ANCHORAGE	KEY-EXPRESSIONS
“On the evaluative method” (arguments)	(examples)
Ranking as a problem	To rank, it is necessary to have synthetic indicators, and it is practically impossible to reduce to a synthetic indicator the 24 indicators that were selected based on a previous study of Fiocruz. Depending on how the indicators are aggregated, they will give different final results... [...] Because comparing a municipality that has five thousand inhabitants and one that has five million obviously is absurd, because it generates distortions, because the indicators will have different behaviors... [...] The result on the score does not match the reality. (Scholar, Public health associations, Rio de Janeiro).
Multidimensionality	The central proposal is that health is multidimensional and should be matricially evaluated and not adding variables of different dimensions to arrive at a single index. And even worse, in cross-section, without taking into account the evolution of each of the variables over time, the evaluation is reductionist by adopting individual scores and does not correspond to the criteria of exemption, multidimensionality and approach by municipalities. (Scholar, Public health associations, Rio de Janeiro).
Municipality “versus” Health Regions	He also criticizes the approach by municipalities. The government itself, according to him, has a decree from last year that states that health must be analyzed by health care networks and by health regions, and not by municipalities… (Scholar, Public health associations, Rio de Janeiro).
Evaluative culture	We have to keep the commitment of all municipalities to periodically feed the information systems of the Ministry of Health so that the indexes are analyzed correctly, share this data with the municipal councils and do not see the results as a way of competition between municipal managers, but yes as a way to join forces to always build the improvement of SUS. (FUNESA).
Link to financial transfer according to performance	I also think that the government cannot yet use IDSUS as a basis for distributing resources and rewarding municipalities without establishing a more consistent methodology for evaluating municipal health systems. For managers, I believe that the greatest importance will be to perceive the limitations of information systems to generate indicators necessary to evaluate the performance of SUS. (PROQUALIS, Federal Management).
Misuse of the information conveyed	…it is very difficult to discuss public policies with authority if the media simply reproduce numbers without even worrying about to explain their meanings to the public. Yes, the score “from 0’ to 10’ stirs with the children’s imagination of all, but we need to go deeper than that if we want to qualify the debate and strengthen democracy” (Citizen, News/Press).
Objectives behind the evaluation	The indices point to a promising path for contracting results in public management—making it possible, for example, to reward managers with better results—but they should not become the only parameter, and ideally, they should be used with caution, while evaluating, over time, the possibilities of correcting deficiencies, adjustments etc… (Citizen, News/Press).
“On the correct application of investment resources” (arguments)	(examples)
General investments responsible for good performance evaluation	For the Municipal Secretary of Health, Sergio Liberato “this achievement belongs to everyone. It is the recognition for the correct application of the municipality’s resources and the transfers from the Federal and State governments”. The Municipal Health Department has been investing in structural reforms of the units, expansion of the fleet for transporting patients, joint efforts for magnetic resonance imaging, ultrasound, x-rays and tomography, in addition to medical and dental care in the health and emergency care units that results in more than 200 thousand medical services per month. The secretary also highlighted the role of the Health Secretariat in preventing AIDS, dengue and other problems with the Epidemiological Surveillance programs, the permanent surveillance of the Health Surveillance and the full supply of the units with medicines. (Individual, Municipal Management).
Specific investments responsible for good performance evaluation	According to Leonardo Davis, Primary Care coordinator, the score is the result of investments made in the Family Health Strategy teams, such as the acquisition of new cars, equipment and permanent materials, as well as the training of health professionals. “Strengthening primary care is a priority in the health pact, and Timon is managing to achieve the goal set” (News/Press, City of Timon).
The minimum required by law (15%) responsible for good performance evaluation	Mayor Raimundo Silveira when asked to comment on this feat, said that he is very proud of his work as manager of the municipality and said that this is the result of the participation of the entire health team, and said that since he took office in 2005 he has never invested only what is stipulated in the law, which is at least 15% of city hall revenues, and has always been passing on more than 30%, so today we are second losing only to Timon (Individual, City of Parnarama).
Planning and evaluation as managerial instruments responsible for good performance evaluation	According to the Health Secretary of Iporã do Oeste, Edson Thesing, this note is the result of the joint effort and work developed by the local Health team. According to him, to ensure quality of care, the secretariat works with planning. Thesing points out that a diagnosis of the health situation in Iporã do Oeste was first elaborated, and later local priorities were planned, so that public health offers quality care. “Based on this survey, we develop activities. We count on the unity of the team, the dedication of community health workers, the training of professionals and the direct dialogue with civil servants. We show the professional and the community how SUS (Unified Health System) is good, just knowing how to use it”, explains the secretary, pointing out the team’s satisfaction when seeing that the municipality has been standing out for the work developed. (Institution, News/Press, City of Iporã do Oeste).
“Day-to-day services better explain reality” (arguments)	(examples)
Between the general and the particular	...long wait for care, few doctors, lack of specialties and equipment problems. This was the scenario found by iG on Wednesday, after visiting five public health units in Rio. Survey released on Thursday by the Ministry of Health—SUS Performance Index (IDSUS 2012)—points out that the city has the worst performance in access and quality of public health services among all capitals of the Country. (Individual, Rio de Janeiro).
The dimensions of the index “versus” the empirical reality	However, it is necessary to celebrate in moderation. IDSUS evaluates service on two fronts: with regard to “effectiveness”, the score is higher, 7.25. With regard to “access”, the score is reduced to 5.93. In practice, this means that people have difficulty in accessing services, due to several problems, such as lack of doctors or bureaucratic problems, which makes waiting time in queue long. Reading numbers of the Idsus, compared with the data found in the empirical reality (the waiting time in the queue, especially with regard to the care of specialties, to mention an example) shows that there is still much to improve in public health in Londrina. Without, obviously, denying advances, however timid they may be. (Institutions News/Press).
An index dimension that justifies performance as a whole	The proportion of tooth extraction (dental extraction) in relation to the procedures received a score of 10 in the survey. This means that the population is taking more care of their teeth and losing them to a lesser extent. One of the factors that contributed to this is the clinical care strategies developed in BH since 2006. (News/Press—Belo Horizonte).