Baptista Tatiana Wargas de Faria
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ 21041-210, Brazil.
Cad Saude Publica. 2007 Mar;23(3):615-26. doi: 10.1590/s0102-311x2007000300020.
Ministry of Health rulings and provisions are important policy regulation tools that aim to orient the enforcement of health-related laws passed by the Legislative Branch, under the terms of the 1988 Federal Constitution. Such provisions have played a major role in the health sector, due not only to the number of documents submitted since the late 1990s, but mainly because of this tool's persuasive power in defining health sector policy. The current article aims to foster reflection on both national health policy management in Brazil and the main obstacles to the implementation of health reform operational aspects. The article classified and analyzed Ministry of Health rulings issued from 1990 to 2002. The study highlights the Ministry's centralizing approach and the use of financial and political persuasion tools that subject State and Municipal governments to the system's rules without creating a negotiated and sustained health policy that the country's institutional realities ratify and support.
卫生部的裁决和规定是重要的政策监管工具，旨在根据1988年《联邦宪法》的条款，指导立法部门通过的与健康相关法律的实施。这些规定在卫生部门发挥了重要作用，这不仅是因为自20世纪90年代末以来提交的文件数量众多，更主要的是因为这个工具在界定卫生部门政策方面具有说服力。本文旨在促进对巴西国家卫生政策管理以及卫生改革实施操作方面的主要障碍的思考。本文对1990年至2002年期间发布的卫生部裁决进行了分类和分析。该研究突出了卫生部的集权方式以及使用财政和政治说服工具，这些工具使州和市政府受制于该系统的规则，却没有制定出一个得到国家体制现实认可和支持的经过协商且可持续的卫生政策。
