Between certification and learning: strategic conformity in local Primary Health Care management

Abstract

Objectives: To analyze preparations for external evaluation, the rationales attributed to them, and their reported repercussions among managers within Brazil’s National Program for Improving Access and Quality of Primary Care. Methods: An interpretive qualitative study based on a thematic reanalysis of 20 semistructured interviews with managers from a health region in Ceará, conducted in June 2019. Full rereading of the transcripts informed the coding of 100 excerpts, organized in a Microsoft Excel matrix and into three thematic axes. A second researcher reviewed the codes and categories, with no substantive disagreements. Results: Accounts described temporary adjustments to supplies and routines, documentation practices, certification-related pressures, and emotional strain. Documentation also appeared as a routine record of changes perceived as legitimate, and the program was acknowledged as a reference for organizing services. The emphasis on financial aspects in health secretaries’ accounts and the more detailed descriptions of operational repercussions by coordinators were tendencies within a corpus with uneven narrative depth. Conclusions: The reanalysis suggests tensions between certification and organizational learning without equating all evaluation preparation with simulation. Its contribution lies in connecting reported manifestations, rationales, and effects while distinguishing strategic conformity from legitimate preparation. The findings neither establish causality nor evaluate policies introduced after the study period.