Contributions of the Simplified Competency Management Model to a Municipal Health Secretariat*

Objective: to present the contributions of the Simplified Competency Management Model in a municipal health secretariat. Method: research of integrated mixed methods of exploratory-descriptive type. The model was applied in a southern Brazilian city, in the following stages: documentary, questionnaire, mapping of gaps and educational proposal. Results: in the first stage, after documentary research, a total of 14 general core competences were described and a questionnaire with specific core competences was chosen, with confirmation of correlation among them; in the second stage, the importance and expression competence at work degrees were obtained, after the questionnaires were filled out by 74 municipal public health managers; in the third one, a formula was adopted for the training priority degree and its classification; the fourth stage presented an educational proposal for the development of one of the competences with the highest priority degree. Conclusion: the model brings contributions by describing general core competences, after documentary research; carrying out the correlation between a questionnaire, containing specific core competences with the general ones; by mapping gaps; and by the proposal of learning trails for the development of competences.

that defines essential knowledge, skills and attitudes for the public health workforce. It also recognizes that the guarantee of compliance with public health obligations depends on competent managers, even with insufficient training offers (8) .
In Brazil, the Unified Health System -Sistema Único de Saúde (SUS) demands from its managers local and regional commitments, participation in various councils, creation and compliance with management instruments, in addition to the constant evaluation of inspection and social control bodies. However, some managers are not prepared to assume the management function, even though they have excellent academic credentials (9) .
Core competencies improve public health by contributing to the development of teamwork, capacity for situational analysis, planning and improvement of health services based on evidence and focused on the population in an equitable and ethical way (4) . In the development of competences, it is assumed the balance between the interests and needs of the organization and the individual with their knowledge, skills and attitudes.
Thus, the consequence of investment in knowledge adds value, not only in the excellence and sustainability of the organization, but also in the social value of the individual (10) .
Due to the complexity of this theme, it is considered that the presentation of models that correlate specific and general competencies through a mapping capable of pointing out their priority degree and educational strategies for the development of public health manager competences, is still a gap of knowledge to be filled.
Thus, it is assumed that the health system can also not only benefit from the description of core competences for public health, but also develop new technologies and tools (11) that present how competency management can be implemented.
Therefore, this study aimed to present the contributions of a Simplified Competency Management Model (SCMM) (1) to the managers of own public health services of a Municipal Health Secretariat (MHS).

