LEADERSHIP IN PUBLIC HEALTH: CHALLENGES AND OPPORTUNITIES IN IMPROVING THE QUALITY OF PUBLIC SERVICES

Purpose: This work examines the role of Leadership in the Public Sector, with a focus on the leaders' interaction with their teams, aiming to build a harmonious interpersonal relationship to ensure successful management. This, in turn, allows for the creation of management with a predominantly democratic character, with the potential to address both local and societal needs. In this context, it is emphasized that motivation is something intrinsic to each individual, and the leader must have the potential to stimulate it. The general objective of this work is to analyse the importance of leadership in improving the performance of employees in the context of Public Health. Theoretical Framework : Leadership permeates all managerial activities and is not an isolated activity. Its importance is underestimated when judged solely in terms of the proportion of managerial activities that are strictly related to team management. Method/design/approach: This research is exploratory in nature, as it conducted a literature review on the role of leadership in public institutions, using various publicly available sources such as books, journals, theses, internet articles, and monographs. Results and conclusion: The coordinator and 10 employees from various positions out of the total of 40 were selected to participate in the


INTRODUCTION
This work analyzes the role of Leadership in the Public Sector, with emphasis on the action of leaders in front of their team, seeking to build a harmonious interpersonal relationship for the management to be successful, which will allow to create a management with democratic predominance, with potential to meet the desires both local and social.In this context, it is stressed that motivation is something that is already in the intimate of each person, and the leader must have potential to stimulate it, according to Meireles (2017).
The theoretical reference of this work is based on the analysis of the role of leadership in the context of the Public Sector, focusing on the interactions of leaders with their teams.The goal is to establish a harmonious interpersonal relationship, with an emphasis on building a successful management that is predominantly democratic and capable of meeting both local and social needs.In addition, it is recognized that motivation is intrinsic to each individual, but the importance of the leader in stimulating it is emphasized, according to Meireles (2017).
The choice of this theme is justified by the need to understand the importance of leadership in Public Health, considering it a key element to ensure proper governance.In this context, according to Meireles (2017), it is imperative that the Public Administration be efficient, prioritizing the results, remaining organized and seeking quality in the provision of services to users.
The research problem was formulated in such a way as to investigate how the leadership can contribute towards an improvement in the performance of the collaborators within Public Management, with special emphasis on the Basic Unit of Health João Paulo II, located in Coelho Neto, in the state of Maranhão.The general objective of this work is to analyze the importance of leadership in improving the performance of employees in the context of Public Health, with a specific focus on the John Paul II Health Unit, with the purpose of making it more sustainable.
To achieve the general objective, specific objectives were outlined, which include describing the desired competencies in a leader and exploring the benefits of these competencies in improving employee performance in the John Paul II Basic Health Unit.In addition, the research seeks to discuss the main theories of leadership, as well as to verify the types of leadership in the context of Public Management and in the Basic Health Unit mentioned.
Therefore, the theoretical benchmark of this work is based on the understanding of leadership as a critical factor for management success in the Public Sector, especially in Public Health.The aim is to explore the influence of leadership on interpersonal interactions, the efficiency of Public Administration and the quality of services offered to users, with the aim of making the John Paul II Health Unit and other public sector organizations more sustainable and effective.

Leadership
When one speaks of leadership, what one imagines is someone who commands, who is at the head of a task (in the function of leading something or people), someone with capacity with the most varied genres of humanity.In Hunter's (2004) view, it can be said that Leadership is purely a mechanism that leads people or a group to achieve a goal in a given circumstance.
Leadership permeates all managerial activities and is not an isolated activity.Its importance is underestimated when judged only in terms of the proportion of managerial activities that are strictly related to the conduct of the work team.(MAXIMIANO, 2000, p.33).
In this context, analyzing the above, it is stated that any organization, regardless of its size, needs a leader, in certain situations up to more than one.Employees value their leaders from the moment they prove authentic, responsibility, commitment, partnership, authenticity, personal ascendancy, clarity in ideas and conceptions, among others.
Leaders need to demonstrate initiative, have the potential to delegate roles, feel righteous (provide equal treatment for all), be emotionally balanced, etc.These are just some attributes or competencies of a leader."In theory anyone can be a leader, depending on the situation" (BARROS, 2002, p. 48).In a group, more than one leader may emerge or suddenly none, there may be several leaders, but in most cases the leader repeats.
Moral formation concerns the assimilation of values, among them goodness, justice, sincerity and honesty, in a lasting way, however, having risk of changes.Psychological training has a relationship in having security in decisions, taking initiatives, being accepted by others and accepting them, facing the varied circumstances of daily life, however, without losing their fundamental values.As for the objective cultural formation that people acquire culture, that is, that they have criticality in the face of reality, not just passing good instructions, and, in this way, people will be able to become leaders in the face of the emergence of opportunities."One style of leadership is not suitable for all situations; therefore one type is not necessarily better than another" (BARROS, 2002, p. 52).

