Sistema de saúde universal e território: desafios de uma política regional para a Amazônia Legal

Abstract

O artigo apresenta os resultados de uma pesquisa sobre a política federal de saúde para a Amazônia Legal de 2003 a 2005, visando fornecer subsídios para o desenvolvimento de políticas regionais na saúde. Tal região é marcada por uma dinâmica peculiar, extensa área de fronteira e indicadores sociais desfavoráveis. A metodologia envolveu: análise documental e financeira, observação participante, entrevistas com dirigentes federais de vários ministérios, secretários estaduais e municipais de saúde da Amazônia; caracterização de situações geográficas na Amazônia e estudos de campo em 15 municípios. Observou-se uma baixa institucionalidade da política de saúde para a Amazônia, no período, por dificuldades estruturais, institucionais e políticas. A identificação de seis situações geográficas foi útil para a sistematização de diferenças nos usos do território que repercutem na saúde e devem ser considerados na condução de políticas públicas. Há certo distanciamento entre as ações federais e a dinâmica territorial, expressa no descolamento entre a política em curso e seu reconhecimento pelos gestores locais. Além da construção de uma política regional para a Amazônia, fica evidente a necessidade de políticas diferenciadas dentro da região.

Regionalização em Saúde no Amazonas: avanços e desafios

“…The conclusions are similar to those of Oliveira 5 and Viana et al [6][7][8][9] for the Amazon. It is valid to infer that the slow and fragmentary rhythm of regionalization process studied here is linked to unfavorable structural conditions at the local level, given the political, economic and administrative constraints of the municipalities that make up the ENMAO Region.…”

“…It is valid to infer that the slow and fragmentary rhythm of regionalization process studied here is linked to unfavorable structural conditions at the local level, given the political, economic and administrative constraints of the municipalities that make up the ENMAO Region. Also important are the institutional political limits, either by the federal manager -more inclined to prioritize major health problems and/or population groups and large municipalities, to the detriment of specific territories and populations -or by managers and technical bodies of the municipal health systems, pointed out by Viana et al 7,9 , as unfamiliar with central government policies. Hardships faced by the ENMAO regional administration to overcome fragmentation established by the federative legal framework of the public administration may be much greater for other health regions in the state lacking technical staff and resources.…”

“…Literature 1,5,6,7,8 has pointed out important inequalities between health regions in the country, particularly in the North, where 46% of health regions have low HDI. There, the health services network is insufficient and it is hard to establish human resources, especially in small municipalities.…”

Saúde ambiental e desenvolvimento na Amazônia legal: indicadores socioeconômicos, ambientais e sanitários, desafios e perspectivas

“…However, one can't help but point out the existing limits in this paper when considering the breadth and diversity of the Amazon which require considering different patterns of geographical and health-related situations, resulting in different modes of use and occupation of space and their stories. In this process of tensions, mediations and combinations between the general and the particular items, it is worth remembering important efforts towards that, in the form of books, such as those organized by Rojas and Toledo (1998), as well as the latest one organized by Oliveira (2014), or even in the form of articles, like Viana et al (2007). With this article, we hope to contribute to the debate on these tensions and mediations, without losing sight of the more general debate on the model of development and its impacts on the environment and health in the Amazon.…”

Primary health care in municipalities at high risk for malaria

“…According to the recommendations of the Health Ministry's Health Care Surveillance Office, one of the most important actions for improving malaria control policies is expanding the PHC network in the Amazon region (3) . In the attempt to establish a regional policy for PHC in this region, in the period from 2003 to 2005, greater funding was given to the ESF and to control of endemic situations, but this favorable treatment was not extended to all programs and there is still great institutional need in municipalities of the Amazon (4) . Ferreira ACS, Suárez-Mutis MC, Campos MR, Osorio-de-Castro CGS.…”