Fabíola Lana Iozzi

Sistema de saúde universal e território: desafios de uma política regional para a Amazônia Legal

This article presents the results of a study on Federal health policy in the Brazilian Legal Amazon (BLA) from 2003 to 2005, aimed at backing the development of regional health policies. The region has peculiar dynamics, an extensive border area, and adverse social indicators. The methodology included documental and financial analysis, participatory observation, interviews with heads of various Federal Ministries and State and Municipal health secretaries from the BLA; characterization of geographic situations in the BLA; and field studies in 15 municipalities. Institutional consolidation of health policy proved to be low in the Amazon during the study period, due to structural, institutional, and political difficulties. The identification of six geographic situations was useful for systematizing land use differences with repercussions on health, and which should be considered when implementing public policies. There is a certain gap between Federal actions and territorial dynamics, expressed as a mismatch between the current policy and its recognition by local administrators. In addition to establishing a regional policy for the Amazon, there is an evident need for differentiated policies within the region.

Regionalização e acesso à saúde nos estados brasileiros: condicionantes históricos e político-institucionais

This article examines the healthcare regionalization process in the Brazilian states in the period from 2007 to 2010, seeking to identify the conditions that favor or impede this process. Referential analysis of public policies and especially of historical institutionalism was used. Three dimensions sum up the conditioning factors of regionalization: context (historical-structural, political-institutional and conjunctural), directionality (ideology, object, actors, strategies and instruments) and regionalization features (institutionality and governance). The empirical research relied mainly on the analysis of official documents and interviews with key actors in 24 states. Distinct patterns of influence in the states were observed, with regionalization being marked by important gains in institutionality and governance in the period. Nevertheless, inherent difficulties of the contexts prejudice greater advances. There is a pressing need to broaden the territorial focus in government planning and to integrate sectorial policies for medium and long-term regional development in order to empower regionalization and to overcome obstacles to the access to healthcare services in Brazil.

Federalism and health policy: the intergovernmental committees in Brazil.

OBJECTIVE To analyze the dynamics of operation of the Bipartite Committees in health care in the Brazilian states. METHODS The research included visits to 24 states, direct observation, document analysis, and performance of semi-structured interviews with state and local leaders. The characterization of each committee was performed between 2007 and 2010, and four dimensions were considered: (i) level of institutionality, classified as advanced, intermediate, or incipient; (ii) agenda of intergovernmental negotiations, classified as diversified/restricted, adapted/not adapted to the reality of each state, and shared/unshared between the state and municipalities; (iii) political processes, considering the character and scope of intergovernmental relations; and (iv) capacity of operation, assessed as high, moderate, or low. RESULTS Ten committees had advanced level of institutionality. The agenda of the negotiations was diversified in all states, and most of them were adapted to the state reality. However, one-third of the committees showed power inequalities between the government levels. Cooperative and interactive intergovernmental relations predominated in 54.0% of the states. The level of institutionality, scope of negotiations, and political processes influenced Bipartite Committees’ ability to formulate policies and coordinate health care at the federal level. Bipartite Committees with a high capacity of operation predominated in the South and Southeast regions, while those with a low capacity of operations predominated in the North and Northeast. CONCLUSIONS The regional differences in operation among Bipartite Interagency Committees suggest the influence of historical-structural variables (socioeconomic development, geographic barriers, characteristics of the health care system) in their capacity of intergovernmental health care management. However, structural problems can be overcome in some states through institutional and political changes. The creation of federal investments, varied by regions and states, is critical in overcoming the structural inequalities that affect political institutions. The operation of Bipartite Committees is a step forward; however, strengthening their ability to coordinate health care is crucial in the regional organization of the health care system in the Brazilian states.

SAÚDE, DESENVOLVIMENTO E INOVAÇÃO TECNOLÓGICA: NOVA PERSPECTIVA DE ABORDAGEM E DE INVESTIGAÇÃO*

This article aims to contribute to the renewal in the formulation of studies covering the triad health, development and technological innovation. The central epistemological task is the rescue and review of the development concept in light of experiences of policies pursued by theorical framework of social welfare and the regulator analyzed from the perspective of the contributions of structuralist theorists. The new perspective and approach to research is based on the latter contribute to improving the design and operation of public policies to induce economic sectors of the health-industrial complex strategic for Brazil, coordinated the increased power of government regulation and strengthening public institutions in strategic technology innovation in healthcare.

The Regionalization Process in Brazil: influence on Policy, Structure and Organization dimensions

Objectives: to analyze the influence and performance on Policy, Structure and Organization dimensions in the regionalization process in five health regions in Brazil. Methods: a quantitative, cross-sectional study using primary data from 217 fulfilled interviews with managers, service providers and representatives of society in five health regions in Brazil. Calculation on the Influence Index that measures the contribution level of three dimensions in regionalization. Results: after analyzing the three dimensions that influence the regionalization process separately, it is necessary to point out that there is a better performance on the Policy dimension in front of all the others; on the other hand, Structure dimension shows itself to be feeble, configuring a real obstacle to progress the regionalization process; Organization occupies an intermediate place in all the regions of the study. The insufficient availability of physical, human and financial resources impedes to advance the regionalization and the achievement of its major objectives, which are the integration of services and coordination care. Conclusions: regionalization follows an uncertain path and without clear direction of its objectives, goals and deployed instruments. The Regional planning, in the case of health, is still a theoretical exercise.