Descentralização da gestão: caminho percorrido, nós críticos e perspectivas

Abstract

Descentralização da gestão: caminho percorrido, nós críticos e perspectivas

O protagonismo dos Conselhos de Secretários Municipais no processo de governança regional

“…In other words, changes in the allocation of resources from the implementation of decentralization have not been satisfactory to modify the pattern of inequality in access to health goods and services in different health regions. In this process, COSEMS' managers and other players responsible for the regionalization process are faced with the task of helping to manage a heterogeneous and non-integrated service network with an insufficient supply of services, especially at medium-complexity level 1 .…”

“…One is the regional consortium, which does not guarantee system integration, but has been a possible arrangement. This scheme has enabled the interaction between the different levels of care and smaller municipalities with medium or large municipalities, which is an important step to ensure access to other services and interaction between municipalities and the services that are provided by them, in order to allow a greater volume of health services and actions to the region 1 . Recent studies have identified consortia as a means of rationalizing scarce resources, particularly in drug procurement 23,24 .…”

“…In Brazil, health management decentralization to the municipal entity is understood as a strategy of democratization and incorporation of new stakeholders in order to ensure greater participation of municipalities 1 . Among advances achieved, we can highlight the expanded access of the population to services, mainly Primary Health Care, and the considerable improvements of national health indicators 2 .…”

A governança e a relação público-privado no cotidiano das práticas em municípios de pequeno porte

“…The interviewees' statements show that the managers do not perceive the operationalization of planning in a bottom-up manner -as described in Decree no. 7508/2011 31 In a scoping review of the decentralization of healthcare management to municipalities, Pinafo et al 32 identified that medium-complexity agreements involve complex processes, in which the rules and definitions are not clear and are poorly defined in planning and monitoring instruments.…”

Redes regionalizadas e garantia de atenção especializada em saúde: a experiência do Ceará, Brasil

“…We understand that the insufficient and fragmented supply of specialized services, responsible for a significant part of public health care and spending, is one of the main obstacles to regionalization 18 , to the establishment of the RAS, besides mobilizing public and private stakeholders with diverse interests 19 . The state of Ceará shows an advanced stage of regional organization 4,20,21 , which may inform other national experiences regarding models of public provision of specialized care in the current context of health crisis and budgetary constraints.…”