Method
Mixed methods research, exploratory descriptive type, which combines qualitative and quantitative approaches as a classification criterion, based on its objectives (12) .
In the presentation of the SCMM contributions, a qualitative approach was used during the documentary stage of the SCMM, in which the meaning of words and phrases were sought in the study of the official documents found, indicating the vision of the future, mission, strategic objectives, management reports, status of municipal civil servants and performance indicators (1) .
The quantitative approach highlighted the contributions of the SCMM with the mapping of gaps in its second stage, performed with multivariate analysis of the data through statistical techniques, such as the analysis of main components and internal consistency (1) .
In the third stage, for the internal consistency tests of data collection, we used the Cronbach' alpha coefficient  The definition of competence used in this study was based on an author (13) who proposes the following: "competence is knowing how to act responsibly and recognized, which implies mobilizing, integrating, transferring knowledge, resources and skills, which add economic value to the organization and social value to the individual". Thus, organizational competence was disseminated internationally with the term core competency (13) , which encompasses a set of skills or aptitudes that unites individual efforts   In the first stage of the SCMM, documentary data collection took place in October and November 2017.
The sources were the official documents of the Municipal Government and MHS, which addressed attributions or job descriptions related to the institution management and organizational strategy. These documents (regulations, rules, statutes, ordinances, action plans and management reports), with potential for interpretation and description of content, were related to the competencies of managers (1) .
After studying the official documents, the general core competences of MHS were described, indicating the composition of an expected performance or behavior of action by means of a verb or an action object accompanied by a condition and a criterion (quality standard) (14) .
Then, there was a correlation between the general core competences described for MHS and the specific core or external competences, understood as valid for the local need, choosing the document of the PAHO MRCESP (8) .
The second stage of the SCMM was applied for data collection through a semi-structured self-assessment questionnaire, translated and adapted to the Brazilian context (15) , based on the MRCESP (8) .
The questionnaire consists of response levels of  (8) .
The results of the structured questions (specific core competences) are presented by means of a central tendency measure (arithmetic mean) and a dispersion measure (standard deviation). The averages can vary between 1 and 5, with 1 being the lowest value regarding the lack of knowledge of the specific core competence and 5 representing that the competence is put into practice, with the possibility of teaching the competence to others.
In the third stage of the SCMM, the mapping of gaps was performed, resulting from the formula PD = CID (5 -CED), adapted from the one presented by Brandão(1), with the Competence Importance Degree (CID) being the result pointed out by specialist managers (15), according to the different importance understood for management (16) . -Commitment (VA § ).
GENERAL CORE COMPETENCE II: Providing moments of health education with a commitment to promoting healthy habits, sustainability and quality of life to transform the social, environmental and economic conditions that impact health.
GENERAL CORE COMPETENCE III: Formulate regional strategies for the development and improvement of the quality of life, prioritizing the most vulnerable regions, according to the assessment of the health situation of the local population and its trends.
GENERAL CORE COMPETENCE IV: Identify care gaps and promote the decentralization of public health services to guarantee the universality of access and comprehensive health care.
-Physical structures in the critical areas of the City Hall (SO*).
GENERAL CORE COMPETENCE V: Coordinate the maintenance and/or expansion of the existing physical structures for the provision of health services to ensure universal access and comprehensive health care.
-Shared management of municipal public services (SO*).
GENERAL CORE COMPETENCE VI: Implement the shared management of municipal public services and promote integration, commitment and respect between them and the improvement of their duties towards society.
GENERAL CORE COMPETENCE VII: To provide health surveillance in the fulfillment of analysis and inspection processes, with justice and transparency, offering more agile, modern, innovative and effective services to promote the respect and protection of society.
GENERAL CORE COMPETENCE VIII: Communicating with citizens, offering them relevant information in clear, objective, accessible and innovative language.
GENERAL CORE COMPETENCE IX: Manage the efficiency of government spending and the quality of municipal public services with zeal, legality, commitment, ethics, respect, transparency and administrative morality.
GENERAL CORE COMPETENCE X: Formulate strategies for establishing partnerships, technical cooperation and attracting external resources for investments in municipal public services.
GENERAL CORE COMPETENCE XI: Formulate strategies for the development and prominence of leaders among municipal employees, updating and expanding their professional knowledge.
GENERAL CORE COMPETENCE XII: Develop motivational and conflict mediation processes to encourage cohesion, harmony and a good organizational environment at work, with ethics, respect, justice and transparency.
GENERAL CORE COMPETENCE XIII: Line the managerial competences of municipal managers to the commitment to the needs pointed out by the administration in compliance with laws, decrees and regulations.  (Figure 3). Among the 56 core competencies, eight were identified as gaps. -Valuing people (SO*); -Know the specific legislation related to their attributions and functional life (S || ).
GENERAL CORE COMPETENCE XIV: Implement policies and processes of corporate education, performance evaluation and reward system supported by justice, transparency and meritocracy.    As a result, a Classification by Score indicating the PD was also adapted, as shown in Figure 3.
Rev. Latino-Am. Enfermagem 2021;29:e3429.  after the manager meets the learning path, with a total of 12 questions with answers structured on a Likert scale of agreement (18) .
In public management decision-making processes by sharing defined objectives (21) .
Another contribution of the first stage is the correlation between the specific general core competences described for the institution (MHS) and the six Domains of MRCESP (8) , a questionnaire chosen as a data collection instrument, which contains the specific (or external) core competences.
It is understood that to put the SCMM into practice, you can choose any questionnaire containing specific competences. However, it is recommended that a correlation be made with the general core competences so that efforts are not expended, by pointing out gaps or time in educational projects, to develop external core competences, which do not add up to what is expected by the public administration.
As a contribution of the second stage of the SCMM, there is the presentation of the evaluation of specific core competences by specialists, resulting in the CID.
Thus, competencies receive individualized results, far from a unanimous ideal among all competencies for a proposition of level of acceptability, which can vary a lot or little between one competence and another, because without the evaluation, among the numerous general and specific competencies that exist, it would be difficult to discern priorities (22) .
In this same second stage, the CED is defined when the questionnaire respondent performs a self-assessment regarding the possession of the knowledge, skills and attitudes necessary to put the specific core competence into practice.
In the third stage of the SCMM, the formula adapted from the one presented by Brandão (1)  Therefore, this is not a concern only in Brazil. In mostly below ten questions (25) , and a 95% confidence interval level and a 5% margin of error. However, it is emphasized that the performance of statistical analysis is not mandatory for the use of the SCMM.
On the other hand, if data are collected for scientific research, it is recommended that there be at least 50 participants (26)  An educational structure is a set of competencies that takes into account performance based on educational needs, personal experience, professional role and role in planning, mitigation, response and disaster recovery (27) .

