Governança local no sistema descentralizado de saúde no Brasil

Abstract

Objetivo. Analisar as mudanças decorrentes do processo de descentralização do Sistema

Regionalização no SUS: processo de implementação, desafios e perspectivas na visão crítica de gestores do sistema

“…Based on Chart 1, it is evident that regionalization can be considered as a structuring guideline for the decentralization of health actions and services in the SUS, based on the perspective of ensuring the right to health through resolute and equitable access of the population to health actions and services provided by the health system 23,25,36 . This is a process in progress since the Organic Health Law, encompasses the operational norms and the Health Pact and is not something that begins or is even renewed a priori with Decree 7508/11 18,26 .…”

“…It is necessary to highlight the effort towards establishing a more solidary and cooperative management, with greater sharing of responsibilities, although, in practice, issues related to system financing and infrastructure of the service network colonize the management agenda and is a hindrance to the full establishment of the regionalization process 19,23,25 , although, in fact, criteria for allocating resources regarding the provision of services in health regions and the directionality of shared investments have not been clearly established, and a wide discussion about the sector's financing model is necessary 43,44 .…”

“…Carvalho et al 18 , analyzing the highlighted process, explain that the recent construction of the Health Pact and its improvement with the enactment of Decree 7508/11, which regulates aspects of Law 8080/90, is based on respect for the constitutional principles of the SUS, with emphasis on the health needs of the population, which implies the simultaneous exercise of the definition of articulated and integrated priorities aiming at improving access to health services and actions, strengthening regional planning with the consequent definition of care networks in the health regions, the improvement of governance mechanisms and the qualification of tripartite pacts 19 . Recent studies [20][21][22][23][24][25][26] developed with the perspective of analyzing the regionalization of the SUS demonstrate that this process has been constructed, from a technical and political point of view, with the effective participation of state and municipality managers, while focused on the induction of the Federal Manager and developed in complex and often conflictive institutionality and governance processes, established through relations between the different levels of government and between these and citizens and the various segments of society, of public or private nature.…”

“…Hence, while being influenced by socioeconomic dynamics, the regionalization process is also influenced by the cycles of implantation / implementation of policies and the level of articulation / cooperation among the social stakeholders that are components of the sector's governance spaces. There is a self-referential process that relies on the theoretical references, interests and projects in which they are involved and active 4 , based on these stakeholders' capacity to generate consensus on shared responsibilities and to build regional designs that aim to ensure access to health services and actions [20][21][22][23]37 . Even with the specific features of the SUS, the trends of the Brazilian health regionalization follow the processes established in different countries regarding the need for coordinated management of actions and services, especially in terms of governance, planning and programming, personnel qualification and training, the development of professional networks, as well as exercises of mutual coping in the event of catastrophes and the operation of urgent/emergency services, including access to high-cost technologies and drugs [38][39][40] .…”

Privatização da gestão e organizações sociais na atenção à saúde

“…Há razoável consenso de que ela foi uma das molas mestras da política financeira neoliberal e da contrarreforma do Estado, avançando, ainda, sobre a autonomia dos entes subfederais (Fleury et al, 2010).…”