[A history of public health concepts: integrity, coordination, decentralization, regionalization, and universality]. / Uma história de conceitos na saúde pública: integralidade, coordenação, descentralização, regionalização e universalidade.

Brazil's Unified Health System (Sistema Único de Saúde) has highlighted a series of concepts specific to the organization of healthcare systems. Among these, integrity - which shares boundaries with almost all other System principles - has been the object of much academic production in Brazil. Based on an extensive review of primary and secondary sources, the article offers a historical recovery of the concepts of integrity, decentralization, regionalization, and universality - ideas and concepts that in good measure are shaped by and interlinked with the set of ideals of the organization of sanitary services according to the district health centers model.

Venous thromboembolism in childhood: where is Brazil after 20 years?

Due to the longer survival of critically ill children, venous thromboembolism is a problem which is becoming increasingly recognized in pediatric practice. In the last decades, several international studies have been published, shedding a light upon the epidemiology of this disease during childhood. These data show peculiarities in the clinical presentation and the significant morbidity and mortality. The new "epidemic of thrombosis" in pediatric hospitals points toward the urgent need for specific treatment and prevention protocols targeting this population. In Brazil, knowledge regarding this disease remains scarce. The lack of epidemiological data impacts both the clinical care and the design of specific public policies in the field. Thus, a national registry of pediatric venous thromboembolism is relevant to the proposal of an appropriate plan of action to create a qualified net of assistance. The improvement in educational initiatives related to the field of Pediatric Hemostasis is also very important. In this review, we have updated the epidemiological, clinical and therapeutic aspects of the disease, as well as the prevention strategies.

The concept of the regionalization of the Sistema Único de Saúde and its historical time. / O conceito de regionalização do Sistema Único de Saúde e seu tempo histórico.

This essay assumes that from a simple administrative guideline, regionalization has become the main concept for enabling the doctrine of equitable and universal coverage behind the Brazilian Sistema Único de Saúde. At the interface between studies of the historicity of the concepts and extensive fieldwork, it is argued that the traditional concept of the regionalization of the Sistema Único de Saúde has reached the historical limits of its productive capacity. However, updating this term challenges novel perspectives for a clinical system integrated in networks within a broader intersectoral strategy of regional production clusters.

Este ensaio assume que, de simples diretriz administrativa, a regionalização se tornou hoje o principal conceito de viabilização doutrinária da universalidade equitativa e integral do Sistema Único de Saúde. Na interface de estudos sobre a historicidade dos conceitos com extensas experiências de campo, argumenta-se que o conceito de regionalização tradicional do Sistema Único de Saúde alcançou limites históricos de capacidade produtiva. Sua atualização, entretanto, desafia perspectivas inovadoras para um sistema clínico integrado em redes, inserido numa estratégia intersetorial de complexos produtivos regionais.

Evaluation of the quality of Primary Health Care services for children: reflections on the feasibility of using the Brazilian version of the Primary Care Assessment Tool as a routine assessment tool.

OBJECTIVE: To assess the quality of the Primary Health Care services provided to children and the feasibility of using the Brazilian version of Primary Care Assessment Tool (PCAT-Brazil) as a routine quality assessment tool. METHODS: A cross-sectional study was carried out in Joanópolis, a small rural town in the State of São Paulo (SP), Brazil. Seven health professionals and 502 caretakers of children using the public health center were interviewed using the PCAT-Brazil, collecting data on the core and related attributes of Primary Health Care provided to children. The score of each attribute was calculated. RESULTS: Caretakers rated as good the following attributes; "degree of affiliation", "first contact care - use of services", "coordinated care", and "comprehensive care - available services". The attributes of "first contact accessibility", "long term person care", "comprehensive care - offered services" and "family- and community-oriented care" were scored as poor. The health professionals only rated the attribute of "first contact accessibility" as satisfactory, and considered that all other Primary Health Care attributes needed improvement. To conduct this study, at least 1,241 working hours were invested, and the estimated budget was R$12.900,00 (or U$3,953.00). CONCLUSION: The use of the PCAT-Brazil as a routine assessment and planning tool seemed to be not feasible in the given setting due to high costs, lack of trained personnel and the huge workload. To overcome the encountered obstacles, advices are given based on field experience.

[When paradigms change in public health: what changes in history?] / Quando os paradigmas mudam na saúde pública: o que muda na história?