Theories About Leadership
When it comes to theories about Leadership, some stand out, as will be seen below.

X Theory and Y Theory
Douglas McGregor (1992) presented administrators' perception of the nature and motivation of workers in the form of two theories: Theory X and Theory Y.According to Chiavenato (2011), Theory X assumes that workers are not interested in taking responsibility, prefer to be directed and are motivated solely by money, material benefits and the threat of punishment.Theory Y postulates that workers are not indolent and irresponsible by nature, but can self-direct and be creative at work if they are properly motivated.McGregor sought to evidence the effectiveness of Theory Y by arguing that people are not indolent in nature, as this type of behavior would happen only because of a lack of opportunity and support at work.
When people are deprived of the opportunity to meet their most important needs at work, they behave exactly as could be predicted, with indolence, passivity, unwillingness to accept responsibility, resistance to change, tendency to embrace demagogues, exaggerated demands for economic benefits.Apparently we end up trapped in the bonds that we ourselves [managers] set up (MCGREGOR, 1992, p.48).
McGregor sought to demonstrate that work is not a necessary evil and can be as pleasant as a game, simply by having challenge and satisfaction stimulated by administrators through attitudes consistent with Y Theory.For Chiavenato (2011), Theory X is based on several erroneous assumptions about human behavior.It preaches a style of administration in which surveillance and rigid external control, example of a variety of means that ensure compliance with working hours.The exact execution of the tasks through the methods or routines and procedures of operation is also mentioned.
Within this perspective, to overcome human laziness and indolence, the salary must be used either as a reward (the salary must be higher as the result of the work is higher) or as a punishment (the salary must be lower as the result of the work is lower).However, the salary becomes the only valid stimulus for Theory X, since always prevails the environment of mistrust, surveillance and control, taking away from people any possibility of own initiative or of choice as to how to work or to carry out the tasks.As opposed to Theory X, McGregor points to Theory Y, according to which managing is basically a process of creating opportunities, releasing potentials towards people's self-development.CHIAVENATO, 2011.According to Theory Y, the conditions imposed by Theory X conditioned people to super-specialized and double-sided tasks, tying them to limited jobs and mechanized by rigid and mechanistic working methods and processes, which do not use all people's abilities, discourage initiative and acceptance of responsibilities, develop passivity and take away all the psychological significance of work.Something that has happened most accurately in the last fifty years.Thus, in the long period of predominance of Theory X, people have become accustomed to being directed, controlled and manipulated by companies and to finding out of work the satisfactions for their personal needs of self-realization.
For McGregor (1992), Theory Y is generally applied in companies through a style of direction based on various innovative and humanistic measures: decentralization of decisions and delegation of responsibilities: in order to allow a greater degree of freedom for people to direct their own tasks, to assume the challenges arising from them and to satisfy their needs for self-realization.
Extending the position to make the work more meaningful.Thus, instead of overspecialization and confinement of tasks, Theory Y leads to the expansion of the position through its reorganization and extension of activities, so that people can know the meaning of what they do and, mainly, get an idea of the contribution of their personal work to the operations of the company as a whole.Participation in decisions and consultative administration: as long as people can also have some participation in the higher decisions and that affect them directly or indirectly, they will become committed to the achievement of business goals.
In Theory X, man is presented as a needy being, who confines himself to doing what is necessary to survive without caring for personal fulfillment.Therefore, motivation is almost irrelevant, making it necessary to use authority to ensure the direction and control of employees.Integration is the basis of this Y theory, because it is it (integration) that assures and validates authority.Suggests self-control when enterprise-employee needs are recognized.We know, however, that it is difficult to integrate personal and organizational interests.

