Goya Neusa, Andrade Luiz Odorico Monteiro de, Pontes Ricardo José Soares, Tajra Fábio Solon, Barreto Ivana Cristina de Holanda Cunha
Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará. R. Professor Costa Mendes 1608/Bloco Didático/5º, Rodolfo Teófilo. 60430-140 Fortaleza CE Brasil.
Departamento de Medicina Comunitária, Centro de Ciências da Saúde, Universidade Federal do Piauí. Teresina PI Brasil.
Cien Saude Colet. 2017 Apr;22(4):1235-1244. doi: 10.1590/1413-81232017224.26982016.
The Public Health Action Organizational Contract (COAP) / Decree 7.508/2011 aimed to seal health agreements made between federated entities to promote the cooperative governance and management of Health Regions. A qualitative study was carried out adopting a hermeneutic approach to understand state health managers' perceptions of the elaboration and effects of the COAP in the State of Ceará. Open-ended interviewees and documental analysis were conducted. It was observed that the COAP led to the strengthening of regionalization in the government sphere; institutional gains through the implementation of ombudsmen and the National System of Pharmaceutical Care Management; increased information about the state health system's workforce; and health budget transparency. The following problems were (re)visited: institutional weakness in the operation of the network; limited state capacity for regulation of care; and underfunding. Regional governance was restricted to the government sphere, coordinated by the state, and was characterized by a predominantly bureaucratic and hierarchical governance structure. The COAP inaugurated a contractual interfederative model of regionalization, but revealed the institutional weaknesses of the SUS and its lacks of capacity to fulfill its principles as the structural problems of the three-tiered model go unaddressed.
《公共卫生行动组织合同》（COAP）/第7508/2011号法令旨在促成联邦实体之间达成的卫生协议，以促进卫生区域的合作治理与管理。采用诠释学方法开展了一项定性研究，以了解塞阿拉州卫生管理人员对COAP的制定及其影响的看法。进行了开放式访谈和文献分析。研究发现，COAP导致政府领域的区域化得到加强；通过设立监察员和国家药品护理管理系统实现了机构收益；增加了有关州卫生系统工作人员的信息；提高了卫生预算透明度。同时也（重新）审视了以下问题：网络运营中的机构薄弱环节；州对医疗服务监管的能力有限；以及资金不足。区域治理仅限于政府领域，由州进行协调，其特点是主要为官僚化和层级化的治理结构。COAP开创了一种区域化的合同式联邦间模式，但揭示了统一卫生系统（SUS）的机构弱点及其在履行其原则方面的能力不足，因为三级模式的结构性问题未得到解决。
