Desafios para implementar a integralidade da assistência à saúde no SUS: estudo de caso no município de São Paulo (SP) / Challenges to implementing the entire health care SUS: a case study in São Paulo, SP

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

Introduction: The Single Health System (Sistema Único de Saúde SUS) presented expressive development during the two decades of its existence. Nevertheless, the issue, which has not been incorporated in the services organization and in the daily basis of the attention, is the global approach. In order to carry out this research and considering the polysemantic word, an operational concept of integrality has been defined, limited to one of its meanings and related so as to organize the health services. Therefore, it has been established the integrality of the health care to the scope related to the permanence of health care, guaranteed by the access to the services, which comprise several levels of technology along all levels of complexity of the health system. Objective: To evaluate the incorporation of the principle of the integrality in the management and organization of health services in a specific area of the city of São Paulo. Methods: The research was performed by utilizing the methodological strategy of case study derived from the following sources of data: (a) management papers (laws, decrees, plans, technical specifications, management reports, minutes of meetings); (b) non-structured interviews with key informers selected among the SUS managers of the city; (c) focal group with users of a Basic Unit of Health of the selected area; (d) active observation, developed in health services and political administrative areas of the City Health Department (SMS-SP). The subject analysis technique has been used for the gathering of the data. The selected subjects were: (1) the decentralization of city management; intercity regionalization, and access to actions and services of medium complexity. Results: Results are presented in the form of 3 articles, being each one related to the selected subjects described. The articles are: (1) The challenge of the decentralization of the Single Health System (SUS in a large city: the instance of the City of São Paulo (SP), Brazil; (2) The intercity regionalization of the Single Health System (SUS): a case study of the City of São Paulo (SP), Brazil; and (3) The complex access to services of medium complexity of SUS in the largest Brazilian metropolis. Final considerations: It has been verified that the Health System applied by the SMS-SP has been a factor to maintain and intensified the fragmentation of the Health System in the City of São Paulo. The present structures and mechanisms used by the City administration have not played the part to produce the integrality of the health care. The SUS in São Paulo is still far from the objective image of a health care system that comprises the principle of global approach as one of its structuring axis.

ASSUNTO(S)

gestão em saúde single health system integrality integralidade health services integration sistemas locais de saúde regionalização health policy política de saúde health management sistema Único de saúde

ACESSO AO ARTIGO

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