O uso de contratos de gestão e incentivos profissionais no setor público de saúde The use of management contracts and professional incentives in the public health sector

A gestão por resultados constitui um dos pilares da reforma na gestão pública, inclusive na área da saúde, tendo como principais inovações: a institucionalização de contratos de gestão e a utilização de incentivos profissionais. O objetivo deste artigo de revisão de literatura é apresentar e discutir a utilidade e aplicabilidade de contratos de gestão e incentivos profissionais na gestão por resultados no setor público de saúde. A gestão por resultados só será possível quando existir corresponsabilidade e compromisso mútuo entre os trabalhadores e o nível diretivo. Por isso, as metas preestabelecidas devem ser pactuadas entre todos os atores envolvidos e avaliadas de forma periódica para que os incentivos profissionais sejam garantidos. Para efetivamente aumentar a responsabilização sobre os resultados desejados é preciso aprimorar os mecanismos de controle e monitoramento, definir de forma mais precisa indicadores e seus padrões no campo da assistência e da gestão, capacitar as partes envolvidas na elaboração do plano e aperfeiçoar o uso de incentivos profissionais.<br>Results-based management is a cornerstone of reform in public administration, including the health field, and has become the basis for other innovations such as the institutionalization of management contracts and the use of professional incentives. This review article aims to introduce and discuss the use of such management contracts in the public health sector. Management by results has developed means and tools that highlight the importance of shared responsibility and mutual commitment between workers and management-level directors. Thus, preset goals are negotiated among all the stakeholders and are evaluated periodically in order to grant professional incentives. It is necessary to improve the mechanisms for control and observation, to more precisely determine the healthcare and management indicators and their patterns, to train stakeholders in designing the plan, and to improve the use of professional incentives in order to effectively increase accountability vis-à-vis the desired results

Evidence of episodic long-lived eruptions in the Yuma, Ginsburg, Jesús Baraza and Tasyo mud volcanoes, Gulf of Cádiz

High-resolution single channel and multichannel seismic reflection profiles and multibeam bathymetric and backscatter data collected during several cruises over the period 1999 to 2007 have enabled characterising not only the seabed morphology but also the subsurface structural elements of the Yuma, Ginsburg, Jesús Baraza and Tasyo mud volcanoes (MVs) in the Gulf of Cádiz at 1,050–1,250 m water depth. These MVs vary strongly in morphology and size. The data reveal elongated cone-shaped edifices, rimmed depressions, and scarps interpreted as flank failures developed by collapse, faulting, compaction and gravitational processes. MV architecture is characterised by both extrusive and intrusive complexes, comprising stacked edifices (including seabed cones and up to four buried bicones) underlain by chaotic vertical zones and downward-tapering cones suggesting feeder systems. These intrusive structures represent the upper layer of the feeder system linking the fluid mud sources with the constructional edifices. The overall architecture is interpreted to be the result of successive events of mud extrusion and outbuilding alternating with periods of dormancy. Each mud extrusion phase is connected with the development of an edifice, represented by a seabed cone or a buried bicone. In all four MVs, the stacked edifices and the intrusive complexes penetrate Late Miocene–Quaternary units and are rooted in the Gulf of Cádiz wedge emplaced during the late Tortonian. Major phases of mud extrusion and outbuilding took place since the Late Pliocene, even though in the Yuma and Jesús Baraza MVs mud volcanism started in the Late Miocene shortly after the emplacement of the Gulf of Cádiz wedge. This study shows that fluid venting in the eastern sector of the Gulf of Cádiz promoted the outbuilding of large long-lived mud volcanoes active since the Late Miocene, and which have been reactivated repeatedly until recent times.This work is a contribution to the SUBVENT Project (CGL2012-39524-C02-02) and the Extension of the Spanish Continental Shelf Project (CTM2010-09496-E).Peer reviewe