Governability of the Unified Health System in interstate regions

This study analyzed the governability of the Unified Health System (SUS) on Brazil’s interstate border. This is a political analysis of health in a territory made up of 53 municipalities, two states, an intermanagement commission and a central interstate regulation committee. Data production included 499 documents and interviews with 35 actors linked to municipal management and influential organizations on the border. Governing the SUS at interstate borders has the following obstacles: the lack of institutionality for tripartite interfederative coordination; the lack of a regulatory framework with mechanisms for planning, financing and interstate management of the system; the low institutionality of agreements in the interstate collegiate; fiscal inequalities and financial dependence of municipalities with less economic power; the political-administrative alternation of management spheres and the low governability of the interstate regulation service in medium and high complexity hospitals in the studied territory. This research contributed to revealing the opposing political forces of the political-social system to SUS regionalization and interstate management projects.

Key words:
Unified Health System; Regional Health Planning; Health Policy; Federalism