Banca de DEFESA: ITALO RICARDO SANTOS ALELUIA

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
DISCENTE : ITALO RICARDO SANTOS ALELUIA
DATA : 03/07/2019
HORA: 14:00
LOCAL: ISC
TÍTULO:

Analysis of an interstate health region: from political design to power dynamics.

PALAVRAS-CHAVES:

Brazilian Public Health System. Health Policy. Regionalization. Federalism. Health Region.

PÁGINAS: 302
GRANDE ÁREA: Ciências da Saúde
ÁREA: Saúde Coletiva
RESUMO:

Interstate Health Regions (IHR) are emerging areas and that are still deprived of appropriate care in the regionalization policy of Brazilian Public Health System (SUS). They are typified by a relevant political complexity due to its triple interdependence, in which, besides the Union and municipalities, they aggregate at least two states with distinct configurations that goes from epidemiological profile to inequalities of political-administrative power. IHR are unique territories that involve both federal entities and several public and private actors and institutions with multiple and divergent interests in a federative model of shared power and without a sufficient juridical framework for sustaining agreements and deliberations. In such complex and heterogeneous scenarios as the IHR, there are gaps to be answered that comprises since how decisions are made in such spaces until the power dynamics features among the actors and institutions. We performed a political analysis of Pernambuco-Bahia IHR. It is a case study that assembles evidence organized by management spheres. We adopted the theoretical basis of the Triangle of Government and the Theory of Social Production by Carlos Matus. Data production included interviews with 35 key respondents and analysis of 499 documents from the municipal to the national scenario. We will present the political background of IHR; the actors and the decision-making process for the formulation of regional design; governance conditions and government capacity in the IHR; the power dynamics, emphasizing the most influential actors and their motivations; the power typologies in dispute, and the conflicting and cooperative features in the region. The region political design emerged from intermunicipal financial disputes and its decision-making process was subsided by multiple actors from municipal to national scenario. The decisions outcomes were permeated by several disputes and progressed towards the implementation of an Interstate Health Network (REIS). Governability conditions in the region were adverse to the implementation of REIS as its project was highly redistributive among the three government spheres and due to unequal control of political, economic, technical, and administrative variables among the social actors. There was not sufficient government capacity of the actors and institutions to operationalize the Interstate Network and its political design was limited to the uncertain institutional ambience and restricted to the ideological plane. Power distribution in IHS was directed to influential actors in health sector as well as on economic and political groups that affect regional decisions. The federal states had unequal political capacities and an ambience of conflictive relations, with double public and private dependency and an extensive network of influential actors with predominantly economic, partisan, or personal motivations. There were several power disputes in the HIS and, among them, the economic and political ones was dominating, with cooperative relations more conducive to little transparent agreements and conflicts that combined, essentially, divergences on realities and interests readings. Overall, the regional power dynamics dissociated itself from the purposes of an Interstate Health Network, revealing that we are much more in the direction of market disputes and political power aspirations than in the way of building institutional alternatives for consolidating interstate health and cooperative health policies.

MEMBROS DA BANCA:
Externo à Instituição - ANA LUIZA D'AVILA VIANA - USP
Interno - 1678369 - ANA LUIZA QUEIROZ VILASBOAS
Externo à Instituição - JOSE ANTONIO DE FREITAS SESTELO - TRT
Interno - 2188285 - LUIS EUGENIO PORTELA FERNANDES DE SOUZA
Interno - 169.194.245-68 - MARIA GUADALUPE MEDINA - UFBA