Julião Karine Sousa, Olivieri Cecília
Centro de Estudos em Sustentabilidade, Fundação Getulio Vargas, São Paulo, Brazil.
Universidade de São Paulo, São Paulo, Brazil.
Cad Saude Publica. 2020;36(3):e00037519. doi: 10.1590/0102-311x00037519. Epub 2020 Mar 13.
This study analyzed the first experience with vertical health consortia in Ceará State, Brazil, in order to shed light on their implementation. In the theoretical field, the article establishes a dialogue with studies on the state government's role in federalism and intergovernmental cooperation in health. A qualitative study was based on interviews with administrators associated with the consortia at the municipal, regional, and state levels, in addition to document analysis and a literature review. The results indicate that the implementation of consortia was designed by the state government and conducted initially in centralized fashion. A relationship of coordination was established with the definition of the arrangement's institutional design. We identified four factors that favor vertical cooperation in the state: (i) the history of health policy in Ceará; (ii) action by the state government as the coordinating body in the regionalization process; (iii) the existence of policy leaders and cohesion in the bureaucracy; and (iv) juxtaposition between the consortia's institutional design and the decision-making structure of the Brazilian Unified National Health System (SUS). Vertical consortia represent a step forward in overcoming the negative effects of decentralization.
本研究分析了巴西塞阿拉州垂直卫生联盟的首次经验，以便深入了解其实施情况。在理论领域，本文与关于州政府在联邦制和卫生领域政府间合作中作用的研究进行了对话。除了文件分析和文献综述外，一项定性研究基于对市级、区域级和州级与联盟相关的管理人员的访谈。结果表明，联盟的实施由州政府设计并最初以集中方式进行。通过确定该安排的制度设计建立了协调关系。我们确定了四个有利于该州垂直合作的因素：（i）塞阿拉州的卫生政策历史；（ii）州政府作为区域化进程协调机构的行动；（iii）政策领导者的存在和官僚机构的凝聚力；（iv）联盟的制度设计与巴西统一国家卫生系统（SUS）决策结构之间的并列关系。垂直联盟代表了在克服分权负面影响方面向前迈出的一步。
