It is essential to develop work processes that enable the creation and management of an oral health care network . Otherwise, a fragmented health care model will persist in which the services of the system are not articulated, the centers act as isolated points and, consequently, they do not continuously and longitudinally respond to the demands of the population [15, 16].
In this sense, it is important of planning in health services since it establishes coordination and integration among the different levels of oral health care in order to detect, analyze and seek systematized process solutions and improvements mainly for unstructured and fragmented processes .
The multivariate analysis of the confounding factors, which was made possible by the use of a logistic regression, allowed us to demonstrate that the execution of planning in an SDC is associated with lower OHT/FHS coverage in the municipalities. This indicates that the performance of this activity is more linked to the behavior and technical capacity of service managers than the existence of a service network.
When analyzing the distribution of an OHT according to the population size of Brazilian municipalities, the largest share of the Family Health teams are in municipalities of up to 30 thousand inhabitants (57% in 2002 and 50,5% in 2011) and the highest mean population coverage of the OHS (73%) is also found in this group of municipalities . Thus, the smallest coverage is in the large cities. Therefore, the SDCs who carried out planning are located in the largest municipalities.
The same occurred when researched the use of planning and self-assessment in the work processes of the Family Health teams in Primary Health Care . They verified that, in all regions, the frequency of responses regarding the topic of planning was lower in the municipalities with up to 50.000 inhabitants. In those municipalities with more than 100.000 inhabitants, the frequency was reversed, becoming larger.
The fact that the conformation of the oral health network does not induce planning is a negative factor since it is a management tool of extreme relevance for the assistance and organization of services in the search for quality services that positively respond to the population’s needs .
The absence of planning in services causes them to function in a disjointed manner; consequently, the health system starts to function in a subjective, fragmented and disordered way . Public policy is not the same as operating within informality or any subjectivity .
Regarding the factors related to the service characteristics, the existence of the association between “complementary training of the manager” and accomplishing planning is in accordance with other studies, which suggests that health organizations have competent managers to face the challenges generated by the complexity of the health sector and the demands for quality in the services provided to the population. To perform this function, it is necessary to have the technical competence and capacity to know the plan, intervention strategies, and the programming; and understand the contract forms, the work process management, the organization of the health network and the issues related to the building infrastructure and maintenance of health facilities .
Still in the field of service characteristics, the strong association (OR = 8,2) found in this study model between the practice of self-assessment and service planning is in accordance with other study . They point out that systemic planning is linked to other important concepts that at first it does not seem to be part of but that stand out after an evaluation of their quality considering their means and results.
It is also in line with the guidelines of Ministry of Health, which considers self-assessment as a crucial point for the development of the National Program for Improving the Access and Quality of Dental Specialties, since the processes oriented for quality improvement begin with the identification and recognition of the positive and problematic dimensions of the management work and health care teams .
In this perspective, that an alternative to find solutions that seek to overcome organizational, geographical and socioeconomic access barriers is to carry out an evaluation to support planning and decision-making .
The planning process should start with the identification of problems, that is, by conducting a self-assessment; and from that diagnosis, the intervention strategies to achieve the necessary changes should be defined . In other words, when services are planned in an intuitive way without self-criticism or little systematization, they create obstacles in the socialization of the elaborated projects and, consequently, compromise the scope of the necessary .
By recognizing the intrinsic connections between planning and evaluating or, more specifically, self-assessment, and the importance of such connections as guiding the work process, we seek to induce dynamism and break with the tradition of planning and evaluation as fragmented and bureaucratic .
Another factor associated with planning in the present study was the achievement of goals, especially with respect to achieving 3 of the 4 evaluated goals. Thus, the high compliance with the goals induces the accomplishment of the planning in the service. No studies were found that used the same cut-off, a goal attainment indicator for planning. However, equivalent to this question, the low rate of utilization of SDCs is related, among other factors, to the lack of a management system with a clear definition of the targets for the provision of procedures by specialty .
Planning, execution and monitoring are crucial factors in the management of health services. Because they directly affect the health-disease costs, low effectiveness can greatly burden health spending, especially as human lifespans increase . Therefore, without there being rationality in the effective control of the results, we will hardly have a sustainable health system and probably will not achieve desirable results in the future.
The SDCs, as the main strategy of the National Oral Health Policy (Smiling Brazil) to guarantee secondary care in Brazil, should organize themselves in health services that act as a reference for Primary Care and integrate into the local and regional planning processes .
Nevertheless, there are limitations inherent to research using secondary data on the production of health services, and the fact that the analysis of Secondary data from specialized procedures performed by the SDCs and data from the first cycle of the NPAQI-SDCs occurs at different times. Even so, it is worth highlighting the importance of public availability of these data and their use by researchers, health professionals and managers, which enables the process of planning and programming health actions and services. Another aspect to be considered in the positive evaluation of the manuscript is that the data were collected from robust and official bases.