Competency-Based Education (CBE) assumes
that different sets of competencies are feasible to be customized for different education needs in the health professions, favoring the flexibility of time, place or learning pace, with multiple paths (28) . The permeability of higher education, which advances to the field of A study carried out with managers of primary health care in southern Brazil pointed out the lack of training as a reason for dissatisfaction, and permanent health education as a strategy for meaningful learning, with a methodological axis in their work processes (30) . This what is practiced (31-32) , because formal education, even in public health, does not, or little, develops the core competences expected of a manager (33)(34) .
This study proposes the development of learning paths for the development of any core competence identified as a gap. It is based on the premise that, when the expected competencies are not expressed, it is possible to manage the development of competences in facing complexities and evolving demands (35) .
The proposal for learning paths for public management is still incipient and little known, as an alternative to training grids. As a strategy to promote the development of competences by combining the expectations of the organization with the characteristics and profile of each person, the trails can be characterized as empirical and non-systematic strategies (36) , even though they offer conveniences for organizational learning.
The formatting that can be chosen for the learning paths is vast and unlimited, relying on the resources of Information Science to organize and represent information (36) , in addition to other better known as lectures, seminars, face-to-face and distance courses, conferences, study trip, specialization course, books, manuals, articles, movies, forums, websites, videos, coaching and mentoring.
As an example of a resource, mentoring has been used for more than a decade in the framework of research in the field of health, in addition to being present in teaching situations. It is also appropriate in specific cases of work and in the development of leadership competences (37) . Mentoring, recognized and recommended as an innovative, low-cost competence development, has been implemented in health institutions, with the temporary stay of a mentor, visits by an itinerant mentor, a team of multi-professional itinerant mentors, a mentor for two health services or permanent manager-mentor (38) .
Without evaluation, the teaching-learning cycle is not closed. The contribution of the fourth stage is also related to the assessment techniques for perceiving the development of the specific core competence identified as a gap. It is considered important to evaluate the results of the impact of learning activities by the individual, in the feedback for the proper improvement of the model and for the organization, in ensuring that the efforts expended are being effective to the disposition (18) .
As limitations of this study, it is pointed out that the questionnaire used does not address financial aspects of management, and they have not been explored. Still, due to the determined validity period of the SCMM, possibly around six months (1) , there is a demand for new applications of the model for continuity of the process, since the services, contexts and their actors are dynamic.

Conclusion
This study analyzed the contributions of a SCMM consisting of four stages (documentary, questionnaire, Albini A, Peres AM, Almeida ML. mapping of gaps and educational proposal) for a MHS and appears unprecedented in Brazilian public health.
In the first stage, the SCMM made contributions by noting the lack of description of the functions, duties, qualifications, profile or responsibilities of managers (secretariat, director, chief or coordinator) in official municipal documents; exemplified how general core competencies can be described; detailed the correlation of general core competences with questionnaires containing specific (external) core competencies.
In the second stage, the SCMM made explicit contributions to the generation of the Importance and the CED through the analysis of the questionnaire results.
In the third stage, the SCMM evidenced contributions on how to generate the PD when performing the mapping of gaps through formula and Classification of the PD.
In the fourth stage, the SCMM presented contributions on how to break down a specific core competence in Knowledge, Skills and Attitudes; proposed an individualized educational intervention through Learning Trails to develop competences; proposed impact assessment techniques for the perception of competence development.
As a recommendation for future studies, it is suggested that the experts consulted to generate the Competences Importance Degree are from the service, as the importance of different competencies is based on local needs, contexts and people. Also, the performance of the gap mapping step must be separated by the different levels of managers and or by departments, which allows more specificity in the planning of the learning trails.