Regional governance |
One of the components of a regionalized network. Understood as a process of participation and negotiation between a wide range of subjects with varying degrees of autonomy. It represents diversity of interests (public and private) in a stable institutional framework that encourages cooperation between governments, agents, organizations, and citizens, in order to establish links and networks between subjects and institutions. It must involve the ways of exercise of authority and the processes of integration of social interests in the government agenda, and it may be used as analytical tool for research and transformation of the policy-making processes and health systems management. The analytic use of governance allows one to describe and explain the interactions of actors, processes, and rules of the game and, thus, achieve better understanding of conducts and decision-making in society. |
(Hufty, Bascolo, Bazzani, 2006HUFTY, M.; BÁSCOLO, E.; BAZZANI, R. Gobernanza en salud: un aporte conceptual y analítico para la investigación. Cadernos de Saúde Pública, Rio de Janeiro, v. 22, p. 35-45, 2006. Suplemento 1.) (Mendes, 2010MENDES, E. V. As redes de atenção à saúde. Ciência e Saúde Coletiva, Rio de Janeiro, v. 15, n. 5, p. 2297-2305, 2010.) (Santos, Giovanella, 2014SANTOS, A. M.; GIOVANELLA, L. Governança regional: estratégias e disputas para gestão em saúde. Revista de Saúde Pública, São Paulo, v. 48, n. 4, p. 622-631, 2014.) (Viana, Lima, 2011VIANA, A. L. A; LIMA, L. D. L. Regionalização e relações federativas na política de saúde do Brasil. Rio de Janeiro: Contra Capa, 2011.) |
Health care Networks (HCN) |
Sets of health services, linked to each other by a single mission, by common goals, and by a cooperative and interdependent action, which allow to offer a continuous and integral attention to a particular population, coordinated by primary health care - provided at the right time, in the right place, with the right cost, with right quality, and in a humanized way -, and with sanitary responsibilities for this population, in a given territory. HCNs have as constituent elements the population, the operational structure, and the model of care. The focus on building HCNs with integrated services and coordinated care bases on the PHC teams the leadership to reorientate health systems. |
(Mendes, 2010MENDES, E. V. As redes de atenção à saúde. Ciência e Saúde Coletiva, Rio de Janeiro, v. 15, n. 5, p. 2297-2305, 2010.) (PAHO, 2008OPAS - ORGANIZAÇÃO PAN-AMERICANA DE SAÚDE. Renovação da Atenção Primária em Saúde nas Américas. Documento de posicionamento da Organização Pan-Americana da Saúde/Organização Mundial de Saúde (OPAS/OMS). Washington, D.C.: OPAS: OMS, 2008.) (PAHO, 2009OPAS - ORGANIZACIÓN PANAMERICANA DE LA SALUD. Redes integradas de servicios de salud basadas en la Atención Primaria de Salud. Washington, D.C., 2009.) (WHO, 2008WHO - WORLD HEALTH ORGANIZATION. Integrated health services - what and why? Technical Brief, Genebra, n. 1, maio 2008.) |
Health care integration |
It is opposed to fragmented models, i.e., it is the search for fleshing out an organicity to health systems. It is supported on three axes: the service offer, continuously, through several points of health care; the integration of these health care points, by means of a clinical management system, and the existence of a registered population, whose health is unequivocal responsibility of the system. The main points of the health system integration mold a Health care Network. |
(Armitage and col., 2009ARMITAGE, G. D. et al. Health systems integration: state of the evidence. International Journal of Integrated Care, S.l., v. 9, n. e82, p. 1-11, 2009.) (Mendes, 2001MENDES, E. V. Os grandes dilemas do SUS. Tomo II. Salvador: Casa da Qualidade, 2001.) (Vazquez and col., 2009VÁZQUEZ, M. L. et al. Integrated health care network in Latin America: toward a conceptual framework for analysis. Revista Panamericana de Salud Pública, Washington, D.C., v. 26, n. 4, p. 360-367, 2009.) |
Primary Health care (PHC) |
PHC is the key component in the organization of HCN, and must be the communication center. It is up to the PHC to coordinate the system's flows and counterflows, be decisive, welcome and be responsible by the demands of the population, with power to coordinate the continuing care, through the appropriate chaining of the other components of the network. This is a set of services of first contact of the user with the health system, of easy access, directed to cover the most common diseases and conditions and solve most health problems of a population. |
Ordinance no. 2,488 (Brasil, 2012BRASIL. Política Nacional de Atenção Básica. Portaria 2.488, de 21 de outubro de 2011. Série E. Legislação em Saúde. Brasília, DF: Ministério da Saúde, 2012.) Giovanella, (Mendonça, 2014GIOVANELLA, L.; MENDONÇA, M. H. M. Atenção Primária à Saúde. In: GIOVANELLA, L. et al. (Orgs.). Políticas e sistemas de saúde no Brasil. 2. ed. Rio de Janeiro: Fiocruz: Cebes, 2014. p. 493-545.) (Mendes, 2010MENDES, E. V. As redes de atenção à saúde. Ciência e Saúde Coletiva, Rio de Janeiro, v. 15, n. 5, p. 2297-2305, 2010.) (WHO, 2008WHO - WORLD HEALTH ORGANIZATION. Integrated health services - what and why? Technical Brief, Genebra, n. 1, maio 2008.) |
Health Region |
Privileged spaces for integration of health services, having as starting point the Regional Directive Plan, but doing the appropriate compositions that respond appropriately to the dynamics of the territories, encouraging intermanaging cooperative action. The region, therefore, is the result of the dialectic between two types of logic: one that is given by the internal arrangements of each regional division of labor (which is more the result of historical formation, spontaneous of regions) and another that is expressed by the increasingly acute influence of external vectors (whether they are standards, flows of information, of capital, of goods, of investments, etc.), which install on these pre-existing combinations their organizational nexus. |
(Almeida, Santos, Souza, 2015SANTOS, L.; CAMPOS, G. W. S. SUS Brasil: a região de saúde como caminho SUS Brasil: a região de saúde como caminho. Saúde e Sociedade, São Paulo, v. 24, n. 2, p. 438-446, 2015.) (Contel, 2015CONTEL, F. B. Os conceitos de região e regionalização: aspectos de sua evolução e possíveis usos para a regionalização da saúde. Saúde e Sociedade, São Paulo, v. 24, n. 2, p. 447-460, 2015.) Decree 7,508 (Brasil, 2011BRASIL. Decreto 7.508, de 28 de junho de 2011. Regulamenta a Lei nº 8.080, de 19 de setembro de 1990, para dispor sobre a organização do SUS, o planejamento da saúde, a assistência à saúde e a articulação interfederativa, e dá outras providências. Brasília, DF: Ministério da Saúde, 2011.) (Ianni et al., 2012IANNI, A. M. Z. et al. Metrópole e região: dilemas da pactuação da saúde. O caso da região metropolitana da Baixada Santista, São Paulo, Brasil. Cadernos de Saúde Pública, Rio de Janeiro, v. 28, n. 5, p. 925-934, 2012.). (Machado, 2009MACHADO, J. A. Pacto de gestão na saúde: até onde esperar uma "regionalização solidária e cooperativa"? Revista Brasileira de Ciências Sociais, São Paulo, v. 24, n. 71, p. 105-119, 2009.) |