May 8, 2020

Territory, Risk and Public Policies

José Manuel Mendes e Maurício Monken

As of the enactment of the 1988 Federal Constitution, the public health policy organization in Brazil starts being recognized as a right of all citizens, through the creation of the Unified Health System (SUS). However, its regulation occurs in 1990, with the promulgation of the Health Organic Law" (LOS). From LOS, other Laws, Decrees, and Ordinances have been issued to regulate SUS. Thus, among the new regulation acts, the "Normas Operacionais Básicas (NOBs)" emerge, with the 1996 law (NOB Nr. 01/96) bringing in SUS's principle of political and administrative decentralisation, in which the municipalities are held responsible for the Public Health Policy Development. Nonetheless, decentralisation becomes truly effective with the health pact issued in 2006. Since then, municipalities task is to elaborate the Regional Master Plan, which shall follow the criteria set out by various regulatory instruments, among which the solidary and cooperative management pact. Thus, one retrieves the regionalising principle in the prospect of providing means to integrate the municipal health systems, now under the coordination of state authorities. Regarding the State of Paraná, there are twenty-two Regional Health Authorities, each covering a region with a range of municipalities. Thereby, this doctoral thesis aims at understanding the socio-political and territorial process of regionalisation for the organisation of services in meeting the social health demands of the population in a region of the State of Paraná. As specific objectives, we aim to understand the regionalisation processes and the impacts on the population; understand the needs and possibilities of the intervention practice within health, in addition to self-referral; contextualise the demand without access to public health policy; and understand the criteria and instruments for monitoring and assessing the results, goals and indicators established in the regional plan. At the methodological level, interviews were applied to health policy managers and coordinators, participant observation was conducted in the Bipartite Interagency Commission meetings, as well as participant observation at the Basic Health Units, in the municipalities of Candói, Guarapuava and Pinhão, all three belonging to the studied region. One concludes that regionalisation still takes place without a proper autonomy, being the actions, goals and guidelines established under the state responsibility. In the definition of health actions and services, it is the municipalities responsibility to perform intermediate complexity service contracts, still under the state management control, focusing on the private sector, taken on by the Health Inter-municipal Consortia. Regarding the primary care, it become effective with a significant reduction of human resources for the core team formation, as defined by the national policy.

Keywords: Decentralisation. Regionalisation. Territorial management. Public health policy.