A governança da política municipal de saúde e as demandas municipais no contexto da coordenação federativa

Abstract

This study aims to discuss municipal health policy in the federative context and the assimilation of specific municipal demands. The federal government, from the mid-1990s, began to exert a significant influence on the formulation and coordination of health policy; and the municipal government became the operator of such policy. Therefore, the development of new forms of governance is expected so that the municipal government is able to operationalize the health policy guided by the federative sphere and also to meet the specific health demands of its municipality. It is important to notice that the operationalization of the health policy by the municipal government should not be considered as an isolated act, since it is inserted in a context, and to understand this process, it is necessary to understand the public governance of the policy carried out by the municipal government and its coordination from the federal sphere. Given the importance of this topic, a qualitative case study was carried out with the objective of analyzing how the Municipal Health Policy Governance of Viçosa-MG assimilates the specific demands of its municipality, towards the coordination exercised by the federal government. For that, an analysis scheme was elaborated based on three dimensions: 'Federative Coordination', 'Public Governance' and 'Municipal Demands'. It was verified that the health policy governance arrangement, established in the city, seeks to give space to non-governmental actors, but in practice, they reproduce Brazilian historical characteristics, such as centralization of resources, decision centralization and administrative discontinuity, which does not favor the recognition of specific municipal demands by the municipal government. Regarding this recognition, there was a lack of administrative capacity on the part of the municipal government, mainly regarding the specific demands of the municipality, and to use those that are presented in the procedures of decision making and planning. This lack of administrative capacity of the municipality, to assimilate its specific health demands, justifies the need for federal control by the municipality, since the municipal government can not organize itself administratively to recognize its own demands. Thus, it was concluded that the municipal government reacts to national guidelines and, due to the predominance of federal government induction, reduced normative and financial autonomy and lack of capacity of the municipal government to propose programs that are peculiar to municipality of Viçosa-MG, the health demands assimilated by the public governance of the municipality, are those determined and established by the federal government, compatible with the municipal needs, being the federal coordination determinant for the effective attendance of the municipal health demands