The Role of Mid-Level Burocracy in the Local Implementation of PMAQ-AB

A Study with Basic Healthcare Unit Directors in the Municipality of Natal/RN

Abstract

The objective of this article is to analyze how mid-level bureaucrats, in the processes of interaction with street-level bureaucracy, influence the local implementation of a national health policy. To this end, the implementation of the Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) was taken as a study object and, through the application of qualitative methodological techniques, the study was conducted in the city of Natal / RN. The global results showed that mid-level bureaucrats, in the figure of BHU directors, have a determining role in transmitting and translating what was previously formulated in the policy's normative design for implementing agents at the front, represented by the members of the primary care teams working in the BHU. In addition, it was identified that the way in which this transmission and translation of the normative design occurs, as well as the attitude in promoting transmission and translation, is variant and conditioned by technical, cognitive and political-relational aspects related to the profile of the director from BHU.