Viana Ana Luiza d'Ávila, Bousquat Aylene, Melo Guilherme Arantes, Negri Filho Armando De, Medina Maria Guadalupe
Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, Cerqueira César. 01246-904. São Paulo SP Brasil.
Universidade Federal de São Paulo. São Paulo SP Brasil.
Cien Saude Colet. 2018 Jun;23(6):1791-1798. doi: 10.1590/1413-81232018236.05502018.
The aim of this article was to reflect on the challenges faced in building the Health Regions and Networks in Brazil. These reflections result from studies conducted in several health regions. The central challenges for the constitution of the Health Regions and Networks are as follows: the Care Model, Primary Health Care, Care for Users with Chronic Diseases, and Hospital Care. In order to consolidate the regions and networks the organization needs to incorporate an ethical sense: focusing on social, public and individual needs, derived from comprehensive care, human and social rights, in broad, multi-scale and inter-sectorial interactions, with the constitution of a systemic, regionalized innovation. Of prime importance is the capacity to devise which general principles are responsible for maintaining the unity(mode of care), seeking to outline the coherence of the different provision models that the system might develop according to the social needs in regional settings. Without that, users will continue to seek and create ways of accessing health services that challenge the rationale of those very services. Hospital reform is also required to integrate and reorient the hospital networks. These reflections are important for the SUS to uphold its solidarity project, expressed in the trinity of universality-comprehensiveness-equality.
本文旨在反思巴西在构建健康区域和网络过程中所面临的挑战。这些反思源于在多个健康区域开展的研究。健康区域和网络构建的核心挑战如下:护理模式、初级卫生保健、慢性病患者护理以及医院护理。为了巩固这些区域和网络,该组织需要融入一种伦理意识:关注源于全面护理、人权和社会权利的社会、公共及个人需求,在广泛、多尺度和跨部门的互动中,构建一个系统性、区域化的创新模式。至关重要的是要有能力确定哪些一般原则负责维持(护理模式的)统一性,力求勾勒出系统可能根据区域环境中的社会需求而发展出的不同服务提供模式的连贯性。否则,用户将继续寻求并创造获取健康服务的方式,而这些方式会对这些服务本身的基本原理构成挑战。还需要进行医院改革,以整合并重新调整医院网络。这些反思对于统一卫生系统维护其以普遍性 - 全面性 - 平等三位一体为体现的团结项目而言至关重要。