Liza Yurie Teruya Uchimura

Tipologia das regiões de saúde: condicionantes estruturais para a regionalização no Brasil

O desenvolvimento socioeconomico, a oferta e a complexidade das acoes e dos servicos de saude no contexto regional podem ser considerados condicionantes estruturais para o exito do atual processo de regionalizacao da saude no Brasil. O presente estudo tem como objetivo identificar os condicionantes estruturais do processo de regionalizacao por meio da construcao de uma tipologia das regioes de saude no Brasil. Foi construida tipologia das regioes de saude brasileiras a partir de fonte de dados secundarios disponivel. A identificacao das dimensoes e dos grupos - que compoem a tipologia - foi realizada por meio de analise fatorial e de agrupamentos/clusters. Tambem foram identificados o tipo de prestador de acoes e os servicos predominantes na regiao tanto para a producao ambulatorial quanto para a internacao. As regioes foram classificadas em cinco grupos, de forma independente, de acordo com suas caracteristicas socioeconomicas e de oferta de servicos de saude. A caracterizacao das regioes de saude brasileiras, a partir da tipologia apresentada, demonstra heterogeneidade do territorio nacional e a complexidade de organizar sistemas de saude regionais. A tipologia proposta pode auxiliar na investigacao e no melhor entendimento desse cenario contraditorio e complexo, apoiando o urgente desenvolvimento de politicas publicas regionais integradas que envolvam, concomitantemente, desenvolvimento economico e social; e o fortalecimento dos espacos de governanca regional, a fim de promover a organizacao de sistemas de saude regionais alicercados nos principios do SUS e numa gestao compartilhada e solidaria que tenha como imagem-objetivo a garantia do direito a saude.

O processo de regionalização do SUS: revisão sistemática

This review focuses only on specific studies into the SUS regionalization process, which were based on empirical results and published since 2006, when the SUS was already under the aegis of the Pact for Health framework. It was found that the regionalization process is now underway in all spheres of government, subject to a set of challenges common to the different realities of the country. These include, primarily, that committee-structured entities are valued as spaces for innovation, yet also strive to overcome the bureaucratic and clientelist political culture. Regional governance is further hampered by the fragmentation of the system and, in particular, by the historical deficiency in planning, from the local level to the strategic policies for technology incorporation. The analyses enabled the identification of a culture of broad privilege for political negotiation, to the detriment of planning, as one of the main factors responsible for a vicious circle that sustains technical deficiency in management.This review focuses only on specific studies into the SUS regionalization process, which were based on empirical results and published since 2006, when the SUS was already under the aegis of the Pact for Health framework. It was found that the regionalization process is now underway in all spheres of government, subject to a set of challenges common to the different realities of the country. These include, primarily, that committee-structured entities are valued as spaces for innovation, yet also strive to overcome the bureaucratic and clientelist political culture. Regional governance is further hampered by the fragmentation of the system and, in particular, by the historical deficiency in planning, from the local level to the strategic policies for technology incorporation. The analyses enabled the identification of a culture of broad privilege for political negotiation, to the detriment of planning, as one of the main factors responsible for a vicious circle that sustains technical deficiency in management.

Unidades de Pronto Atendimento (UPAs): características da gestão às redes de atenção no Paraná

As Unidades de Pronto Atendimento (UPAs) sao classificadas, segundo a Politica Nacional de Atencao as Urgencias, de acordo com a capacidade fisica instalada, o numero de leitos disponiveis, gestao de pessoas e a capacidade diaria de realizar os atendimentos medicos. Objetivou-se identificar as caracteristicas estruturais e de planejamento do servico das UPAs as redes de atencao no Parana. E um estudo de casos com entrevistas semiestruturadas com os coordenadores das UPAs, realizadas em 2012. Os dados foram armazenados e analisados em frequencias absolutas e relativas. As UPAs necessitam estar integradas em uma politica de Redes de Atencao a Saude para ampliar a sua resolutividade.

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.