Godoi Heloisa, Castro Renata Goulart, Santos José Luís Guedes Dos, Moyses Samuel Jorge, Mello Ana Lúcia Schaefer Ferreira de
Universidade Federal de Santa Catarina, Florianópolis, Brasil.
Pontifícia Universidade Católica do Paraná, Curitiba, Brasil.
Cad Saude Publica. 2020 Nov 23;36(11):e00184719. doi: 10.1590/0102-311X00184719. eCollection 2020.
The study aimed to analyze public governance in the regionalized healthcare network in the state of Santa Catarina, Brazil, and its influence on decision-making in the organization of oral healthcare. This was an exploratory analytical study with a qualitative approach, with the methodology based on Grounded Theory. Thirty in-depth interviews were held with managers from the Regional Inter-Managers Commissions and Bipartite Commissions (CIR and CIB, respectively, in Portuguese), under the State Health Department, representatives from the State Health Councils, and administrators of specialized oral healthcare services, in two sample groups, in addition to non-participant observation in CIB meetings. After comparative data analysis, the theoretical model was formulated in which the central category was expressed in the title Influence of Failures in Governance on the Oral Healthcare Network: The Erratic Expansion of Services by Vertical Induction and Confirmation of the Peripheral Status Assigned to Oral Health. The governance practiced in the Santa Catarina State Health System displays well-established formal support structures, such as the consolidation of the CIR. However, weaknesses were identified that reveal problems in the governance systems' legitimacy. The situation perpetuates the peripheral status assigned to the structuring of oral healthcare in network format and the erratic expansion of services, characterized by vertical induction and without contextualized recognition of oral health problems as guidance for planning the services. There is a need for greater public awareness and the inclusion of professionals and managers that can advocate for the importance of oral health as a major priority in public health policies.
该研究旨在分析巴西圣卡塔琳娜州区域化医疗网络中的公共治理及其对口腔医疗组织决策的影响。这是一项采用定性方法的探索性分析研究，其方法基于扎根理论。除了对 bipartite 委员会会议进行非参与式观察外，还在两个样本组中对州卫生部下属的区域间管理者委员会和 bipartite 委员会（葡萄牙语分别为 CIR 和 CIB）的管理人员、州卫生委员会代表以及专业口腔医疗服务管理人员进行了30次深度访谈。经过对比数据分析，构建了理论模型，其中核心类别在标题《治理失败对口腔医疗网络的影响：通过纵向诱导导致服务的不稳定扩张以及对口腔健康所赋予的边缘地位的确认》中得以体现。圣卡塔琳娜州卫生系统所实行的治理展现出完善的正式支持结构，比如 CIR 的巩固。然而，也发现了一些弱点，这些弱点揭示了治理体系在合法性方面存在的问题。这种情况使以网络形式构建的口腔医疗的边缘地位以及服务的不稳定扩张长期存在，其特点是纵向诱导且在规划服务时未将口腔健康问题的情境化认知作为指导。有必要提高公众意识，并纳入能够倡导口腔健康作为公共卫生政策首要重点的重要性的专业人员和管理人员。
