Municipal health plans and the potentialities of recognition of health needs: a study on four Brazilian municipalities

Abstract

This study was designed to identify the potential and the limits of the Municipal Health Plan as a management tool for recognition of health needs and vulnerabilities of social groups. A qualitative, documentary study, performed through the organization of data in WebQDA® software and Bardin’s content analysis, of Municipal Health Plans (PMS) of the municipalities of Araraquara, Santos, Valinhos and Vinhedo, which met eligibility criteria: medium-sized municipalities in the state of São Paulo; not belonging to the Metropolitan Region; with 50 thousand inhabitants or more; presenting the best Human Development Index and the worst Gini coefficients; and having publicized Municipal Health Plans. The results showed a predominance of a health conception centered on multi-causality; epidemiologically, the scenarios were described from their risk factors, with emphasis on morbidity/mortality indicators; there was no articulation of health-disease profiles to those of social reproduction. In health diagnoses and planning, there was disregard of the interpretative theory of the social determination of the health-disease process. Thus, all the scenarios presented difficulties in identifying social groups, vulnerabilities and differentiated needs, making health management impossible for equity and integrality in care.