Abstract:O artigo apresenta uma análise a partir da vivência dos autores do processo de implantação do Sistema Único de Saúde - SUS - na cidade de São Paulo, Brasil. Aborda questões técnicas e políticas acerca da gestão e gerência pública do sistema municipal de saúde em uma cidade de grande proporção geográfica e populacional, desigual em sua organização territorial e em regime de transição para um modelo de assistência em saúde descentralizado. Narra e ilustra o processo de distritalização do sistema de saúde e apres… Show more
“…Artículos respuesta al marco regulatorio promueve la participación promueve la democracia incrementa la eficiencia en la asignación de recursos mejora las capacidades y prácticas de gestión (Gerschman, 2000) x x (Gerschman, 2001) x x (Scatena & Tanaka, 2001) (Lima, 2001) x (Atkinson, 2002) x x x (Labra & Figueiredo, 2002) x x (Costa, 2002) x (Arretche & Marques, 2002) x (Borges & Fernandes, 2002) x (Viana et al, 2002) x (Elias & Cohn, 2003) x x (Ugá et al, 2003) x x (Alves Sobrinho & Capucci, 2003) x (Atkinson & Haran, 2004) x x x (Gerschman, 2004) x x (Borges & do Nascimento, 2004) x x x…”
AGRADECIMIENTOSEste trabajo no hubiera sido posible sin el apoyo de mis seres queridos, familia, compañero de vida y amistades que durante este tiempo me acompañaron en este camino de nuevos aprendizajes. A mi tutor, por su apoyo, orientación y paciencia durante este proceso. Al Instituto de Salud Colectiva y la Universidad Nacional de Lanús por brindarme este espacio de aprendizaje y crecimiento profesional. eficiencia en la asignación de recursos; además supondría la democratización de la toma de decisiones, el empoderamiento de los gobiernos locales y mayor participación de actores diversos en la toma de decisiones sobre su situación de salud, todo esto orientado a lograr procesos más democráticos y horizontales. En el contexto de la Reforma Sanitaria en Brasil, la descentralización del sistema de salud se convirtió en el medio por el cual se garantizaría el acceso y la integralidad de la atención de salud de la población.
PALABRAS CLAVE: descentralización; sistemas de salud; Brasil
ABSTRACTDecentralizing processes predominated in Latin America during the 1990s, many of which coincided with the transition to democracy of those countries that had been under dictatorial regimes. Health was one of the areas of social policy in which the decentralization model was applied more widely and which also represented a pattern to be followed for the different areas of public policy. The objective of this research is to analyze the fundamentals and controversies of the process of decentralization of the Brazilian health system based on the review of scientific articles published between 1985 and 2015. The question that serves as the main theme of the research is: what are the arguments that sustained the decentralization processes in Brazil? To answer this question, a review of scientific articles published between 1985 and 2015 and the analysis of the content of these articles was carried out. The arguments that underpinned the decentralization process in Brazil are of an economic nature, since decentralization is expected to favor efficiency in the allocation of resources; it would also involve the democratization of decision-making, the empowerment of local governments and greater participation of diverse actors in decision-making about their health situation, all aimed at achieving more democratic and horizontal processes. In the context of the Health Reform in Brazil, the decentralization of the health system became the means by which access and comprehensive health care for the population would be guaranteed.
“…Artículos respuesta al marco regulatorio promueve la participación promueve la democracia incrementa la eficiencia en la asignación de recursos mejora las capacidades y prácticas de gestión (Gerschman, 2000) x x (Gerschman, 2001) x x (Scatena & Tanaka, 2001) (Lima, 2001) x (Atkinson, 2002) x x x (Labra & Figueiredo, 2002) x x (Costa, 2002) x (Arretche & Marques, 2002) x (Borges & Fernandes, 2002) x (Viana et al, 2002) x (Elias & Cohn, 2003) x x (Ugá et al, 2003) x x (Alves Sobrinho & Capucci, 2003) x (Atkinson & Haran, 2004) x x x (Gerschman, 2004) x x (Borges & do Nascimento, 2004) x x x…”
AGRADECIMIENTOSEste trabajo no hubiera sido posible sin el apoyo de mis seres queridos, familia, compañero de vida y amistades que durante este tiempo me acompañaron en este camino de nuevos aprendizajes. A mi tutor, por su apoyo, orientación y paciencia durante este proceso. Al Instituto de Salud Colectiva y la Universidad Nacional de Lanús por brindarme este espacio de aprendizaje y crecimiento profesional. eficiencia en la asignación de recursos; además supondría la democratización de la toma de decisiones, el empoderamiento de los gobiernos locales y mayor participación de actores diversos en la toma de decisiones sobre su situación de salud, todo esto orientado a lograr procesos más democráticos y horizontales. En el contexto de la Reforma Sanitaria en Brasil, la descentralización del sistema de salud se convirtió en el medio por el cual se garantizaría el acceso y la integralidad de la atención de salud de la población.
PALABRAS CLAVE: descentralización; sistemas de salud; Brasil
ABSTRACTDecentralizing processes predominated in Latin America during the 1990s, many of which coincided with the transition to democracy of those countries that had been under dictatorial regimes. Health was one of the areas of social policy in which the decentralization model was applied more widely and which also represented a pattern to be followed for the different areas of public policy. The objective of this research is to analyze the fundamentals and controversies of the process of decentralization of the Brazilian health system based on the review of scientific articles published between 1985 and 2015. The question that serves as the main theme of the research is: what are the arguments that sustained the decentralization processes in Brazil? To answer this question, a review of scientific articles published between 1985 and 2015 and the analysis of the content of these articles was carried out. The arguments that underpinned the decentralization process in Brazil are of an economic nature, since decentralization is expected to favor efficiency in the allocation of resources; it would also involve the democratization of decision-making, the empowerment of local governments and greater participation of diverse actors in decision-making about their health situation, all aimed at achieving more democratic and horizontal processes. In the context of the Health Reform in Brazil, the decentralization of the health system became the means by which access and comprehensive health care for the population would be guaranteed.
“…Em cada distrito foram criados conselhos de unidade de saúde, compostos de usuários (50%), gestores (25%) e prestadores de serviços (25%), que deveriam contribuir para a definição e o monitoramento das políticas de saúde na região, passando a cidade a contar com mais de trezentos conselhos de saúde e 4 mil conselheiros. Também foram criados conselhos distritais e autarquias (Alves Sobrinho e Capucci, 2003 [17] Uma reconstituição acurada dos dilemas políticos enfrentados por Eduardo Jorge durante sua gestão é apresentada em Dowbor e Houtzager (2014).…”
The study analyses the evolution of the supply and consumption of public healthcare services within the municipality of São Paulo between 2000 and 2012. In the period services offered grew and the disparity between the supply and consumption of public health services across the areas with the best and worst indices of income, education and health decreased. To explain these results we discuss the municipal policies adopted during the period and explore their relation with both electoral competition and the commitment to universal access to health care by a group of politicians and health professionals.
“…Foi utilizada como unidade de análise territorial a divisão intramunicipal das subprefeituras. Esta divisão da cidade foi criada dentro de uma proposta de descentralização da política municipal e de distritalização da saúde nos anos 2000, visando possibilitar a identificação clara das demandas do território, onde as atividades relativas a saúde básica (desde a prevenção e vigilância até a reabilitação) ficariam sob o comando de uma autoridade sanitária local (MARTINS e CAPUCCI, 2003).…”
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