Vroom theory
As for Vroom's theory, Chiavenato (2005) states that it is based on the hypothesis that there is always a better way to motivate people, either by satisfying the prevailing need or by enriching the position.According to these theories, people, in any situation, can be motivated in the same way if their predominant needs are the same.
According to Chiavenato (2005), Victor H. Vroom ( 1964) created a contingency model on motivation, based on the observation that the motivational process is not only related to individual goals, but also to the work context in which individuals are inserted.For Chiavenato (2005), in the conception of Vroom there are three basic forces that act within individuals and that influence their level of performance: a) Expectation; b) Instrumentality; c) Valencia.
Thus, it should be noted that these three aspects have influence, according to Vroom, to motivate people at work.If one of the elements is absent, the motivation becomes weak.If all of them are present (high expectation, high instrumentality and high valence), the motivation is high.Vroom Theory leads to the conclusion that organizations obtain from their employees the desired performance not only when they meet their individual objectives, but when they show them that the path to the satisfaction of individual objectives is in reach of the desired performance.

Types of Leadership
According to Chiavenato (2011), types of leadership are theories that study leadership in terms of the leader's style of behavior towards his subordinates, i.e. ways in which the leader guides his conduct, his style of behavior to lead.The main theory that explains leadership through behavioral styles, without worrying about personality characteristics, is that referring to three styles of leadership: authoritarian, liberal and democratic.The following chart gives an idea of the main features of each of these leadership styles.

Autocratic leadership
According to Possi (2006), in this type of leadership, the guidelines are fixed by the leader, without the participation of the group's components.The procedures, tasks and technical aspects surrounding them are determined by the leader, in a sequence, so that the group does not have a predictability of how they will happen.In this context, the tasks that each one must perform and even the partnerships are determined by the leader, who has characteristics of dominator, acting in a "personal" way as to the compliments, as well as in the possible criticisms of the components of the group.

Democratic
According to Possi (2006), in this type of leadership, the group, with encouragement and assistance from the leader, debates the guidelines.In the pursuit of achieving the objectives, what should be done and the technical procedure is outlined by the group itself, and the leader is summoned and functions as an adviser, as needed, providing for more than one possibility for group choice.The debates bring new perspectives to the tasks.The way of dividing the tasks and partnerships is defined by each component of the group.In this context, the leader stands as just another member of the group, not being far ahead of the execution of the tasks.The leader acts objectively, limiting the facts to both praise and criticism.

Liberal (Laissez-Faire)
The leader's participation is very small, the members, in the decision-making process, whether individual or group, have complete freedom.The leader, in this context, participates and provides opinions when requested.The process of allocating tasks, as well as the selection of partnerships for carrying out the work, are the total responsibility of the group, without the interference of the leader.No, on the part of the leader, any form of evaluation or regulation about the procedures and facts.The leader's participation is irregular, only happens when it is requested and questioned.(POSSI, 2006).

The Skills of a Leader and Contributions to Employee Performance in Public Administration
In Vergara 's view (2003, p.38) "competence is a specific ability to perform the action at a level of skill that is sufficient to achieve the desired effect".Competence presents itself as a new way of conceiving the potential for using knowledge at specific times.In order for competence to be developed, it is necessary to use resources to expand knowledge, learning ability, and test the resilience to coping with adverse conditions.In this context, Chiavenato (2008, p.142)

