Processo de regionalização da saúde : um estudo do Hospital de São Jerônimo como hospital regional na região carbonífera.

Abstract

The approach of the process of implementation of the regionalization of health was made through analysis of a case study, having as reference, the Regional Hospital of São Jerônimo, located in the region 9 of health, belonging to the Região Carbonífera, what happened from the publication of Law Decree 7508/2011, instituting 30 health regions in RS. The purpose of the research is to analyze the process of the regionalization of the hospital, with the focus on the look of the actors who made and are part of the SUS regionalization. Were interviewed subjects (actors) who acted or participated in the implementation of the regionalization of the hospital: municipal and state managers, and municipal health councilors. It was a documentary and bibliographic research, systematic observation and interviews with the actors in its main decision-making arenas. The Regionalization of Health produces a dynamic during the implementation, in which one can observe a diversity of interests and power games that involve the different actors, instances of government, institutional and organizational arrangements that influence and guide the implementation and formulation of the policy, as well as the decision dynamics, where the actors do not participate directly, but rather peripherally, and without even putting itself in the strategic moments of decisions. As factors that hindered the process studied, appeared the economic and population diversity of the municipalities of the region appeared, which are relevant because make it clear the differences in posture and political capacity to integrate in a harmonic process of composition. The implementation of regionalization in Rio Grande do Sul is still a slow and troubled process, suffering internal and external pressures. The standardization that generated the 30 health regions in the state of Rio Grande do Sul since 2013, during the Tarso Genro government, reconfigured new care networks and political networks in these regions. With the change of management, there was continuity in the process, but with significant changes. External actors, with representativeness and organized political force, influenced the process of implementing of the health services in the region, constituting important governance networks forming important networks of governance in this region, strengthening these services. The increased responsibility to offer health services that solve the health needs of this region, made it appear the fortification of the regional hospital, but with different views of the actors who participated or still participate in this process. The regionalization of health, as a strategy for the regional development, was not discussed at the moment of structuring the health regions, much less the implementation of regional hospitals in the actors' vision. Finally, the State's difficulties in to draw a strategy that strength the implementation of regionalization of health as a process that, besides offering health services to the health region, can participate in the development of the region through the production of a support network in the governance of regions for addressing of the regional inequalities, is still far from the reality and experience of the actors. For two administrations, the regionalization of health was not treated as a priority in the State, making the policy not become a strategy for the governors as a way to improve the health indicators of the population of the regions.