Government funding of cancer research in Brazil.

BACKGROUND: Cancer research is a prominent theme on national and international development agendas. In many developed countries, funding for this area comes mainly from government sources. This article analyzes government funding of cancer research in Brazil, identifying the main funding instruments and examining the regional distribution of resources, research project and researcher profiles. METHODS: Exploratory study of government funding of cancer research in Brazil between 2007 and 2016. The primary data were federal and state funding agencies. RESULTS: A total of 8565 research awards were identified for the period 2007-2016. Amounting to almost US$489 million, these awards were linked to 7622 research projects and 3068 researchers. The proportion of grants awarded to women was slightly higher. It is noteworthy that just 3% of researchers received 20 % of the grants. The multiple-grant history of individual researchers seemed to be a conditioning factor for obtaining new grants/fellowships. Funding was highly concentrated in the Southeast region, accounting for 84.4 % of total awards. There was a positive correlation between number of awards and amount awarded. The most frequently studied cancers were breast (11.8 %), head and neck (9.0 %) and skin cancer (5.3 %). Studies that did not specify the type of cancer accounted for 36.8 % of grants and 45.1 % of funding. CONCLUSION: The findings show a fall in the share of cancer research funding in the three largest funders. Cuts in government spending triggered by the country's political and economic crisis, highlight the vulnerability of science and technology. Greater transparency through access to information on funding, researcher, and research profiles is key to obtaining a better understanding the cancer research funding landscape in Brazil and reducing regional inequalities. POLICY SUMMARY: A more centralized management of public cancer research funding and constant investment and monitoring is needed to ensure the effective implementation of funding policy.

[Workforce management in Emergency Care Units: government strategies and profile of healthcare professionals]. / Gestão do trabalho nas Unidades de Pronto Atendimento: estratégias governamentais e perfil dos profissionais de saúde.

In the late 2000s, the expansion of Emergency Care Units (UPAs) in Brazil's policy for provision of urgent healthcare included hiring a large contingent of health professionals. This article analyzes government strategies for workforce management and the profile of these professionals in the UPAs in the State of Rio de Janeiro, which has the largest number of such units in the country. The methods included document analysis, interviews with managers, and visits to the UPAs and interviews with coordinators, physicians, and nurses. The results showed that the workforce management strategies varied over time and according to administrative sphere (state versus municipal). The so-called Social Organizations became the main hirers of health professionals in the UPAs, since they allowed management flexibility. However, there were problems with selection and stability, with a predominance of young professionals with limited experience and high physician turnover. Instability associated with outsourced hiring reinforced the view of work at the UPA as a temporary job.

[Public budget, region and funding in health care: oil revenues and inequalities between municipalities]. / Orçamento público, região e financiamento em saúde: rendas do petróleo e desigualdades entre municípios.

The effects of the allocation of revenues from oil production on socioeconomic development and the funding of public policies have been questioned in the literature. The main objective of this study was to analyze the importance of financial compensation - in the form of royalties and special participation - for public financing of local health services in the Norte Fluminense region of Rio de Janeiro State, namely the state bordering on the offshore area that accounts for more than 70% of the oil produced in Brazil. The methodology involved secondary data analysis of municipal health revenues and expenditures in the 2000s. The results suggest that the variation in oil-derived budget funds were correlated to the significant difference in total health spending in the region's municipalities. However, the execution and distribution of health spending by specialty did not occur proportionally to the variation in the availability of revenues. The heavy dependence on oil revenues suggests greater municipal autonomy in health spending when compared to other municipalities in Brazil. The conclusion drawn is that other criteria for the distribution and use of funds are needed in order to equalize spending and streamline governmental actions in the regional sphere.

Interdependence between government levels in Brazilian health policy: the implementation of Emergency Care Units in the State of Rio de Janeiro, Brazil.

This article addresses policymaking related to Emergency Care Units (ECU) in the State of Rio de Janeiro between 2007 and 2013, duly identifying the relationships between the various levels of government in this process. It prioritized the context of policy formulation, the factors that motivated the inclusion and maintenance of ECUs on the state agenda and the process of how the policy was implemented in the state. The study was based on the literature that defines the agenda and implementation of public policies and on contributions from historic institutionalism. The research involved analysis of documents, secondary data, and 51 interviews with people in positions of authority in state and municipal governments. The priority given to ECUs in the government agenda was the result of a confluence of historical, structural, political and institutional factors, as well as the current context. The results of this study indicate the existence of interdependence between levels of government, however federal coordination problems have prejudiced the integration of the various components of emergency health care in the state.