highlights:
A competence is a repertoire of behaviors capable of integrating, mobilizing, transferring knowledge, skills, judgments and attitudes that add economic value to the organization and social value to the person.In each individual, competence is built on their innate and acquired characteristics.
For Botelho (1993, p. 21), there is a need to invest in order to develop the potential of leaders for various reasons, since nowadays leaders are required with the capacity to: -to transform difficult situations into practical and profitable solutions; -to face crises in a positive and optimistic way; -to create constantly and that have sufficient inner strength to face new facts without letting oneself be destroyed; -to make the future from institutions and sensations and not just from rationalisms based on the history already lived; -to overcome the conditionings that accompany everyone, throughout their lives; -to transform groupings into groups; -to awaken all the potential that people have, and capable of making them apply this potential in their daily activities; -to make work be faced with pleasure and satisfaction, and that need and love are synonymous.
In the conception of Laner;Junior (2008), the meaning of competence is conceived as a set composed of knowledge, skills and attitudes, i.e. a set of human skills that justify a high performance, believing that the best performances are grounded in the intelligence and personality of the people.
According to Dubrin (2003, p.266) "an effective leader must have appropriate cognitive skills, or mental ability and knowledge".Leaders have problem-solving skills, they can predict problems before they occur, and they persevere until they are solved.They demonstrate imagination, creativity and willingness to experiment with new working methods.
Dubrin ( 2003) also describes the competence of leaders that reliability contributes to effective leadership in many situations, demonstrating behavioral integrity, to the fact that it is reliable and predictable.Another important factor is the emotional intelligence that contributes in the forms among the led.Emotional intelligence is broad and involves behavioral traits related to leadership effectiveness, including self-confidence, empathy, and visionary leadership.In this way, the behavior and attitudes of the leaders are considered essential competencies for the good relationship of a team, contributing to the effort and performance of the people involved.Leadership has the ability to influence a group by generating values and beliefs in the organizational culture, their behavior can present changes in the leaders, achieving goals in diverse situations and achieving effectiveness in organizations.
Thus, the importance of the leader is to know the organization where it is inserted and the people, because their behavior and the way of managing the team can influence the group positively.The leader being the one who develops characteristics that are important both for the effective administration of the organization, both for the harmony and trust of the people he is leading so that the work is motivating and has quality.
Today, the changes affect organizations in a blunt manner, and these changes are necessary to overcome challenges.For this, the motivation of the collaborators is indispensable.In the public sphere, the difficulties are even greater, given that civil servants are differentiated, presented in a heterogeneous way, and motivators are distinct from the private sector.BERGAMINI, 2009.

METHOD
This research presents itself as exploratory, since it made a bibliographical survey about the role of leadership in public offices, using as instruments various bibliographies found in the public domain such as: books, magazines, monographs, theses, internet articles.In order to build the Theoretical Grounds and the basis of this work, information was sought within the Google Academic Platform, as well as in the IBICT/BDTD database of articles, dissertations and theses.In order to facilitate the searches, the keywords were used in articles, monographs, theses, among others: Public Administration; Competences and Leadership.In the course of the consultation, works were discarded that contained only incomprehensible mentions of the theme in question or with dates considered outside the scope of the theme.On bibliographic survey or bibliographic research, Oliveira (1997) points out that "The purpose of bibliographic research is to know the different forms of scientific contribution that have been made on a given subject or phenomenon".Also part of this work was a field survey, using as instruments pre-prepared questionnaires on the subject in question with 10 (ten) employees, both male and female, effective civil servants and contractors of various positions, of the total of 40 (forty), which represents a sample of 25%, as well as was interviewed the coordinator, i.e. the leader (a woman of 34 years, being in Nursing and being of the effective staff of the municipality as Nursing Technician for more than 10 years) of the Basic Unit of Health -UBS John Paul II, in the municipality of Coelho Neto -MA, that serves with health services mainly needy families of the largest neighborhood in the city, Bairro Sarney.
The questionnaire used for the leader had 10 questions, 5 of which were open and subjective, and the one used for those led contained 10 closed and objective questions, emphasizing and analyzing the last 5 in the two cases.The questions were delivered in person to the Basic Health Unit, and the interviewees were chosen randomly as being led.Both the leaders and the leader had a period of 5 days to return the completed questionnaires, which happened without any problem.According to Franco (1985), field research has as its main procedure the observation of phenomena and facts exactly as they are in reality, with the objetive of understanding and elucidating the problem.
Taking into consideration the technique used, the research can have a quantitative or qualitative stamp, this work fits into the two options, because it describes the facts giving to the relevance of the social reality of the question and quantifies the interviewees' views to define a trend.These two stages made it possible to deepen the research, establishing a comparison between theory and practice, making up the association of what the authors and theoreticians say with which was found in the field research.

