's studies (2013)  System, both managers of the health system (strategic level) and unit managers , departments, sectors that provide services to users (tactical and operational levels) negatively influencing system performance.
From Azevedo's studies (2010) it was noticed that health management is very complex and permeated by conflicts of interest, thus, the health manager is required a range of skills and abilities that are directly related to the good performance of the system, among them: negotiation skills, since the manager will participate in several interfederative meetings, corroborating the feminization pointed out in other studies (FLEURY et al., 1997;VILAR, 2003).
Regarding the professional training of the managers interviewed, a heterogeneity is identified in relation to the undergraduate courses of the subjects participating in the research. These data suggest that SES-TO is incorporating and expanding multidisciplinarity to the extent that it has been forming management teams with different academic backgrounds, not necessarily from the medical or nursing category, as in the past.  With regard to the knowledge and application of the laws that govern the bidding process, 93% of the interviewees know the bidding laws and use them in their daily work, while 6.7% Health manager at SES Tocantins: Evaluation of knowledge and competencies www.nucleodoconhecimento.com.br are aware of the subject, but do not use it in the performance of their tasks.
Regarding the legal bases of the SUS, the vast majority of respondents (73%) affirms to know the legal framework of the SUS against 26.7%. These results point to failures during the training process of these professionals, because it was expected that 100% of managers knew the main laws that guide the SUS.
The Fiscal Responsibility Law (LRF) seeks to create a condition of budgetary, financial and fiscal balance in order to inhibit a common practice of some governments, by making large long-term investments compromising the ability to pay the current government and the next elected representatives. The LRF has contributed to greater transparency in public spending, thus facilitating the fight against corruption. Regarding the knowledge/use of The LRF. The data show that 80% of the professionals are aware of this instrument, while 20% say they do not know it.
With regard to the annual budget law, only 40% of the professionals interviewed claim to know, while 60% of them, that is, the majority, are unaware of the existence of this budget mechanism. Of all the instruments addressed in the research, the LOA presented the most worrying result, pointing once again to the deficiency in the professional education of the interviewees.
The Budget Guidelines Act -LDO is known to only 60% of survey participants. During the interviews, there was a certain discomfort when answering this specific question, reaffirming again important gaps in the training of the managers interviewed, as shown below: constant updates that occurred in the rules of operation of the public health system during the construction of the SUS. These results suggest the urgent need for a permanent qualification and updating process that allows professionals to discuss their experiences and challenges faced in the day-to-day day of public health management during the work process (MINTZBERG, 1995). Among the data collected and presented in Graph 2, 93% of professionals always use the laws that govern the procurement process in public administration. Regarding the legal bases of the SUS, 73.3% of the interviewees stated that they always use SUS legislation in the development of their activities. 80% of professionals always seek to adapt to the LRF, observing the prudential limits between expenses and planned revenues.
What is most striking is that 7 of the 15 managers, that is, 46.6% never use the annual budget law for monitoring and evaluation of activities. Regarding The LDO, only 5 of the 15 managers (33.3%) they use this instrument in the development of their activities as a health manager, which reveals a serious deficiency in management and an urgent need to invest in the training of these professionals.
Another management tool that is never used by 7 of the 15 professionals (46.6% of the group) is the information system on public health budgets; 11 of the 15 managers (73.3%) It is important to highlight that these are the information and understanding expected for a person who acts in the management of the Brazilian health system, that is, to know well the legal institution of the organization in which it operates, understanding its laws and principles, ensuring its objectives. The requirement of a solid knowledge of the legal foundations and administrative, logistical and budgetary instruments that underpine the SUS thus avoiding the introduction of inconsistent and unfeasible noises, myths and proposals for the solution of problems affecting management in the SUS (MENDES, 2002). In addition to facilitating the achievement of the objectives and goals agreed between the federated entities.
Health manager at SES Tocantins: Evaluation of knowledge and competencies www.nucleodoconhecimento.com.br

FINAL CONSIDERATIONS
The findings of this research show that many managers claim not to use some basic instruments of SUS management, including: PPI, SIOPS and LDO, thus pointing out weaknesses in management, especially with regard to public budget planning, and decentralization of financial resources and the process of agreement among federated entities, whose results reveal the urgent need for alignment with training institutions with regard to the definition of curricular components for professionals and health can act in the health management, linking to the needs of the service, the allocation of public resources, government planning and the anides of the user population. In the field of management, the emergence of new modalities of organization and provision of services poses new challenges for which managers are not prepared to act effectively and efficiently.
The results allow identifying the competencies, today, necessary for the manager to perform his role in the best possible way, considering the leadership capacity, ethical and social responsibility, negotiation skills and conflict management, time and change management, performance in planning, monitoring and evaluation of results. These items need to be worked through a process of permanent education of these professionals.
The qualification of this workforce will also configure as another element in favor of the success of management, translated into more effective and efficient actions, provided by the knowledge and use of management support mechanisms included in the legal framework of the SUS.
In view of the results found and the complicating factors pointed out by the professionals interviewed, it is concluded that management practices in the health department should be planned by the teams and managers.
At the end of the study, we noticed the influence of the characterization of the profile of managers in the improvement of management practices, since it showed the potentialities,