PMAQuiagem practices in the Brazilian PMAQ-AB: : strategic compliance and its effects on evaluation culture and local management

Abstract

The National Program for Improvement of Access and Quality in Primary Care (PMAQ-AB, 2011–2019)—Brazil’s largest nationwide external assessment with pay-for-performance in Primary Health Care (PHC)—triggered strategic responses across municipalities. This article analyzes, from the perspectives of municipal health secretaries and PHC coordinators, how “PMAQuiagem” practices are configured and their effects on evaluative culture and local management. We conducted a thematic reanalysis of interviews with 20 managers from 13 municipalities in Ceará’s 20th Health Region, using inductive–deductive coding and comparative organization by management level. Recurrent forms of performative compliance were identified—temporary reallocation of supplies/equipment, episodic routines tailored to the assessment visit, and ad hoc documentation—underpinned by managerial dissonance: a political-financial logic (secretaries), focused on resources and reputation, clashes with a technical-managerial logic (coordinators), oriented to sustaining care processes. Reported effects include emotional overload, reorientation of work toward the “audit showcase,” and a weakening of evaluative culture. Lessons from PMAQ-AB speak to the current policy framework established by Ordinance GM/MS No. 3,493/2024, indicating governance safeguards, formative feedback, rolling measurement windows, triangulation of information sources, and vulnerability weighting, to mitigate gaming and support continuous improvement.