This conceptual essay investigates the idea of paradigmatic rupture and its implications in historical interpretations of public/collective health, where the dimensions of politics and science intermingle. The polysemic and pre-conceptual nature of "paradigm" is clarified, taking account of the conceptual implications, while reaffirming their semantic usefulness. Essential and cumulative ruptures are discussed and applied to the confrontation of the epistemic rupture brought about by district health centers and the goals of the public health reform movement. The difficulty of the collective health paradigm in maintaining its discursive independence is presented, such that the global spread of the discursive matrix of health centers by the Rockefeller Foundation still constitutes the most recent holistic paradigmatic rupture in Brazilian public health.

Policies for fostering health science, technology and innovation in Brazil and the role of clinical research. / Políticas de fomento à ciência, tecnologia e inovação em saúde no Brasil e o lugar da pesquisa clínica.

The purpose of this article is to highlight a number of underlying issues that may be useful for a comprehensive review of the management of Health-Related Science, Technology and Innovation policies (ST&I/H), and its strategies and priorities. It is an analytical study supported by an extensive review of the technical and journalistic literature, clippings, legislation and federal government directives. The results show that the Healthcare Production Complex undeniably and increasingly needs science to maintain itself. One may infer that a framework of institutional milestones is being built in Brazil, to strengthen, guide and encourage Research and Development, and that clinical research creates scientific knowledge to address public healthcare issues by generating new inputs or enhancing existing techniques, processes and technologies that will be produced, marketed and used in the different segments, thus feeding the Healthcare Productive Complex.

A systematic review of the process of regionalization of Brazil's Unified Health System, SUS. / 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.

A public health physician named Walter Leser.

A brief review of the career of the public health physician Walter Sidney Pereira Leser, who died in 2004 aged 94. Self-taught, from his 1933 doctoral thesis he became a country reference in the field of statistics and epidemiology, with dozens of studies and supervisions. In the clinical field he is one of the founders of Fleury Laboratory, and participates in the creation of CREMESP. As an academic, Leser was a professor at the Escola de Sociologia e Política de São Paulo, Escola Paulista de Medicina e Faculdade de Farmácia e Odontologia da USP. Also, Leser introduced objective tests in the college entrance examination, and led the creation of CESCEM and Carlos Chagas Foundation. In the Escola Paulista de Medicina he created the first Preventive Medicine Department of the country. As a public official, he was secretary of the State Department of Health of São Paulo between 1967 and 1971 and between 1975 and 1979, responsible for extensive reforms and innovations. Among the most remembered, the creation of sanitary medical career. Throughout this legacy, he lent his name to the "Medal of Honor and Merit Public Health Management" of the State of São Paulo.

Fatores condicionantes na conformação e desempenho das redes de pesquisa fomentadas pelo Ministério da Saúde com foco em saúde coletiva / Conditioning factors in the conformation and performance of research networks promoted by the Ministry of Health with a focus on collective health

Este artigo apresenta uma análise integrada de três estudos de caso sobre fomentos de redes de pesquisa instituídas pelo Departamento de Ciência e Tecnologia do Ministério da Saúde (Decit), envolvendo três grandes áreas de interesse estratégico nacional: pesquisa clínica, doenças negligenciadas e saúde coletiva. Com foco na saúde coletiva, o estudo desenvolvido, estimulado pelo insucesso do fomento da Rede Nacional de Pesquisas sobre Política de Saúde (RNPPS), busca fundamentar condicionantes que dificultam ou promovem a consolidação de redes de pesquisa nessa área. A capacidade de construção das chamadas, relacionada ao grau de maturidade do campo disciplinar, o modelo de gestão de redes complexas, e o perfil de liderança estão entre os principais condicionantes observados. A par de desafios comuns na consolidação de redes de pesquisa, a saúde coletiva deve aprender a equilibrar com maior propriedade os pesos político e científico na balança do seu campo disciplinar.

Fatores condicionantes na conformação e desempenho das redes de pesquisa fomentadas pelo Ministério da Saúde com foco em saúde coletiva / Conditioning factors in the conformation and performance of research networks promoted by the Ministry of Health with a focus on collective health / Factores condicionantes en la conformación y desempeño de las redes de investigación promovidas por el Ministerio de Salud con enfoque en salud colectiva

Este artigo apresenta uma análise integrada de três estudos de caso sobre fomentos de redes de pesquisa instituídas pelo Departamento de Ciência e Tecnologia do Ministério da Saúde (Decit), envolvendo três grandes áreas de interesse estratégico nacional: pesquisa clínica, doenças negligenciadas e saúde coletiva. Com foco na saúde coletiva, o estudo desenvolvido, estimulado pelo insucesso do fomento da Rede Nacional de Pesquisas sobre Política de Saúde (RNPPS), busca fundamentar condicionantes que dificultam ou promovem a consolidação de redes de pesquisa nessa área. A capacidade de construção das chamadas, relacionada ao grau de maturidade do campo disciplinar, o modelo de gestão de redes complexas, e o perfil de liderança estão entre os principais condicionantes observados. A par de desafios comuns na consolidação de redes de pesquisa, a saúde coletiva deve aprender a equilibrar com maior propriedade os pesos político e científico na balança do seu campo disciplinar.

