Regionalization as a structuring guideline for the decentralization of actions and services in the SUS |
● To ensure the right to health, promoting equity and contributing to the reduction of social inequalities; |
● The regionalization is legally based in Law 8.080/1990, developed by means of Operational Norms and Decree 7.508 2011 and its complementary devices; |
● To reduce care gaps; to organize health care actions and services in a care network; to ensure resolving access; to direct investments; |
● Regionalization is not yet in the effective agenda management of the system; |
● To allow a solidary, cooperative management, sharing responsibilities; to strengthen the process of decentralization and the role of the state and municipalities and intensify negotiation and agreement among managers. |
● It must be considered that some States have advanced in the issue of the regionalization of care, and that there are different movements in the country. |
● The health regionalization model has been constructed in a detached way from the other processes of regionalization; |
● It is only possible to progress in the regionalization process by re-discussing the SUS financing model. |
Configuration of the regions and establishment of the regionalized service network |
● The aspects taken into account to configure the regions were population; scale and scope; care flows; territorial contiguity; road network (transport network); communication network; accessibility; sufficiency of basic care and accomplishment of part of the medium complexity; socioeconomic and cultural profile; and epidemiological profile. |
● The managers’ interest in shaping the regions is not based on users’ needs; its establishment occurred due to administrative rather than health issues; |
● Municipalities with greater capacity have no interest and / or incentives to materialize the principle of solidarity; |
● SUS norms do not consider the regional specificities, which are strictly done for non-existent ideal municipalities; |
● A party-political bias is hampering the process of regionalization. |
Structure of “Governance” and the role of managers in the regionalization process of the SUS |
● To institutionalize CIR, promoting the creation of technical chambers subsidizing the construction of agreements between regions in the CIB; |
● The bureaucracy has defined the actions of the CIR; the spaces of negotiation and decision of the SUS managers in the health regions are fragile; and the lack of technical groups that advise managers in the CIR weaken these decision settings; |
● Ensure greater participation of the state manager, strengthening the continuity of regional projects by CIR members; |
● The low technical qualification and the personnel deficit in the municipal and state structures compromise the management of the system; |
● Increase the participation of other actors in the regional governance process (Health Councils, social movements, private initiative, etc.), establishing partnerships between SES, State Regional Administration and COSEMS; to rely on field sponsors; public consortia and ombudsmen in place. |
● The normative “fury” of the SUS has disrupted the original functions of negotiation and decision-making spaces of the system; The implementation of the programs ends up becoming unfeasible by party interests and disputes; |
● Political /party issues directly interfere with federative relationships, with negative impacts on the health sector. |