Atenção especializada em região de saúde: governança, organização e oferta

Abstract

The aim of this study was to analyze the organization and provision of specialized services in the health region of Feira de Santana, in the state of Bahia. This is a qualitative case study performed with secondary data (documents, reports and records) and semi-structured conducted interviews with state and municipal managers, and technicians from the scheduling and regulation centers. Among the main results, there was an improvement in the supply of specialized services through the implementation of the regional polyclinic in the health region and the viability of sanitary transport; fragmentation of user care; limitations in user regulation to specialized services (waiting lists and lines; incorrect appointments, lost or idle vacancies); political interference; hiring difficulties for some specialties with a smaller amount of specialist professionals; expansion of the private sector; hiring specialist professionals to provide assistance in municipalities with adjacent intermediary typology; maintence of significant difficulty in providing specialized care in municipalities with an adjacent rural typology; recurrence problems related to offer through the agreed and integrated programming (physical-financial relationship). It was identified fragilities related to the regional governance mechanism and its formal instances, lack of regional articulation in the process of achieving the Interfederative Health Consortium and Regional Polyclinic, mischaracterization of the design of the state regional master plan, with the presence of municipalities belonging to other health regions in the conformation of the consortium. This study can contribute to the formulation of strategies that can provide sustainability to the polyclinic equipment in the studied region, strengthen local regional agreement and reinforce the importance of planning to define priorities for regional services and equipment.