The challenge of decentralization of the Unified National Health System in large cities: the case of Sao Paulo, Brazil

The challenge of decentralization of the Unified National Health System in large cities: the case of Sao Paulo, Brazil

Author Spedo, Sandra Maria Autor UNIFESP Google Scholar
Tanaka, Oswaldo Yoshimi Google Scholar
Silva Pinto, Nicanor Rodrigues da Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Universidade de São Paulo (USP)
Abstract Decentralization of Brazil's Unified National Health System (SUS) still poses challenges in large cities. To characterize decentralization as an essentially political process, institutional policy variables, including local management capacity, are determinant for shaping decentralization in each context. Using the government triangle reference to evaluate management capacity, a case study was conducted with the objective of analyzing the system's decentralization in the city of Sao Paulo, Brazil's largest metropolis. An analysis of selected health system managers and administrative documents identified a trend towards focusing health management at the municipal level in 2005-2008, accompanied by dismantling of local/regional structures in the Municipal Health Secretariat, resulting in technical and policy depletion at these levels. Despite the limits of decentralization, the article emphasizes its power as an operational strategy to achieve the SUS' objectives. The article also stresses the need to resume the health decentralization process in the city of Sao Paulo, both moving towards local/regional levels and linked to the decentralization of municipal public management.
Keywords Decentralization
Health Management
Health Policy
Single Health System
Language Portuguese
Date 2009-08-01
Published in Cadernos De Saude Publica. Rio de Janeiro: Cadernos Saude Publica, v. 25, n. 8, p. 1781-1790, 2009.
ISSN 0102-311X (Sherpa/Romeo, impact factor)
Publisher Cadernos Saude Publica
Extent 1781-1790
Origin http://dx.doi.org/10.1590/S0102-311X2009000800014
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000269122200014
SciELO ID S0102-311X2009000800014 (statistics in SciELO)
URI http://repositorio.unifesp.br/11600/43215

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