Exploring frontliners' knowledge, participation and evaluation in the implementation of a pay-for-performance program (PMAQ) in primary health care in Brazil

Purpose This paper employs implementation theory and the political literature on performance measurement to understand how frontline health workers know, participate evaluate Brazilian National Program for Improving Access Quality of Primary Care (PMAQ, 2nd round). Design/methodology/approach develops an theory-driven qualitative analysis. The research is developed in city Goiania (Brazil): a challenging organizational context primary care (PHC). Interviews were carried out with 25 frontliners – managers, doctors, nurses community workers. Data thematically hierarchically analysed according theoretical concepts such as policy knowledge, adherence, forms accountability, alternative logics, capacity feedback. Findings Results show need foster capacity, participation feedback at frontline. Successful would require those adaptations counteract challenges/failures or emergence logics. Research limitations/implications study was conducted only one setting, however, our sample includes different types professionals working units levels organization located distinct HDs, expressing well PMAQ/P4P. Qualitative researches be further exploring same/other factors. Social implications can used improve discussions/planning design P4P programs State Goias. Originality/value majority analysis PMAQ are quantitative results-based nature. article focuses politically significant unanswered questions regarding PMAQ.