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Regional-based Integrated Healthcare Network policy in Brazil: From formulation to practice

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dc.creatorVargas, Ingridspa
dc.creatorMogollón Pérez, Amparo Susana
dc.creatorUnger, Jean-Pierrespa
dc.creatorda-Silva, Maria Rejane Ferreiraspa
dc.creatorDe Paepe, Pierrespa
dc.creatorVázquez, María-Luisaspa
dc.date.accessioned2020-05-26T00:09:53Z
dc.date.available2020-05-26T00:09:53Z
dc.date.created2015spa
dc.description.abstractBackground Regional-based Integrated Healthcare Networks (IHNs) have been promoted in Brazil to overcome the fragmentation due to the health system decentralization to the municipal level; however, evaluations are scarce. The aim of this article is to analyse the content of IHN policies in force in Brazil, and the factors that influence policy implementation from the policymakers' perspective. Methods A two-fold, exploratory and descriptive qualitative study was carried out based on (1) content analysis of policy documents selected to meet the following criteria: legislative documents dealing with regional-based IHNs; enacted by federal government; and in force, (2) semi-structured individual interviews were conducted to a theoretical sample of policymakers at federal (eight), state (five) and municipal levels (four). Final sample size was reached by saturation of information. An inductive thematic analysis was conducted. Results The results show difficulties in the implementation of IHN policies due to weaknesses that arise from the policy design and the performance of the three levels of government. There is a lack of specificity as to the criteria and tools for configuring and financing IHNs that need to be agreed upon between involved governments. For their part, policymakers emphasize the difficulty of establishing agreements in a health system with disincentives for collaboration between municipalities. The allocation of responsibilities that are too complex for the capacity and size of the municipalities, the abandonment of essential functions such as network planning by states and the strategic role by the Ministry, the 'invasion' of competences among levels of government and high political turnover are also highlighted. Conclusions The implementation of regional-based IHN policy in Brazil is hampered by the decentralized organization of the health system to the municipal level, suggesting the need to centralize certain functions to regional structures or states and to define better the role of the government levels involved. © 2014 Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.eng
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.1093/heapol/czu048
dc.identifier.issn14602237
dc.identifier.issn02681080
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/24186
dc.language.isoengspa
dc.publisherOxford University Pressspa
dc.relation.citationEndPage717
dc.relation.citationIssueNo. 6
dc.relation.citationStartPage705
dc.relation.citationTitleHealth Policy and Planning
dc.relation.citationVolumeVol. 30
dc.relation.ispartofHealth Policy and Planning, ISSN:14602237, 02681080, Vol.30, No.6 (2015); pp. 705-717spa
dc.relation.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-84937402653&doi=10.1093%2fheapol%2fczu048&partnerID=40&md5=bff66733b7144ae5b863062092bba0cespa
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto Completo)spa
dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subject.keywordAdministrative personnelspa
dc.subject.keywordBrazilspa
dc.subject.keywordGovernmentspa
dc.subject.keywordHealth care planningspa
dc.subject.keywordHealth care policyspa
dc.subject.keywordHumanspa
dc.subject.keywordIntegrated health care systemspa
dc.subject.keywordInterviewspa
dc.subject.keywordOrganization and managementspa
dc.subject.keywordProgram developmentspa
dc.subject.keywordPsychologyspa
dc.subject.keywordPublic healthspa
dc.subject.keywordQualitative researchspa
dc.subject.keywordAdministrative personnelspa
dc.subject.keywordBrazilspa
dc.subject.keywordDelivery of health careeng
dc.subject.keywordHealth policyspa
dc.subject.keywordHumansspa
dc.subject.keywordInterviews as topicspa
dc.subject.keywordLocal governmentspa
dc.subject.keywordNational health programsspa
dc.subject.keywordProgram developmentspa
dc.subject.keywordQualitative researchspa
dc.subject.keywordRegional health planningspa
dc.subject.keywordBrazilspa
dc.subject.keywordCo-ordination of carespa
dc.subject.keywordDecentralizationspa
dc.subject.keywordHealth policyspa
dc.subject.keywordIntegrated delivery networksspa
dc.subject.keywordRegionalizationspa
dc.titleRegional-based Integrated Healthcare Network policy in Brazil: From formulation to practicespa
dc.typearticleeng
dc.type.hasVersioninfo:eu-repo/semantics/publishedVersion
dc.type.spaArtículospa
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