Política pública de saúde : um estudo sobre o processo de implementação da descentralização/regionalização da saúde na região do Vale do Rio Pardo-RS.

Abstract

The implementation of the principles of the Unified Health System (SUS) faces multiple challenges due to the characteristics of the country diversity and the several institutions involved in the problem. The strategy of regionalization of the health system has been adopted by the Health Ministry aiming at guiding the organization of that system. The goal is to conform a hierarquized network with the possibility of extrapolating the territory of a county with human resources, medical equipments, information technology and professional training. The understanding of the implementation process of health regionalization was oriented through the political analysis by a case study, which analyzed the municipal realities of the 13th Regional Health Coordination, located in the Rio Pardo Valley – RS: the decision making process, the involved actors’ discourses, as well as official documents (Operational Norms, meetings’ records of the Regional Health Council and of the Intermanager Bipartite Commission, and other registrations regarding regionalization. The policy implementation dynamics of Health Regionalization sets a diversity of interests and power groups, involving different actors and government instances, mechanisms, institutional and organizational arrangements that influence and orientate the implementation and formulation of health policies, as well as the decision taking dynamics. As hindering factors to the studied process, we analyzed the conditions of the counties of the region due to their economic and demographic diversities, thus compromising the process of mediation of the regional relationships. Furthermore, the financial difficulties of the health sector is one of the most mentioned problems and pointed as impediment. The end of the mandate and the government changes by frequent and not coincident electoral processes at state and county levels also interfere in the political dynamics of health and the distribution of the scarce resources. The punctual initiatives that react to emergency demands of each county, apart of the collective context, weakens the managers’ articulation as a group. In that scenery of differences and multiple interests, the study revealed the need for constant and effective follow-up of the health regional coordination of the process. Such interference might be decisive to transform the competitive culture in cooperation and solidarity among the counties.