Physis: Revista de Saúde Coletiva
Print version ISSN 0103-7331
PARADA, Roberto. Building-up the State Health System: antecedents and ways of insertion. Physis [online]. 2001, vol.11, n.1, pp. 19-104. ISSN 0103-7331. http://dx.doi.org/10.1590/S0103-73312001000100003.
The construction 01' a Unified Health System in a country with a federal system 01' government constitutes a challenge to the extent that government authorities whose autonomy is guaranteed by the Constitution must establish agreed guidelines for their relationship in order to maintain their right to exerci se their power within their respective territorial limits, as well as in order to share this same power at times, in specific acls and in carrying out general and sectorial policies. Thus, the construction 01' a system where various degrees 01' hierarchy exist, means making compatible the various specific powers that are characteristic 01' the scope of each sphere of government. Based on this premi se, this article analyzed the formation 01' a State Health System in the state 01' Rio de Janeiro from the point of view 01' decentralization and intergovernmental relations. For this, the formation of the federal state in 1975, from the merger 01' the formeI' state of Guanabara (municipality 01' Rio de Janeiro) with the state of Rio de Janeiro was taken as a starting point. In the whole history 01' the formation 01' this system, it was observed that there are no signs that the merger occurred in the health area. The municipality of Rio de Janeiro acts autonomously, referring to itself only, without depending on the state, and maintains direct relations with the federal government. It shows that ali the times of change in the area of health were intimately related to federal transformation in lhe country. Each change has a characteristic: Pre-AIS, the state governments act independently; in the AIS, the federal authority is supreme - centralized federalism; in lhe SUDS, the state takes command - return to the politics of the state governors, and in the SUS, there is federal chaos and the municipalities organize themselves autonomously - there is a lack of definition in the role 01' the states and the federal government reduces its role in social policies. The rhythm 01' the transformation from centralized federation to co operativism that has been occurring in the general and sectorial spheres produces various complexities, depending on the state, on the social set-up and on its history, which is the reason why the state 01' Rio de Janeiro faithfully portrays the social-political-cultural nuances present in the current changes, whosc course is still uncertain.
Keywords : Unified Health System; SUS; decentralization.