[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.

[Decentralization and regionalization: dynamics and conditioning factors for the implementation of the Health Pact in Brazil]. / Descentralização e regionalização: dinâmica e condicionantes da implantação do Pacto pela Saúde no Brasil.

Decentralization and regionalization represent constitutional guidelines for the organization of the Unified Health System, which in the last 20 years has required the adoption of mechanisms to coordinate and accommodate federative tensions in Brazil's healthcare sector. This paper analyzes the national implementation of the Health Pact between 2006 and 2010 involving a strategy that reconfigures intergovernmental relations in the sector. The study involved the analysis of documents, official data and interviews with federal, state and municipal managers in the Brazilian states. The content of the national proposal is initially discussed, including its implications for health policy. The different rhythms and degrees of implementation of the Health Pact are then reviewed, with respect to adherence by states and municipalities and the formation of Regional Management Boards. Lastly, the conditioning factors for the multiplicity of experiences observed in the country are identified and the challenges facing progress toward a decentralized and regionalized health system in Brazil are discussed.

[Health and territorialization from the perpective of development]. / Saúde e territorialização na perspectiva do desenvolvimento.

The relationship between health and development is complex and lies in the field of political economy, given that it involves different social, political, and economic interests. In the Brazilian case, this association is particularly relevant in terms of the territorial dimension, in light of the central role of healthcare services in the organization of the urban network and the demarcation of territorial schedules and limits. In the theoretical-conceptual field, this study explores analytical areas that approach the relations between health and development, as well as between health and the territorial issue; and analyzes the history of the decentralization and regionalization policy in the Unified National Health System (SUS) and Federal investments that constitute the basis for its spatial evolution. Based on this conceptual review and empirical data, the study attempts to establish theoretical and political-institutional connections between health and development. The aim is thus to support the discussion on challenges facing a new role for health in the Brazilian development model, historically marked by economic and social inequalities with strong territorial overtones.

[Structural conditions for regionalization in health care: typology of Regional Management Boards]. / Condicionantes estruturais da regionalização na saúde: tipologia dos Colegiados de Gestão Regional.

An explanation is required for the delay in implementing the regionalization strategy and the fragile nature of the combined decentralization and regionalization initiatives in Brazil. The article raises some hypotheses to clarify this intricate issue and reviews the structural conditioning factors of the regionalization process ongoing in the states. A national typology of the health care regions is prepared, differentiating them according to the degree of socio-economic development and the characteristics of the health care network and of the municipalities that form the Regional Management Boards (CGR), formally implanted by January 2010. Factorial and cluster analysis models were used to build the typology. Five major socio-economic groups of CGRs were identified, described according to their regional distribution, population, health care spending, profile of services offered (including the public-private sector mix) and health service coverage. The results obtained serve as guidelines for the constitution of health care networks and new initiatives at the regional level, in order to improve the regionalization policy and favour the construction of diverse and flexible regulatory instruments that are more in tune with the regional state of affairs.

[National planning of health policy in Brazil: strategies and instruments in the 2000s]. / O planejamento nacional da política de saúde no Brasil: estratégias e instrumentos nos anos 2000.

This paper discusses the national planning of health policy between 2003 and 2010, in the light of the development of state planning in Brazil and Lula's administration. Firstly an historical overview is presented of the key moments for national planning, regarding its effects on health care. The governmental context is then described with a review of the strategies and instruments in health planning over recent years. The methodology involved a bibliographic and documental review - including the Multi-year Plans, the National Health Plan, the Health Pact and the More Health program - considering their intention, contents and development processes. The results indicate that national health planning has been condensed in order to enable better direction of the policy. Two key moments in federal health planning were identified: between 2003 and 2006 a managerial and participative line was followed; between 2007 and 2010, the managerial line was kept allied to an effort to tie health policy to the development model. Despite the advances, health planning has displayed limitations, such as: restrictions in health financing, which has compromised the execution of the plans; failure to tackle structural problems in the health care system; and the fragile territorial organization.

