Suchergebnisse

Decentralization of Brazil's Unified National Health System (SUS) still poses challenges in large cities. To characterize decentralization as an essentially political process, institutional policy variables, including local management capacity, are determinant for shaping decentralization in each context. Using the government triangle reference to evaluate management capacity, a case study was conducted with the objective of analyzing the system's decentralization in the city of Sao Paulo, Brazil's largest metropolis. An analysis of selected health system managers and administrative documents identified a trend towards focusing health management at the municipal level in 2005-2008, accompanied by dismantling of local/regional structures in the Municipal Health Secretariat, resulting in technical and policy depletion at these levels. Despite the limits of decentralization, the article emphasizes its power as an operational strategy to achieve the SUS' objectives. The article also stresses the need to resume the health decentralization process in the city of Sao Paulo, both moving towards local/regional levels and linked to the decentralization of municipal public management. ; Univ Fed Sao Paulo, Dept Prevent Med, Escola Paulista Med, BR-04023900 Sao Paulo, Brazil ; Univ Sao Paulo, Fac Saude Publ, Sao Paulo, Brazil ; Univ Fed Sao Paulo, Dept Prevent Med, Escola Paulista Med, BR-04023900 Sao Paulo, Brazil ; Web of Science

This paper discusses part of the results obtained from a study carried out in two cities of the so-called ABCD Paulista Region in the period 2010-2012, in an attempt to spot the existence of non-state regulatory rationale towards access and consumption of health care services. The first stage includes interviews carried out with strategic stakeholders (managers and politicians) and key workers players. The second stage collected the stories of 18 very frequent users of health care services. This study revealed the leading role played by users to produce "health care maps", with emphasis on the frequent use of public and private resources in their itineraries, circumventing or merging with government regulation to obtain the care they need. The different formats of public-private mix transcend the still prevailing "official" concepts about the clear distinction between the two systems, which reveals the importance of this theme to public health management. ; O artigo problematiza parte dos resultados de estudo realizado em dois municípios do ABCD paulista no período de 2010 a 2012 com o objetivo de evidenciar a existência de lógicas regulatórias não estatais na viabilização do acesso e consumo de serviços de saúde. Na primeira etapa, foram realizadas entrevistas com atores estratégicos (gestores e políticos) e atores-trabalhadores-chave. Na segunda, foram coletadas histórias de vida de 18 pessoas com elevada frequência de utilização de serviços de saúde. O estudo revelou o papel protagonista dos usuários na construção de "mapas do cuidado", com destaque para a utilização frequente de recursos públicos e privados nos seus percursos, contornando ou se mesclando com a regulação governamental, para a obtenção do cuidado de que necessitam. Os diferentes formatos do mix público-privado observados transcendem as concepções "oficiais" ainda vigentes sobre a distinção nítida entre os dois sistemas, revelando a importância desse tema para a gestão pública da saúde. ; Univ Fed Sao Paulo, Dept Med Prevent, R Botucatu 740, BR-04023062 Sao Paulo, SP, Brazil ; Inst Univ Lisboa, Inst Super Ciencias Trabalho & Empresa, Lisbon, Portugal ; Univ Estadual Campinas, Fac Ciencias Med, Dept Saude Colet, Campinas, SP, Brazil ; Univ Fed Sao Paulo, Dept Med Prevent, R Botucatu 740, BR-04023062 Sao Paulo, SP, Brazil ; Web of Science