Casanova Angela Oliveira, Cruz Marly Marques, Giovanella Ligia, Alves Glaydes Dos Reis, Cardoso Gisela Cordeiro Pereira
Escola Nacional de Saúde Pública, Fiocruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
Cien Saude Colet. 2017 Apr;22(4):1209-1224. doi: 10.1590/1413-81232017224.26562016.
This paper aims to analyze the potential, limits and challenges of regional governance in the implementation process of health care networks in three Brazilian regions: Alto Solimões (Amazonas), Belém (Pará) and an interstate region comprising Tocantins, Pará and Maranhão states (Topama). The study is based on the evaluation study on the implementation of the Quality Health Care Network Development and Improvement Project (QualiSUS-Rede). This is a qualitative multiple case study with the analysis of official documents and use of semi-structured interviews with key stakeholders conducted from July to December 2014. Governance review encompassed three components: stakeholders involved, especially local steering groups and their regional coordination capacity; strategies used for strengthening regional governance, anchored on the intervention's modeling; and implementation of local health care networks. Results point that the regional managing commissions were the main governance strategy and that the QualiSUS-Rede Project strengthened regional governance and integration differently in every case, depending on stakeholders' administration and consensus capacity on regional and political priorities.
上索利蒙伊斯（亚马孙州）、贝伦（帕拉州）以及由托坎廷斯州、帕拉州和马拉尼昂州组成的州际地区（托帕马）在医疗保健网络实施过程中区域治理的潜力、局限和挑战。该研究基于对优质医疗保健网络发展与改善项目（QualiSUS-Rede）实施情况的评估研究。这是一项定性多案例研究，分析了官方文件，并于2014年7月至12月对关键利益相关者进行了半结构化访谈。治理审查包括三个部分：涉及的利益相关者，特别是地方指导小组及其区域协调能力；用于加强区域治理的战略，以干预模式为基础；以及地方医疗保健网络的实施。结果表明，区域管理委员会是主要的治理战略，并且QualiSUS-Rede项目在每种情况下对区域治理和整合的强化方式各不相同，这取决于利益相关者对区域和政治优先事项的管理和达成共识的能力。