This article presents an integrated analysis of three case studies on the promotion of research networks by the Brazilian Decit - Departamento de Ciência e Tecnologia do Ministério da Saúde (Department of Science and Technology of the Ministry of Health), involving three major areas of national strategic interest: clinical research, neglected diseases and collective health. With the focus on the collective health field, the study seeks to justify the conditions that hinder or promote the consolidation of research networks, and it was stimulated by the failure on the promotion by the RNPPS - Rede Nacional de Pesquisas sobre Política de Saúde (National health policy research network). The capacity for the construction of tjhe formal requests related to the degree of maturity of the study field, the complex network management model, and the leadership profile are among the main conditions observed. With knowledge of common challenges in the consolidation of research networks, the collective health may learn to balance more appropriately the political and scientific weights in the scale of its study field.

Este artículo presenta un análisis integrado de tres estudios de casos sobre el fomento de redes de investigación instituidas por el Decit ­ Departamento de Ciência e Tecnologia do Ministério da Saúde (Departamento de Ciencia y Tecnología del Ministerio de Salud brasileño), abarcando tres grandes áreas de interés estratégico nacional: investigación clínica, enfermedades olvidadas y salud colectiva. En el caso de la salud colectiva, el estudio fue impulsado por el fracaso del fomento de la RNPPS ­ Rede Nacional de Pesquisas sobre Política de Saúde (Red nacional de investigaciones sobre políticas de salud) y busca fundamentar los condicionantes que dificultan o promueven la consolidación de redes de investigación. La capacidad de construcción de las convocatorias relacionada al grado de madurez del campo de estudio, modelo de gestión de redes complejas y perfil de liderazgo están entre los principales condicionantes observados. Con el conocimiento de desafíos comunes en la consolidación de redes de investigación, la salud colectiva debe aprender a equilibrar con mayor propiedad los pesos político y científico en la balanza de su campo de estudio.

Venous thromboembolism in childhood: where is Brazil after 20 years?

Abstract Due to the longer survival of critically ill children, venous thromboembolism is a problem which is becoming increasingly recognized in pediatric practice. In the last decades, several international studies have been published, shedding a light upon the epidemiology of this disease during childhood. These data show peculiarities in the clinical presentation and the significant morbidity and mortality. The new "epidemic of thrombosis" in pediatric hospitals points toward the urgent need for specific treatment and prevention protocols targeting this population. In Brazil, knowledge regarding this disease remains scarce. The lack of epidemiological data impacts both the clinical care and the design of specific public policies in the field. Thus, a national registry of pediatric venous thromboembolism is relevant to the proposal of an appropriate plan of action to create a qualified net of assistance. The improvement in educational initiatives related to the field of Pediatric Hemostasis is also very important. In this review, we have updated the epidemiological, clinical and therapeutic aspects of the disease, as well as the prevention strategies.

Evaluation of the quality of Primary Health Care services for children: reflections on the feasibility of using the Brazilian version of the Primary Care Assessment Tool as a routine assessment tool / Avaliação da qualidade dos serviços de Atenção Primária à Saúde para crianças: reflexões sobre a viabilidade do uso rotineiro do Primary Care Assessment Tool-Brazil

ABSTRACT Objective To assess the quality of the Primary Health Care services provided to children and the feasibility of using the Brazilian version of Primary Care Assessment Tool (PCAT-Brazil) as a routine quality assessment tool. Methods A cross-sectional study was carried out in Joanópolis, a small rural town in the State of São Paulo (SP), Brazil. Seven health professionals and 502 caretakers of children using the public health center were interviewed using the PCAT-Brazil, collecting data on the core and related attributes of Primary Health Care provided to children. The score of each attribute was calculated. Results Caretakers rated as good the following attributes; "degree of affiliation", "first contact care − use of services", "coordinated care", and "comprehensive care − available services". The attributes of "first contact accessibility", "long term person care", "comprehensive care − offered services" and "family- and community-oriented care" were scored as poor. The health professionals only rated the attribute of "first contact accessibility" as satisfactory, and considered that all other Primary Health Care attributes needed improvement. To conduct this study, at least 1,241 working hours were invested, and the estimated budget was R$12.900,00 (or U$3,953.00). Conclusion The use of the PCAT-Brazil as a routine assessment and planning tool seemed to be not feasible in the given setting due to high costs, lack of trained personnel and the huge workload. To overcome the encountered obstacles, advices are given based on field experience.

