Public health administration and occupation of management positions: analysis of two large municipalities of the State of São Paulo and a Canadian province

Introduction: The Brazilian Federal Constitution of 1988 (CF) determined the public tendering process, establishing the Single Juridical Regime – RJU, as the exclusive form of entry for public servants, obeying the principles of: impersonality, morality, legality and publicity. In 1995, the Ministry of Administration and State Reform (Mare) was created, formulating the State Reform Master Plan (PDRAE), in which the RJU was abolished as the unique form of entry and the principle of efficiency was added to the constitutional text governing the entry of the servers. Currently, public administration uses four forms of work regime: statutory, clerk, special and commission positions. Faced with the changes brought about by the state administrative reform in the public health sector, there is interest in raising and analyzing how the occupation of public management positions in the Brazilian Unified Health System occurs. Canada also has a universal health system, and its health law is governed by five principles: universality, comprehensiveness, reasonable access, portability and public administration, yet with greater administrative autonomy between the provinces. General objective: To analyze the process of occupying public positions in the health sector in two large municipalities in the state of São Paulo and a Canadian province, investigating the relationship of these processes with Quality of Life at Work - QVT. Method: Qualitative descriptive research with integrative review. The method was organized in three stages: 1) integrative review, the data were collected in the databases: Scielo, Lilacs and Google academic, the keywords were: public office, public health service, occupation in health and positions in health posts until mai 2017. Data analysis was based on four principles of art. 37 of the Federal Constitution, as amended by constitutional amendment 19 of 1998: impersonality, morality, publicity and efficiency, 2) Semi-structured interviews with four managers from Ontario / Canada, 3) Semi-structured interviews with the regional directors and respective Human Resources managers of two municipalities in the state of São Paulo (M1 and M2). Both interviews were analyzed using Bardin content analysis. The project was approved by the Research Ethics Committee of the Federal University of São Paulo, through the number CAAE 51326215.7.0000.5505. Results: The results were presented in three parts: 1) Public health management positions in Brazil: an integrative review of the literature, 697 articles were found and after careful reading of titles and abstracts 12 were selected for categorical analysis based on the principles of CF, evidencing the need for advances in policies that defend the interest of health workers, 2) Occupation of public positions in the health area from the perspective of managers of Ontario / Canada, content analysis organized four categories: Public and transparent recruitment and selection process, Specific criteria for assuming the management position, Indication, union and financing interfere in the hiring and management of work in health. It was pointed out that transparency in recruitment and selection, professional support and the exercise of fair negotiations would provide more adequate employment contracts, providing a personal balance to the occupants of the public office, and could serve as a model for other countries, and 3) Occupation of public offices in the area of health in the two municipalities of São Paulo, content analysis organized five categories: Personnel policies, skills and competence influence the occupation of positions, Importance of public and transparent recruitment and selection process, Delimitation of the specific criteria for management position in public health, Indication, financing and geographic location interfere in the contracting and Personal and professional development affect quality of life at work - QVT. Discussion: The discussion sought to consolidate the responses of the interviewees, linking them to the categories developed. Canadian workers pointed out the importance of the role of trade unions as negotiators in the hiring of public employee, which was not described by the directors of the municipalities of São Paulo and Guarulhos (M1 and M2). There was heterogeneity of respondents' responses in both Brazilian municipalities. M1 and M2 have similar contracting forms, differences and similarities occur at local levels of management and have not been extensively questioned. Conclusion: Both in the Canadian province and in the two Brazilian municipalities, the results revealed that transparency in recruitment and selection, professional support and fair negotiations promote better hirings and favors QVT. The role of the manager in achieving the QVT was significantly emphasized in the interviews in M1 and M2 as a secondary result of horizontality in decision making process at work. It was evidenced that the indications of managers by criteria and not oriented by republican principles may interfered in the quality and the work environment.

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