Regionalização e Redes de Saúde

Abstract

The aim of this article was to reflect on the challenges faced in building the Health Regions and Networks in Brazil. These reflections result from studies conducted in several health regions. The central challenges for the constitution of the Health Regions and Networks are as follows: the Care Model, Primary Health Care, Care for Users with Chronic Diseases, and Hospital Care. In order to consolidate the regions and networks the organization needs to incorporate an ethical sense: focusing on social, public and individual needs, derived from comprehensive care, human and social rights, in broad, multi-scale and inter-sectorial interactions, with the constitution of a systemic, regionalized innovation. Of prime importance is the capacity to devise which general principles are responsible for maintaining the unity(mode of care), seeking to outline the coherence of the different provision models that the system might develop according to the social needs in regional settings. Without that, users will continue to seek and create ways of accessing health services that challenge the rationale of those very services. Hospital reform is also required to integrate and reorient the hospital networks. These reflections are important for the SUS to uphold its solidarity project, expressed in the trinity of universality-comprehensiveness-equality.

A atenção primária em regiões de saúde: política, estrutura e organização

“…As heterogeneidades observadas intrarregionalmente e entre regiões revelam diferenças que podem estar relacionadas a diferentes fatores como desenvolvimento tecnológico, aprendizado institucional prévio na trajetória de organização do sistema de saúde, background cultural e institucional, entre outros. Isso impõe um grande desafio, posto que os problemas e soluções exigem acurácia de investigação empírica na análise de cada situação particular, dado que, como bem assinala Viana et al 33 , não são soluções normativas ou burocráticas que darão conta de resolver de forma eficiente e eficaz os obstáculos que se colocam para a integração e coordenação do cuidado de qualidade em contextos regionais diversos. Nesse particular, cabe ressaltar a multiplicidade de atores, expertises, saberes e experiências que precisam ser mediados por meio de mecanismos de ausculta e compartilhamento de poder, tendo em vista a organização de fluxos e o compartilhamento de responsabilidades que permitem dar concretude à operação e funcionamento autorregulatório das redes nas regiões de saúde.…”

Enfrentando desigualdades na saúde: impasses e dilemas do processo de regionalização no Brasil

“…Recent federal and state policies in favor of a system operated in network format put Brazil in the position of a certain contemporary consistency with the international profile, by determining that the organization of care within health systems should be operated by networks (http://www.resbr.net. br), aimed at building integrated health systems 36,37,38 .…”

“…For example, greater understanding of the networks and Brazil's urban complexity, based on multi-scalar analyses, given the great interdependence between the country's urban, peri-urban, and rural areas. Other elements that also need to be included are: (a) an integrated vision of health systems and socio-spatial determinants, with different types of inter-sector interventions operated by a multiplicity of agents and institutions; (b) definition of standards for public-public and public-private contracts, given the accelerated process of profitization of health care in the public sector; (c) introduction of a new technological paradigm, since connectivity, integration, and regulation assume the intensive use of new devices and platforms, such as telemedicine, related to territorial inequalities in technologies and professional staffing; (d) new and complex formats in regulation, not only classic regulation of access, but regulation of professionals and providers (services), regulation of treatment or care, and new tools that occupy the regulation of quality of care and patient safety 38 .…”

Avaliação de desempenho da regionalização da vigilância em saúde em seis Regiões de Saúde brasileiras

“…Novos estudos mostrarão impasses, desafios e saídas desse novo ciclo do SUS, mas é certo que suas debilidades são claras e apontam para a necessidade de lideranças institucionais, a serem exercidas pelos estados; políticas públicas mais efetivas; ambientes organizacionais voltados para cooperação e arranjos de participação e controle social, sem os quais a consolidação da regionalização não será viável 41 .…”