Descentralização do componente especializado da assistência farmacêutica em Minas Gerais: percepções de gestores municipais

Abstract

Research objective: To analyze the perceptions of municipal Pharmaceutical Services managers regarding the implementation of the decentralization of the Specialized Component of Pharmaceutical Assistance in Minas Gerais, identifying challenges, benefits, and opportunities associated with this process from the perspective of municipal public management. Theoretical framework: The study is situated within the Public Policies research line by addressing the implementation of a public health policy at the municipal level and articulating decentralization, interfederative governance, municipal administrative capacities, and Pharmaceutical Services management. It contributes to this research line by showing how local managers perceive the transfer of responsibilities, institutional support, operational workflows, and the effects of the policy on the daily routine of public administration. Methodology: This was a descriptive mixed-methods study conducted in two sequentially integrated stages in the state of Minas Gerais. Data collection took place between August 2025 and May 2026. In the quantitative stage, a sociodemographic and professional characterization questionnaire for managers and a guiding script for the qualitative stage were developed and submitted to content validation by expert judges. Validation considered the criteria of objectivity, simplicity, clarity, relevance, and language adequacy, and the Content Validity Index was calculated using a cutoff point of 0.80 or higher. The results of this stage supported adjustments and the definition of the final version of the script used in the qualitative stage. Three municipal managers participated in this stage. One focus group session was conducted with two participants, and one semi-structured interview was conducted with one participant, both using the same guiding script. The empirical material was transcribed, organized, and subjected to thematic analysis, including the identification of meaning units, their grouping into empirical categories, and interpretation of the findings in light of the theoretical framework. Results: The validation indicated that the instruments were appropriate for use with municipal managers, with specific adjustments resulting from the contributions of the expert judges. In the qualitative stage, the findings showed that decentralization was perceived as a strategy capable of bringing services closer to users, increasing municipal autonomy, improving communication with prescribers, and enabling greater local organization of care workflows. However, its implementation required concrete reorganization of municipal Pharmaceutical Services, including adaptation of physical infrastructure, expansion and qualification of staff, acquisition of equipment, redefinition of routines, and incorporation of new administrative responsibilities. Managers reported differences between regional technical support, perceived as closer and more responsive, and decisions made at the central state level, which were sometimes viewed as top-down and insufficiently sensitive to municipal realities. Challenges were also identified regarding bureaucratization of operational routines, excessive documentation, duplication of records, the need for process digitalization, limited integration between information systems and records, financing, and unclear responsibilities among the federative entities. Despite these limitations, participants recognized gains related to expanded access, greater proximity to users and prescribers, local autonomy, and increased municipal accountability for pharmaceutical care. Originality/relevance: The study is relevant because it analyzes decentralization from the perspective of municipal managers who directly experience its implementation, contributing to filling a gap regarding the concrete conditions under which this policy is operationalized at the local level. Practical contributions: The potential impacts span scientific, organizational, practical, societal, and public policy domains by supporting recommendations for training, planning, workflow organization, improvement of information systems, and strengthening of local governance. Based on the findings, a Final Technical Report was developed containing a guiding matrix designed to support the planning, implementation, monitoring, and improvement of CEAF decentralization in municipalities in Minas Gerais.