State health managers' perceptions of the Public Health Action Organizational Contract in the State of Ceará, Brazil. / Percepções de gestores estaduais da saúde sobre o Contrato Organizativo da Ação Pública da Saúde no Ceará, Brasil.
Cien Saude Colet
; 22(4): 1235-1244, 2017 Apr.
Article
em Pt, En
| MEDLINE
| ID: mdl-28444048
ABSTRACT
The Public Health Action Organizational Contract (COAP) / Decree 7.508/2011 aimed to seal health agreements made between federated entities to promote the cooperative governance and management of Health Regions. A qualitative study was carried out adopting a hermeneutic approach to understand state health managers' perceptions of the elaboration and effects of the COAP in the State of Ceará. Open-ended interviewees and documental analysis were conducted. It was observed that the COAP led to the strengthening of regionalization in the government sphere; institutional gains through the implementation of ombudsmen and the National System of Pharmaceutical Care Management; increased information about the state health system's workforce; and health budget transparency. The following problems were (re)visited institutional weakness in the operation of the network; limited state capacity for regulation of care; and underfunding. Regional governance was restricted to the government sphere, coordinated by the state, and was characterized by a predominantly bureaucratic and hierarchical governance structure. The COAP inaugurated a contractual interfederative model of regionalization, but revealed the institutional weaknesses of the SUS and its lacks of capacity to fulfill its principles as the structural problems of the three-tiered model go unaddressed.
Texto completo:
1
Coleções:
01-internacional
Temas:
Aperfeicoar_gestao_SUS
/
Atencao_primaria_forma_integrada
Contexto em Saúde:
1_ASSA2030
Base de dados:
MEDLINE
Assunto principal:
Assistência Farmacêutica
/
Saúde Pública
/
Atenção à Saúde
/
Programas Nacionais de Saúde
Tipo de estudo:
Health_economic_evaluation
/
Prognostic_studies
/
Qualitative_research
Aspecto:
Determinantes_sociais_saude
Limite:
Humans
País/Região como assunto:
America do sul
/
Brasil
Idioma:
En
/
Pt
Revista:
Cien Saude Colet
Ano de publicação:
2017
Tipo de documento:
Article