RESUMO Objetivo Avaliar a qualidade dos serviços de Atenção Primária à Saúde prestados às crianças e a viabilidade de usar a versão brasileira da Primary Care Assessment Tool (PCAT-Brazil) como ferramenta rotineira de avaliação da qualidade. Métodos Estudo transversal, realizado em Joanópolis, um pequeno município rural no Estado de São Paulo. Sete profissionais de saúde e 502 responsáveis legais de crianças que usaram o centro de saúde foram entrevistados usando a PCAT-Brazil, para coleta de dados sobre os atributos essenciais e derivados dos serviços de Atenção Primária à Saúde oferecidos às crianças. Foi calculado o escore para cada atributo. Resultados Os responsáveis classificaram como satisfatórios os atributos como "grau de afiliação", "acesso de primeiro contato − utilização", "coordenação" e "integralidade − serviços disponíveis". Os atributos "acesso de primeiro contato − acessibilidade", "longitudinalidade", "integralidade − serviços prestados" e "orientação familiar e comunitária" foram classificados como insatisfatórios. Por outro lado, os profissionais de saúde apenas classificaram o atributo "acessibilidade do primeiro contato" como satisfatório e consideraram todos os outros atributos de Atenção Primária à Saúde como necessidade de melhoria. Para realizar este estudo, foram investidas pelo menos 1.241 horas de trabalho e o orçamento estimado foi de R$12.900,00 (ou U$3,953.00). Conclusão Usar a PCAT-Brazil como ferramenta de avaliação e planejamento de rotina pareceu não ser viável neste estudo, pelos altos custos, pela falta de pessoal treinado e pelo grande número de horas de trabalho exigido. Para superar os obstáculos encontrados, conselhos foram formulados com base na experiência de campo.

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.

[Classical public health thinking in São Paulo during the era of health centers and health education]. / Pensamento clássico da saúde pública paulista na era dos centros de saúde e educação sanitária.

The article reviews the ideas and concepts of health service organization that followed the introduction of the Health Center model by the Health Service reform in 1925. It discusses the thinking of Geraldo de Paula Souza, Rodolfo Mascarenhas and Reinaldo Ramos, distinguished representatives of "classical thought" of public health in São Paulo, Southeastern Brazil.

Quando os paradigmas mudam na saúde pública: o que muda na história? / When paradigms change in public health: what changes in history?

Resumo Trata-se de ensaio conceitual sobre a ideia de ruptura paradigmática e sua implicação na leitura histórica da saúde pública/coletiva, campo em que se confundem as dimensões política e científica. Um argumento inicial serve para esclarecer o caráter polissêmico e pré-conceitual de “paradigma”, atento às implicações conceituais, mas reafirmando sua utilidade semântica. Segue com a discussão de rupturas essenciais e cumulativas, aplicada ao confronto da ruptura epistêmica promovida pelos centros de saúde distritais e idealização do movimento de reforma sanitária. Conclui pela dificuldade do paradigma “saúde coletiva” em sustentar sua independência discursiva, de modo que a difusão planetária da matriz discursiva dos centros de saúde pela Fundação Rockefeller ainda se configura como a última ruptura paradigmática holística da saúde pública brasileira.

Abstract This conceptual essay investigates the idea of paradigmatic rupture and its implications in historical interpretations of public/collective health, where the dimensions of politics and science intermingle. The polysemic and pre-conceptual nature of “paradigm” is clarified, taking account of the conceptual implications, while reaffirming their semantic usefulness. Essential and cumulative ruptures are discussed and applied to the confrontation of the epistemic rupture brought about by district health centers and the goals of the public health reform movement. The difficulty of the collective health paradigm in maintaining its discursive independence is presented, such that the global spread of the discursive matrix of health centers by the Rockefeller Foundation still constitutes the most recent holistic paradigmatic rupture in Brazilian public health.

