Brazilian Payment for Performance (PMAQ) Seen From a Global Health and Public Policy Perspective: What Does It Mean for Research and Policy?

This supplement of the Journal of Ambulatory Care Management on the Brazilian National Program for Improving Access and Quality of Primary Care (PMAQ) reveals a relevant gap in the Brazilian literature on pay for performance/PMAQ, and is therefore an opportunity to bring contributions from global health and public policy to the debate. We discuss the relevant gap in the light of developments in evaluation and policy analysis. We afterward present the state of knowledge regarding global health and public policy in pay for performance, giving attention to diverse themes, methods, types of analyses, theoretical contributions, and limitations. Finally, we suggest some possible implications for research and policy in Brazil.

The politics of implementing a performance measurement program (PMAQ) at the front line of primary health care in Goiania, Brazil: a qualitative political analysis

We develop a political policy analysis to understand how front line health workers in Goiania evaluate the Brazilian NationalProgram for Improving Access and Quality of Primary Care (PMAQ). We interviewed 25 front liners, including doctors, nurses, community health agents and local managers. Analysis was based on political themes highlighted by the public policy/implementation and performance measurement political literature. We explored seven key themes: adherence, organizational capacity, participation, alternative logics, feedback, perceived impact and culture of assessment. Results show the need to deconstruct rhetoric/ambiguities on the front line of implementation, by means of fostering organizational capacity, knowledge, participation and policy feedback.