CIR - Supported by the Inland Executive Secretariat and regional management. Attempt to prepare regional projects and Consortium support. Without technical chambers. Dynamics of relationships: 2015 - HIGH QUALITY, FREQUENT INTERACTION (interaction of all in all matters related to the sectoral policy) / 2016-2017 - INFREQUENT (contacts with varying frequency and intensity). Change in coordination and contingencies of state management weakened space as a forum for negotiation. Possible replacement of discussions for group formation in a social network (faster and without the difficulties of travel among managers). Guidance for regional issues, although agendas guidelines for the qualification of services or approving projects are found. It ranges from orientation to regional issues and municipal management. |
CIR - PPriority for municipal management issues. Supported by state regional structure and technical chambers. Weaknesses in resolutions due to the discontinuity. High dependence on CIB for processing topics with scope for other regions. Technical chambers with low-resolution potential. Dynamics of relationships: contacts vary in frequency and intensity with alternation of managers in meetings and some situations, cancellation due to lack of quorum. |
CIB - Participation of former CIR coordinator in this space ensured that the interests of the region remained represented in this space. Delays in the decision-making process regarding issues deliberated in the CIR. |
CIB - Five components of the Metropolitan CIR with seats. Limited autonomy of the capital in the relationship with providers that include service to other municipalities, especially outside the metropolitan region. Dependence of consensus in the CIB to facilitate proposals/arrangements/reformulations because the care network coverage exceeds the limits of the region. |
COSEMS - Strong support to municipalities established by direct relationships between COSEMS and municipal managers. Recognition of the critical role of the presidency (reelected) and the sponsor in guiding managers and conducting processes. |
COSEMS - Strong relationship of managers with COSEMS. Facilitated by the access and representation of COSEMS in the CIR. Negotiations between secretaries and COSEMS without going through the intermediary of CIR. Objectives of articulation also with border municipalities that are not part of the region. |
Municipal Health Councils – Long stay in the cadre leading to the advocacy of corporate or clientelist interests. Difficulties in the managing performance. |
Municipal Health Councils – Little information in this respect, but strong performance of two councils of the municipalities of the region with involvement in regional issues/agreements coordinated by the State identified. |
Public Consortium – ASAVIDA Little priority of mayors. Lack of guarantee in the transfer of municipal resources to ensure infrastructure has created difficulties for its full operation and discredit vis-à-vis the strategy of joint procurement of medicines with managers. New management: attempt to revive its operation to recruit human resources – medical specialties. |
Teaching-Service Integration Commission (CIES) Regional Commission for the Metropolitan region, linked to CIR for the implementation of the regional continuing education policy. Representation established in CIR resolution to ensure participation and to avoid modifications of the group’s components. Throughout 2016, beginning of the process to elaborate the regional continuing education plan. Strong leadership of the CRS team and state management. |
Indigenous Health Subsystem (DSEI) – Relationship of strong interdependence, with varying degree of conflict. |
Regional Health Center (Metropolitan CRS 1) – Requests not answered by regional technical support made to CIR. Performance of technical areas strongly oriented to the municipalities although some are oriented to the region. Ability to understand regional issues relative to the boards. |
External articulation channels and other extra-sectoral stakeholders
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Interfederative Coordination of HIV / AIDS Mentioned by some managers of the region. No reference in the CIR. This is interdepartmental cooperation established by the Ministry of Health to build an agenda among the three governmental spheres to respond to the epidemiological situation of STIs, HIV/AIDS, and viral hepatitis. Focus on prevention actions for vulnerable populations, increased capacity and efficiency of health services expanded access to rapid diagnosis and improved management. |
Inter-institutional Committee for Administrative Resolution of Health Claims (CIRADS) State Management, municipality of the capital and institutions of external and judicial control. Articulation of municipal management, with the State, to address with issues brought to justice, with the renewal and reorientation of processes with municipalities, supported by external control agencies. |
Ministry of DefenseArmy Battalions: Articulation with battalions of the Armed Forces for disease prevention and control actions. Garrison Hospital: Difficulties to ensure reference to hospital linked to the Ministry of Defense |
Universities Education; internship; residencies. |
Municipal health secretariats of border countries Personal articulation of some municipal managers especially for communicable disease surveillance, prevention, and control activities. |
Social organization - private providers Lack of transparency regarding the set of actions provided, professionals and other providers recruited, regional references and contracting process. |
Professional bodies – especially medical and nursing councils: Difficulties with corporate requirements regarding education, qualification, and performance - doctors and nurses. Supervision of recruitment processes and scope of action of doctors and nurses. |
Professional bodies: Divergences between corporate interests X SUS interests. |
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Belém Pact for Life Project (Belém municipality) Councils of diverse sectors, federation of therapeutic communities, UNICEF, SENAD, religious entities, NGOs, Court of Justice, Public Defender’s Office, Public Prosecutor’s Office, social welfare, sports, culture and leisure secretariats, etc. |