Analysis of the <i>Mais Médicos</i> (More Doctors) Program in terms of its institutional arrangements: sector cooperation, federative relations, social participations and territoriality

Lotta, Gabriela Spanghero; Galvão, Maria Cristina Costa Pinto; Favareto, Arilson da Silva

doi:10.1590/1413-81232015219.16042016

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Article • Ciênc. saúde colet. 21 (09) • Sept 2016 • https://doi.org/10.1590/1413-81232015219.16042016 linkcopy

Analysis of the Mais Médicos (More Doctors) Program in terms of its institutional arrangements: sector cooperation, federative relations, social participations and territoriality

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Abstract

This article analyzes the Mais Médicos (More Doctors) program based on the concept of an institutional arrangement, understood as the set of rules, organizations and processes that define the specific design of a given public policy, defining how it will articulate across players and interests. This concept will allow us to understand the dynamics of the players in this arrangement, as well as their governance, decision-making and governability, and how these factors reflect on public policy performance. A deeper analysis is based on four categories considered essential to understand an organizational arrangement in Brazil: sector cooperation (sometimes referred to as intersecoriality), federative relationships, social involvement and territoriality.

Key words Institutional arrangements; Mais Médicos program

Horizontal integration (sector cooperation)	Vertical integration (federative subsidiarity)	Involvement dimension	Territorial dimension
Is policy formulation inter-sectoral? - It is an incremental policy born from rearticulating actions of the Ministries of Education and Health. Sector cooperation of formulation was limited due to incrementality.	Who is responsible for regulation? - The Ministries of Education and Health, formulation is the responsibility of the federal government (Provisional Measure).	Are players involved in policy formulation? - Because of the emergency nature of the program launch, there really was no time for a broader discussion with government sectors and society, which had a negative effect on program planning and execution.	How does the policy address the territorial dimension? - Priority criteria for allocating program physicians are based on a territorialized diagnostic.
Is policy implementation inter-sectoral? - Yes, especially coordination between Program activities and the responsibilities assigned to the different Ministries.	Who funds the policy? What is the funding instrument? - Funding is the responsibility of the Federal Government. Cities are responsible for providing food and lodging for the physicians.	Which players are involved in policy implementation? - Policy implementation is limited to government bodies.	Does the program include spaces for territorial involvement? (forums, boards, committees, collegiates) - Considering that this is a program within the Unified Healthcare System, territorial involvement is based on the areas already involved in policy formulation - Boards and Conferences
Is policy monitoring and assessment inter-sectoral? - To a limited extent, as it is included in the more traditional healthcare monitoring system using SUS tools.	Who implements the policy? - the federal, state and city governments as follows: The federal government coordinates program players and physician specialization and oversight. The state governments oversee compliance with the program rules and working conditions. The city governments are responsible for actions at the UBS level.	Which players are involved in policy assessment? - Monitoring and assessment are handled by the city (data gathering) and federal governments, who actually performs the assessments. A Mais Médicos Program Observation Network was created, made up of 14 universities and research institutions, to promote participative assessments.	Are there existing mechanisms of articulation/dialog/integration with other participating areas in the territories? - Articulation takes place with the SUS-related participating institutions that already exist in the territories.

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