The process of implementation of emergency care units in Brazil.

OBJECTIVE: To analyze the process of implementation of emergency care units in Brazil. METHODS: We have carried out a documentary analysis, with interviews with twenty-four state urgency coordinators and a panel of experts. We have analyzed issues related to policy background and trajectory, players involved in the implementation, expansion process, advances, limits, and implementation difficulties, and state coordination capacity. We have used the theoretical framework of the analysis of the strategic conduct of the Giddens theory of structuration. RESULTS: Emergency care units have been implemented after 2007, initially in the Southeast region, and 446 emergency care units were present in all Brazilian regions in 2016. Currently, 620 emergency care units are under construction, which indicates expectation of expansion. Federal funding was a strong driver for the implementation. The states have planned their emergency care units, but the existence of direct negotiation between municipalities and the Union has contributed with the significant number of emergency care units that have been built but that do not work. In relation to the urgency network, there is tension with the hospital because of the lack of beds in the country, which generates hospitalizations in the emergency care unit. The management of emergency care units is predominantly municipal, and most of the emergency care units are located outside the capitals and classified as Size III. The main challenges identified were: under-funding and difficulty in recruiting physicians. CONCLUSIONS: The emergency care unit has the merit of having technological resources and being architecturally differentiated, but it will only succeed within an urgency network. Federal induction has generated contradictory responses, since not all states consider the emergency care unit a priority. The strengthening of the state management has been identified as a challenge for the implementation of the urgency network.

The process of implementation of emergency care units in Brazil / O processo de implantação das unidades de pronto atendimento no Brasil

ABSTRACT OBJECTIVE To analyze the process of implementation of emergency care units in Brazil. METHODS We have carried out a documentary analysis, with interviews with twenty-four state urgency coordinators and a panel of experts. We have analyzed issues related to policy background and trajectory, players involved in the implementation, expansion process, advances, limits, and implementation difficulties, and state coordination capacity. We have used the theoretical framework of the analysis of the strategic conduct of the Giddens theory of structuration. RESULTS Emergency care units have been implemented after 2007, initially in the Southeast region, and 446 emergency care units were present in all Brazilian regions in 2016. Currently, 620 emergency care units are under construction, which indicates expectation of expansion. Federal funding was a strong driver for the implementation. The states have planned their emergency care units, but the existence of direct negotiation between municipalities and the Union has contributed with the significant number of emergency care units that have been built but that do not work. In relation to the urgency network, there is tension with the hospital because of the lack of beds in the country, which generates hospitalizations in the emergency care unit. The management of emergency care units is predominantly municipal, and most of the emergency care units are located outside the capitals and classified as Size III. The main challenges identified were: under-funding and difficulty in recruiting physicians. CONCLUSIONS The emergency care unit has the merit of having technological resources and being architecturally differentiated, but it will only succeed within an urgency network. Federal induction has generated contradictory responses, since not all states consider the emergency care unit a priority. The strengthening of the state management has been identified as a challenge for the implementation of the urgency network.

RESUMO OBJETIVO Analisar o processo de implantação das unidades de pronto atendimento no Brasil. MÉTODOS Realizou-se análise documental, entrevistas com 24 coordenadores estaduais de urgência e um painel de especialistas. Analisaram-se questões relativas a: antecedentes e trajetória da política; atores envolvidos na implantação; processo de expansão; avanços, limites e dificuldades de implantação; e capacidade de coordenação estadual. Utilizou-se o referencial teórico da análise da conduta estratégica da teoria da estruturação de Giddens. RESULTADOS As unidades de pronto atendimento foram implantadas a partir de 2007, inicialmente na região Sudeste, e em 2016 existiam 446 unidades de pronto atendimento considerando todas as regiões. Atualmente, há 620 unidades de pronto atendimento em construção, indicando expectativa de expansão. O financiamento federal foi um forte indutor da implantação. Os estados planejaram suas unidades de pronto atendimento, mas a existência de negociação direta entre os municípios e a União contribuiu com o significativo número de unidades de pronto atendimento construídas que não funcionam. Em relação à rede de urgência, há tensão com o hospital pela insuficiência de leitos no país, gerando internação na unidade de pronto atendimento. A gestão das unidades de pronto atendimento é predominantemente municipal, com a maioria das unidades de pronto atendimento localizadas fora das capitais e classificadas como Porte III. Os principais desafios identificados foram: o sub-financiamento e a dificuldade de contratar médicos. CONCLUSÕES A unidade de pronto atendimento tem o mérito de ter recursos tecnológicos e ser arquitetonicamente diferenciada, mas só será bem-sucedida dentro de uma rede de urgência. A indução federal gerou respostas contraditórias, pois nem todos os estados consideram a unidade de pronto atendimento como prioritária. O fortalecimento da gestão estadual foi identificado como desafio para a implantação da rede de urgências.