RESULTS AND DISCUSSIONS
Here begins the analysis about the point of view, initially of the leader and, afterwards, of those led by the Basic Health Unit John Paul II, in Coelho Neto -MA, chosen for field research.The coordinator and 10 employees from various positions out of the total of 40 were chosen to take part in the research.It should be noted that the leader has a higher education in Pedagogy and is studying Nursing, is 34 years old, female, and was once coordinator of the same UBS for 4 years in the near past, her first experience as a leader, at the age of 26 years.It currently leads 40 people

Leader Perception of Leadership Aspects
Below, we analyze some subjective questions answered by the leader during the field research.For confidentiality reasons, the leader will be referred to as the LEADER only.
The first subjective question was "In a self-analysis, what points do you consider as your strengths?And what do you consider your limitations (weaknesses)?",when the LEADER replied: LEADER -I consider myself a person of solidarity and consensus of justice, which gives priority, above all, to respect to subordinates, who are co-workers.I believe that my greatest weakness is to have more energetic difficulty when necessary, in some situations avoid possibilities of conflicts and clashes, I have a little difficulty to impose myself in order to maintain full respect for the working standards and the working objectives proposed.
In the speech of LEADER, she describes herself as a caring person, sympathetic, friend and, above all, respectful of the rights of subordinates.As for its weaknesses, it is described as someone with little energy, considering that this factor can interfere to a small degree in maintaining the standards of the sector, according to itself within a self-analysis.
The second subjective question was "To be in this position, what difficulties were faced by you?", when the LEADER replied: LEADER -Unfortunately, being a woman and a young person still generates mistrust.This has certainly been the most important factor in achieving a situation of tranquility and naturalness, allowing the activities of this sector to be carried out with quality.
Despite being in the 21st century, claims of prejudice against women still exist.In the speech of the LEADER, two factors weighed in its acceptance as a leader of the sector that acts: the condition of woman and youth, factors with different weight, and youth may show inexperience for the position, however, the gender of the leader must be seen as element with no weight to lead a team in any sector of society.
The third subjective question was "What do you consider important that a leader has and can bring inspiration to those led?", when the LEADER answered: LEADER -In my opinion, first of all, the leader must be optimistic, transmit positive energies, be respectful and polite, treat subordinates well, with professional zeal and protection.To have the idea of a group, both in hits and in mistakes.I believe that these factors create a relationship of trust and complicity in the pursuit of the objectives defined by the organization.Something very important is to have the intelligence and sensitivity to predict, deal with and solve any problems in the sector.
In the speech of the LEADER there are several interesting factors in the profile of a leader, among them optimism, respect and good treatment with the led.An interesting question in this speech is part that highlights the ability and intelligence to deal with problems, being in line with Dubrin (2003, p. 266) when it says, in this context: "an effective leader must have appropriate cognitive skills, or mental ability and knowledge".
The fourth subjective question was: "Through what strategies do you try to motivate your work team?", when the LEADER answered: LEADER -To motivate, first of all, the leader needs to be motivated.People have their problems, their needs and their desires, which need to be taken into consideration.From the moment that the collaborators are treated with attention, they feel welcomed, strengthening the team spirit.
The speech of the LEADER points out that it is necessary to take into consideration what the collaborators expect and desire, aiming at cohesion.This can be considered as ways and means of motivating, joining and joining forces and concentration around the proposed goals, because, as Robbins (2005) defines, motivation is the concentration of efforts to achieve the defined goal that include the characteristics of persistence, intensity and direction.LEDER -The rules governing public administration in many situations are distinct from those of the Private Sector.However, what changes are the attitudes, the feeling that the public belongs to everyone, and, at the same time, it does not belong to anyone specifically, which, in many cases, causes a certain relaxation.Another fatora of differentiation between the areas lies in the motives that motivate the collaborators.
Initially, the LEADER addresses the difference between normative aspects of Public and Private Administration, reinforced by Para Meirelles (2005, p. 112) when she says: "In Public Administration there is neither freedom nor personal will.While in private administration it is lawful to do everything that the law does not prohibit, in public administration it is only allowed to do what the law authorizes".The differentiated attitude in the Public and Private sectors is also highlighted in the speech of the LEADER, as well as the factors that motivate people, referring to Bergammini (2009) when it points out that, in the public sector, the degree of difficulty is even greater, since dealing with the civil service is dealing with a differentiated, heterogeneous group of people, where the factors that motivate this category are not the same as the private initiative (FAÇANHA NETO et al., 2023).

