Análise da agenda de saúde do Governo do Estado do Rio Grande do Sul de 2007-2012 : pacto pela saúde e o processo de regionalização.

Abstract

This is a study of the process of formulation of the agenda of the Pact for Health in the state of Rio Grande do Sul, during the government of Yeda Crusius and Tarso Genro, with focus on regionalization, approaching how the state government played its institutional role on the Unified Health System. The purpose of the research is to analyze the health agenda of the state of Rio Grande do Sul between 2007-2012 with focus on the assumptions of the Pact for Health, which defines the strategy of SUS regionalization. In order to do so, we used the theoretical models of agenda formation (agenda-setting) that highlight the dynamics of agents and their influence in the formulation of government agenda, together with data from both materials and publications of the State and Federal Government, as well as reports related to the topic. The research focused on a case study analyzing the 13th Regional Health Coordination - CRS, through the cities of Santa Cruz do Sul and Venâncio Aires, considering the actions of the State Health Department on policy, through a qualitative research. The subjects of the research were managers, technicians and coordinators, who worked on the implementation of the Pact for Health process. We have carried out a documentary and bibliographical investigation, systematic observation and interviews with the agents. For the analysis of the data, we have chosen to work with the dialectic method through Minayo (2007). To contextualize the specificities of the theme, the concepts of public policy, the theory of Multiple Streams of Kingdon (1995) were researched, as well as a retrospective on the National Health Conferences and Public Policies in contemporary Brazil (NOB, NOAS, Pact for Health) . The implementation of the Pact for Health in Rio Grande do Sul was a slow and messy process, suffering internal and external pressures. The joining to the Pact in RS occurred in 2007, however, the cities only began the process of agreement in early 2010 (approval by CIT). In virtually all the management period of Governor Yeda Crusius, the State had zero percent (0 %) of City endorsement. With the change in management, there was continuity in the process, but without significant changes. In 2012, Rio Grande do Sul was in 3rd place among the states that agreed less, with 69.15% of no City Endorsement in the Pact for Health Pact, result of problems of several origins ( political, organizational, technical). External agents, with representation and organized political force, influenced the lack of endorsement, preventing important issues from having an impact on changes in the agenda. The increase of responsibility of the cities on the planning and on the actions of health influenced the agents positively and negatively. The regionalization of health care as a strategy for regional development was not discussed at the time of the endorsement and planning of the Management Agreement. Finally, the state’s difficulties in tracing a planning that produces impact on the confrontation of problems with the articulation of levels of management and its decentralized entities (CRS) worsened the scenario that hindered the implementation of the policy. For two terms, the Pact for Health was not treated as a priority in the state, making the policy does not become a Decisional Agenda for the rulers.