Facing COVID-19 pandemic: care management productions, inventions and challenges

The scenario of the health emergency caused by the COVID-19 pandemic imposed new and immense challenges for the managers of the Unified Health System (SUS). The speed and high rate of transmission, the production of serious and fatal cases, and the consequent risk of collapse for the health network, required the establishment of contingency plans. Analyzing the experiences of managers in health regions is of unequal importance given the differences in health, economic, social, demographic and access to health services, particularly in the State of São Paulo, where the disease indicators are significant.Objective: to analyze the productions, inventions and challenges in the management of care implemented by health care networks in two Health Regions of the State of São Paulo to face the COVID-19 pandemic, and to present proposals that can improve the response capacity SUS.Methodology: a qualitative study, type study of multiple cases, will be carried out in 3 phases. The first, of an exploratory nature, will seek to understand how the 63 health regions of the state have been managing network care to cope with COVID-19. It will be developed through a semi-structured questionnaire, to be completed by local and regional health managers. From a first analytical plan, two health regions will be chosen, considering relevance, originality and preliminary results, to be studied in depth, one in the interior and another in the Metropolitan Region of São Paulo.The second phase aims to analyze in depth the productions, inventions and challenges in care management implemented in these two health regions, and will be carried out in three stages:Stage 1 - Document analysis and evaluation of the Contingency Plans and other documents of the state of São Paulo and of municipalities of different sizes that belong to the two health regions.Stage 2 - Mapping of the care management arrangements produced in response to the COVID-19 pandemic, from semi-structured workshops and interviews with regional and municipal health managers, characterizing the specific participation of primary care in coping with COVID-19 and the strategies implemented for populations in situations of social vulnerability. It is also intended to investigate relations with the private sector.Stage 3 - Recognition and analysis of the strategies implemented for (and by) populations in situations of social vulnerability, based on the identification by the municipalities that integrate the regional, of the territories of high social vulnerability. Open interviews and workshops will be held with leaders of social and community movements. This stage of the research aims to seek an approximation to the ways of life and the concrete needs of people and communities. For the analysis of this material, narratives of the experiences reported and / or monitored will be constructed.In the third phase of the study, the results of the investigation will be returned, from shared workshops and seminars, to state, municipal and community leaders, aiming at the elaboration of proposals. Techniques of participatory strategic planning that contribute to the analysis and validation of the findings and proposals that contribute to overcoming the challenges encountered will be used.The study will involve researchers linked to universities, the State Health Secretariat of São Paulo (SES-SP), Municipal Health Secretariats and the Council of Municipal Secretaries (Cosems-SP) in all its phases, through their respective projects. support - Primary Care (SES-SP) and Regional Supporters (Cosems-SP). This methodological strategy will facilitate the production of empirics and the desired construction of effective propositions to face COVID -19.Expected contributions: qualification of the country's response capacity to face the COVID-19 pandemic and the organizational improvement of SUS. (AU)