O desempenho dos municípios no Pacto pela Saúde no âmbito das relações federativas do Sistema Único de Saúde

Abstract

This study evaluates the results of the Health Pact, which seeks to regulate the SUS's federative relations, regarding the achievement of the goals and the compliance with the agreements made by the federated entities considering national priorities and the actual performance of the cities in comparative terms. Some indicators of the Health Pact were selected for the period of 2007-2011 and sought to answer the following questions: (1) Have the cities fulfilled what was agreed? How did this evolve in the period? (2) The effective performance of the cities has positively improved during the period? (3) What is the degree of inequality between cities in terms of performance? (4) Are the results associated with structural factors exogenous or endogenous to the health sector? Data from Datasus and Sispacto were used. Measures were developed to assess the degree of compliance with the agreed targets, to evaluate the actual performance of the cities and the degree of inequality between them. Regression models sought to gauge the influence of structural factors on this performance. Results show that the pact has not extended the cooperation between federated entities; there were positive developments in the achieving the goals, particularly in the indicators with punitive mechanisms; the performance varies between indicators and is mainly associated with the availability of financial resources.

Qualidade do gasto e destinação orçamentária à saúde

“…As variáveis de controle Gini e Taxa de Crescimento Populacional foram inseridas para darem maior robustez ao modelo. Os municípios brasileiros que apresentam menores índices de desigualdade combinado com maior disponibilidade de recursos financeiros são aqueles que dispõem de melhores resultados em suas ações na atenção primária em saúde (16) .…”

Diferentes padrões de coordenação estadual

“…Em algumas áreas, como é o caso da Saúde, a coordenação nacional consolidou-se e institucionalizou-se, induzindo os governos estaduais a assumirem um papel de coordenação regional junto a seus municípios, ainda que exista uma variação na atuação coordenadora entre os estados (Licio et al, 2021;Lima et al, 2012;Marques, 2016;Menicucci et al, 2017;Silva, 2020). Em outras políticas, como a Educação e a Proteção e Defesa Civil, a coordenação nacional fortaleceu-se, mas em menor medida do que na Saúde e, como consequência, a coordenação estadual não foi determinada de forma explícita ou efetiva, havendo maior heterogeneidade.…”

Regionalização da saúde e cooperação federativa no Brasil: o papel dos consórcios intermunicipais

“…Given this reality and hardships of fully materializing the decentralization process in many municipalities, efforts were made by the Ministry of Health, mainly from the 1990s, to consolidate the process of regionalization of health policies [5][6][7][8][9] . Government strategies focused on the consolidation of regionalized health system management bodies, such as the organization of Regional Interagency Coordination Offices, the setting of Health Regions, the consolidation of inter-municipal consortia and establishment of the Integrated Agreed Programming and public action organizational contracts [9][10][11][12][13][14][15][16][17][18] .…”