Governança na saúde pública regional: caso do Consórcio Intermunicipal de Saúde do Médio São Francisco

Abstract

Considered one of the largest and most complex public health systems in the world, the Unified Health System (SUS) aims to guarantee full, universal, and free access to the entire Brazilian population. Its ability to generate social impacts goes far beyond its infrastructure. However, the operationalization of public health policy in Brazil has historically unfolded in a tangle of singular political, social, and economic relations in which the present work is concerned. The heterogeneity of the municipalities adds complexity to the management of public health services, requiring new alternatives, and the strengthening of the spheres of agreement and sharing of management. Consortia have proven to be important governance structures, enabling medium and high complexity services at the municipal level and supporting the management of the local SUS and for negotiations necessary to make health care viable. In the microregion of Pirapora-MG, the performance and results of the Intermunicipal Health Consortium of the Middle São Francisco (CISMESF) for the micro-regional health system have not yet been measured, opening the possibility for this research to act in an attempt to better elucidate the real role of the consortium within the context of public health in the micro. The methodological procedures used in this qualitative, empirical, and exploratory case study combined techniques of literature review, document analysis, interviews, and analysis of secondary data as mechanisms of collection and construction of the case. The analysis of the discourse of the actors in the micro-region revealed barriers that the majority face to activate participation, especially the municipal councilors, thereby compromising the entire micro-regional network. Also, the statements indicate that the lack of adequate information may reflect the non-participation and, consequently, the weakening of the consortium as an instance of governance within the micro. Most of the actors interviewed consider themselves to be an active participant with relevant contributions to governance meetings, but issues involving the defense of the interests of the networks may be underprivileged, weakening relations and the development of the territory. Quantitatively, the Pirapora microregion has a few health equipment both about the municipalities of Montes Claros and Belo Horizonte and concerning the microregions of Vespasiano and Bom Despacho. Regarding the number of professionals, all categories, and medical specialties, the microregion of Pirapora remains with less availability compared. The analysis made suggests that the benefits of the consortium are different for each municipality. Managers need to be aware of their benefits to exploit them better. Finally, reflecting on the role of CISMESF can enhance its micro-regional performance to meet the expectations of the actors and strengthen the development of the region.