Políticas de fomento à ciência, tecnologia e inovação em saúde no Brasil e o lugar da pesquisa clínica / Policies for fostering health science, technology and innovation in Brazil and the role of clinical research

Resumo Este artigo tem o objetivo de agregar relevo a algumas questões de base que podem ser úteis em um amplo processo de revisão do tema para a gestão das políticas de Ciência, Tecnologia e Inovação em Saúde (CT&I/S), bem como suas estratégias e prioridades. Trata-se de um ensaio analítico amparado por extensa revisão narrativa de literatura técnica, jornalística, legislação e portarias do governo federal. Como resultados conclui-se que o Complexo Produtivo da Saúde necessita, de modo indeclinável e crescente, da ciência para a sua manutenção. É possível inferir que vem sendo construído, no Brasil, um arcabouço de marcos institucionais que fortalece, orienta e incentiva as atividades de Pesquisa e Desenvolvimento (P&D) no país e que a investigação clínica gera conhecimento científico para a resolução dos agravos da saúde pública, a partir da geração de novos insumos ou incremento de técnicas, processos e tecnologias já existentes, que, por sua vez, serão produzidos, comercializados e empregados nos seus diferentes segmentos, alimentando, assim, todo o processo do Complexo Produtivo da Saúde.

Abstract The purpose of this article is to highlight a number of underlying issues that may be useful for a comprehensive review of the management of Health-Related Science, Technology and Innovation policies (ST&I/H), and its strategies and priorities. It is an analytical study supported by an extensive review of the technical and journalistic literature, clippings, legislation and federal government directives. The results show that the Healthcare Production Complex undeniably and increasingly needs science to maintain itself. One may infer that a framework of institutional milestones is being built in Brazil, to strengthen, guide and encourage Research and Development, and that clinical research creates scientific knowledge to address public healthcare issues by generating new inputs or enhancing existing techniques, processes and technologies that will be produced, marketed and used in the different segments, thus feeding the Healthcare Productive Complex.

O processo de regionalização do SUS: revisão sistemática / A systematic review of the process of regionalization of Brazil's Unified Health System, SUS

Nesta revisão foram incluídos apenas estudos específicos sobre o processo de regionalização do SUS, baseados em resultados empíricos e publicados a partir de 2006, já sob o referencial do Pacto pela Saúde. Foi evidenciado que o processo de regionalização é hoje uma realidade em todas as esferas de governo, sujeito a um conjunto de desafios comuns às diversas realidades do país. Entre os principais, os colegiados são valorizados com espaços de inovação, mas ainda em busca da superação da cultura política burocrática e clientelista. A governança regional é ainda prejudicada pela fragmentação do sistema e, em particular, pela histórica deficiência com planejamento, desde o nível local às políticas estratégicas de incorporação tecnológica. As análises permitiram implicar a cultura de amplo privilégio para negociação política em detrimento do planejamento como uma das principais responsáveis por um ciclo vicioso que sustenta a deficiência técnica da gestão.

O processo de regionalização do SUS: revisão sistemática / A systematic review of the process of regionalization of Brazil's Unified Health System, SUS

Resumo Nesta revisão foram incluídos apenas estudos específicos sobre o processo de regionalização do SUS, baseados em resultados empíricos e publicados a partir de 2006, já sob o referencial do Pacto pela Saúde. Foi evidenciado que o processo de regionalização é hoje uma realidade em todas as esferas de governo, sujeito a um conjunto de desafios comuns às diversas realidades do país. Entre os principais, os colegiados são valorizados com espaços de inovação, mas ainda em busca da superação da cultura política burocrática e clientelista. A governança regional é ainda prejudicada pela fragmentação do sistema e, em particular, pela histórica deficiência com planejamento, desde o nível local às políticas estratégicas de incorporação tecnológica. As análises permitiram implicar a cultura de amplo privilégio para negociação política em detrimento do planejamento como uma das principais responsáveis por um ciclo vicioso que sustenta a deficiência técnica da gestão.

Abstract 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.

[Regionalization and access to healthcare in Brazilian states: historical and political-institutional conditioning factors]. / 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.

[Health Centers: science and ideology in the re-organization of public health in the twentieth century]. / Centros de Saúde: ciência e ideologia na reordenação da saúde pública no século XX.

Health Centers appeared in the United States around 1910. They provided social assistance in conjunction with some type of medical care. Their original separation between preventive and curative medicine was superseded by the concept of whole health in the 1940s, when Health Center discourse became part of medical education. In the 1960s, the notion of community medicine arose out of the war on poverty. These ideas spread through Brazil in the 1920s and were strengthened under the Vargas policy of national construction, but it was the Serviço Especial de Saúde Pública (Special Public Health Service) that was primarily responsible for lending them their practical and conceptual shape in this country.