Garnelo Luiza, Sousa Amandia Braga Lima, Silva Clayton de Oliveira da
Centro de Pesquisas Leônidas & Maria Deane, Fiocruz. R. Teresina 476, Adrianópolis. 69057-070 Manaus AM Brasil.
Cien Saude Colet. 2017 Apr;22(4):1225-1234. doi: 10.1590/1413-81232017224.27082016.
This paper analyses the health services regionalization process in the State of Amazonas through a case study covering the health sub-region Manaus Surroundings. This is a qualitative, descriptive and analytical research, which data were collected using interviews, documents and Internet reviews, oriented by the guiding concept of health regionalization. Study findings revealed a social setting dominated by asymmetry, verticality, competitiveness and fragile multilateral relations among municipalities, associated to a bureaucratic profile of local institutions operating in the region under study. The political agents have limited acknowledgement of the sociopolitical and institutional conditions in which they operate. They usually impute healthcare networks' management and operational issues to the natural and geographical characteristics of the Amazon region, but their financing, governance and technical capacity are insufficient to overcome them.
本文通过对玛瑙斯周边健康次区域的案例研究，分析了亚马孙州的卫生服务区域化进程。这是一项定性、描述性和分析性研究，数据收集采用访谈、文件和互联网评论的方式，以卫生区域化的指导理念为导向。研究结果显示，该社会环境的特点是各城市之间存在不对称、垂直性、竞争性和脆弱的多边关系，这与在所研究区域运营的地方机构的官僚作风有关。政治行为体对其运作所处的社会政治和体制条件认识有限。他们通常将医疗保健网络的管理和运营问题归咎于亚马孙地区的自然和地理特征，但他们的融资、治理和技术能力不足以克服这些问题。
