Paradoxos das políticas de descentralização de saúde no Brasil Paradoxes of health decentralization policies in Brazil

• Main Authors: Dário Frederico Pasche, Liane Beatriz Righi, Henrique Inácio Thomé, Eveline Dischkaln Stolz
• Format: Article in Journal/Newspaper
• Language: English; Spanish; Portuguese
• Published: Pan American Health Organization 2006
• Subjects: descentralização; políticas; políticas públicas de saúde; responsabilidade social; Brasil; delivery of health care; health care reform; models; public health administration; social responsibility; Brazil; Medicine; R; Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270; Arctic
• Online Access: https://doaj.org/article/6f95ec4ce8484bcea1ba43f2131ba6e6

The constitution of Brazil directs that the country’s health system, the Unified Health System (Sistema Único de Saúde), be politically and administratively decentralized. Nevertheless, handing over competencies, responsibilities, and resources to subnational levels, especially to municipal governments, has been a slow process, lasting almost two decades. Advances have been brought about by the Unified Health System, which, from a analytical perspective, is a public and universal system. Despite that, the decentralization process needs to overcome norms that keep all levels of management dependent on Brazil’s federal Government. The subnational levels have consistently faced difficulties in performing their macromanagement functions with autonomy, especially when it comes to financing and to the establishment or organization of health care networks. Boldness and responsibility will be needed to prevent Brazil’s health decentralization process from leading to fragmentation. New political agreements between different levels of government, with a reassignment of responsibilities and the enhancement of a culture of technical cooperation, are fundamental requisites to making the Unified Health System have a health policy that is truly public and universal.