Measures by a Regional Inter-managerial Commission to regulate specialized services in Brazil's National Health System

Abstract

Fragmentation of care and the difficulty of offering comprehensive care pose the need to establish a cohesive regional health territory with cooperation among municipalities. As a locus of regional governance, the health authorities' Regional Inter-managerial Commission (Comissão Intergestores Regional, CIR) is a space for concertation and cooperation to strengthen the health region. This paper aims to identify how regulation of specialized health services is addressed in CIR discussions and what the chief recommendations are. A qualitative study was conducted from 2013 to 2015, on the basis of a documentary review, by analysis of the minutes and monthly observation of CIR meetings, which involved 19 municipalities. The results indicated that, despite diversified agendas, the focus was hospital care. Regulatory processes considered were restricted to creating regional flows to hospital care. A concern was observed with the permanent review of the funding ceiling for the agreed integrated programme (Programação Pactuada e Integrada, PPI) and with the indicators of the system for agreeing health guidelines, goals, targets and indicators (Sistema de Pactuação de Diretrizes, Objetivos, Metas e Indicadores de Saúde, SISPACTO). In the case studied, the CIR was a powerful space for regional governance. The meetings highlighted the common difficulties and the managers' strategies for surmounting problems in supply and access to specialized services among municipalities.

Key words:
regional health planning; health services accessibility; health services administration; secondary health; health services coverage