[Health financing conditions in large cities in Brazil]. / Condições de financiamento em saúde nos grandes municípios do Brasil.

We evaluated the funding of the Brazilian Unified National Health System (SUS) in municipalities with more than 100,000 inhabitants. The main goal was to evaluate the impact of policies for health resource allocation within the municipal budget. A database was organized with information from revenues reported by municipalities in the Information System on Government Health Budgets (SIOPS) for the year 2005. Reported budgets were compared and correlated to the municipalities' geographic location. We conducted a cluster analysis to create more homogeneous groups according to health-related budget. The study showed a major variability among different regions and States, with varying degrees of municipal dependence on external funds. Although the large variability in sources may indicate multiple strategies for ensuring the necessary budget funds, the study suggests some barriers to public health funding in larger municipalities.

State responsibility and right to health in Brazil: a balance of the Branches' actions.

The 1988 Federal Constitution set forth a new political-institutional moment in Brazil reasserting the Democratic State and defining a broad social protection policy including health as a social citizenship right. Since its promulgation, a great number of laws, ministerial decrees and administrative actions have attempted to make feasible the political project outlined in the Constitution. On the other hand, in the same period, the number of legal orders regarding health related demands has increased. Such a movement has revealed inconsistencies and contradictions in the legal and normative scope of SUS (Unified Health System), as well as problems not calculated by health policies, questioning the Executive Branch's actions and creating a new demand for legislation. This article discusses the role of the State in health as of 1990, considering the action of the Branches. The perspectives on the right to health in the construction of a democratic State oriented to social wellbeing, facing the challenges related to coordination mechanisms and balance among Branches in the health issue, are discussed.

[Connections between fiscal federalism and the funding of the Brazilian health care policy]. / Conexões entre o federalismo fiscal e o financiamento da política de saúde no Brasil.

In the Brazilian society's context of meager financial resources for health care, associated with structural features of fiscal federalism and with the current model of funding transfers for the Unified Health System's (SUS), important inequities directly impact political negotiations and the deployment of federal financing alternatives which are not directly linked to the supply and production of health care activities and services by states and municipalities. We observed that health policies, since the second half of the nineties, have developed their own mechanisms that, in the above mentioned context, tend to accommodate different interests and federative conflicts generated by structural factors and by institutional rules. However, the absence of an integrated planning program between the criteria to establish resource redistribution for financing the Unified Health System and the Brazilian Federation's fiscal sharing system, end up reinforcing certain asymmetric patterns and generating new imbalances, making the compensation of inequities difficult in public health spending at the sub-national domain.

[Research for decision-making: a case study in Brazil]. / Pesquisa para a tomada de decisão: um estudo de caso no Brasil.

This article analyzes the experience of the relationship between researchers and decision-makers in a study based on the hypothesis that this relationship would favor the incorporation of research results in health policy implementation. The attempt was made to identify elements that affect the relationship according to different policy and research phases, with an emphasis on the appropriation of the results by the decision-makers. It was shown that this research model per se does not guarantee the incorporation of the results, since variables related to the political/institutional context, the decision-makers' profile, and the forms of relationship played a preponderant role in this case. In research oriented towards decision-making, the use of the results depends on the decision-making timing, the capacity for dialogue, the policy's institutionality, and the decision-makers' place in the overall political context.

[Significant changes in the health system decentralization process in Brazil]. / Mudanças significativas no processo de descentralizaçao do sistema de saúde no Brasil.

This article discusses the trends and limits of the Brazilian health system decentralization process, identifying the three elements that constitute the strategic induction performed by the national system administrator in accordance with the guidelines contained in the Operational Norms of the Unified National Health System: systemic rationality, intergovernmental and service provider financing, and health care model. The effects of the Federal regulations are analyzed based on the results of the evaluation study focused on the implementation of the full management scheme at the Municipal level. The decentralization strategy induced by Basic Operational Norm 96 has succeeded in improving institutional conditions, management autonomy, and supply, as measured by the Federal resources transferred, installed capacity, production, and coverage of outpatient and hospital services, with the Municipalities authorized to conduct fully autonomous management, without altering the existing patterns of inequity in the distribution of funds to poorer Municipalities.