Leaders' perception of Leadership aspects
Below, we present the results of the interview with the leaders, with emphasis on the last 5 open questions and objectives.
In Graph 1 below, the question is asked about the leader's attitude towards asking for suggestions and ideals from those led to solve problems.
Graph 1: Does your leader ask for suggestions and ideas from subordinates to solve problems?Source: Authors, 2023.
The results show that there is predominance of the option "always", showing that the leader resorts to those led in the face of difficulties and problems, that is, is a person open to ideas and suggestions.This attitude of going to the leaders and asking for ideas and suggestions to solve the problems suggests an action that inspires confidence between the leader and the leaders, being among the competences cited by Bergamini (2009), Istikhoroh (2023) that emphasizes that one should attribute four competencies to those who are responsible for directing people: "attracting attention, giving meaning to things, inspiring trust and managing oneself".
Graph 2 below shows the evaluation of the relationship between leader and led in the perspective of the led.The results show that the leaders consider that the relationship with the leader is optimal and good for 90%, that is, the great majority.Only 10% consider the regular relationship.This suggests a harmonious organizational climate, which favors the quality of the services developed and provided in this health unit.
In Graph 3 below, we analyze the leader's help in the activities to the other collaborators Responses from the leaders showed that the leader actively assists those led in the dayto-day activities of the work environment, which leads to the inference that she is a person of solidarity and cooperation.These characteristics can motivate employees, since example is the best way to stimulate people.
Graph 4 below discusses the leader's stance on being open to receiving criticism and suggestions from the leaders.The results of this questioning of those led showed that the leader listens to those led, with 80% answering most of the times and 10% almost always, only 10% saying not always.One can say that one has democratic leadership, because, according to Possi (2006), in this type of leadership, the guidelines are debated by the group, stimulated and assisted by the leader.
Graph 5 below shows the degree of employee satisfaction with the current leader.Responses from the leaders showed that the way to conduct and lead the leader's activities pleases the vast majority, because 60% say they are "very satisfied" and 30% say they are "satisfied", only 10% opted for "more or less satisfied", which suggests that the style of leadership adopted is well accepted by the leaders, favoring the performance of activities and services provided in this sector of Public Administration.Considering that this style is efficient for this environment, and would need to be tested in others to see its acceptability, because "One style of leadership is not suitable for all situations; therefore one type is not necessarily better than another" (BARROS, 2002, p. 52).

FINAL CONSIDERATIONS
This work showed that, although faced with so many theories and models of leaders, it was seen that the leader excels in function of his involvement with the values of the organization where he works, inspiring, in the subordinates, the feeling of trust, which will make them follow him.You need to be able to articulate and personify the goals set by the organization in which you are a leader.Have sensitivity and potential to make sense of the activities developed by the employees, making them feel pleasure in performing them.Thus, the leaders will feel an important part of the group, improving performance and enabling the achievement of goals and objectives.

13
The results of the field research showed a leader with self-criticism, who assumes his weaknesses, pointing out where he can improve, in a demonstration of professional humility.It shows emotional intelligence to deal with problems and seek motivation from collaborators through a friendly, supportive and welcoming posture.As for those led, they show great acceptance by the leader, although it is not total unanimity.The positive factors overlapped the negative ones in a very significant way, signaling a leadership guided by respect and harmony, which needs to improve some factors, like the normative organization, aiming at greater organization of the researched sector.Based on these results, it is assumed that the organizational climate of the research field is excellent and favors the smooth running of the activities developed by that organization.
It is concluded that the leader's profile directly influences the relationship that involves commanders and leaders, and that the team's objectives result.In this way, it has to be that leadership is configured as an activity carried out by people, different from the bureaucratic and administrative aspects or activities that make up the planning.We need to know how to lead, especially in the Public Sphere, for the improvement of the services offered and for the good of society.
___________________________________________________________________________ Rev. Gest.Soc.Ambient.| Miami | v.18.n.2 | p.1-14 | e04441 | 2024.10 The fifth subjective question was "What challenges do you point to as the main ones in the leadership role and in managing a team in the Public Administration?", when the LEADER answered:

Graph 2 :
How do you evaluate the relationship between leader and leader?Source: Authors, 2023.

Graph 3 :
When needed, does your leader help employees with activities?Source: Authors, 2023.

Graph 4 :
Is your leader open to criticism and suggestions from subordinates?Source: Authors, 2023.

Graph 5 :
How do you rate your satisfaction with your current leader?Source: Authors, 2023.