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CIR – Important regional mobilization and articulation space. Its operation was structured through the Project. Discussions and agreements not necessarily coordinated with management performance at the local level |
CIR – Under establishment. Elaboration of regulations. |
Interstate CIR – Mobilization for its establishment based on previous experiences (PEBA Region). Creation of interstate collegiate, by terms of commitment between states. Internal agenda to define how to institutionalize this space considering definitions of Decree 7.508. |
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Initial planning based on municipal plans and needs diagnosis. Initial disputes (disputes over resources, technical areas, different needs / different priorities) |
Planning: more strategic initial discussion contents, with strengthening of regional planning, despite conflicts over priorities. Demobilization during implementation |
Planning based on the priorities of each state. Great effort to establish regional objectives (interstate perspective) |
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Intergovernmental relations: characterized initially by disputes over resources and local vision to the detriment of regional objectives. Further strengthened in the process, especially in the relationship between State and municipalities. Greater integration between managers and strengthening of discussion on regional issues and care network. |
Intergovernmental relations: characterized initially by disputes over resources and local vision to the detriment of regional objectives. Strong role of the State in coordination. Agenda priority and institutional capacity building. |
Intergovernmental relations: Initial agreement difficulties, characterized by divergent interests and interstate disputes over resources. Predominance of local vision to the detriment of regional vision, also among municipalities. States with different priorities in coordination and different institutional capacities. In the process, it was possible to advance and agree on priorities for the interstate region, with greater maturity of managers regarding the regional perspective. |
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SMS – Little knowledge and use of planning and management tools. Turnover - management discontinuity, with implications for regional governance. |
SMS – Little knowledge and use of planning and management tools. High turnover - management discontinuity, with implications for regional governance. |
SMS – Little knowledge and use of planning and management tools. Turnover - management discontinuity, with implications for GC work regional governance. |
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Local context with structural problems of logistics (transport and connectivity) and insufficient service network. |
Local context with poor network of services and logistical problems. Previous institutional political context favorable to regionalization, with process initiated to redefine health regions and qualification. |
Local context with characteristics that hinder regionalization in the interstate perspective (geographic and logistic aspects, network structure of services, flows, connectivity and different municipal information systems). |
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Advances in regional planning: Window of opportunity established for the region to support its regionalization process. Efforts for synergy between the various proposals that have started to be region-oriented. Preparation of a regional plan not yet validated by the CIB. |
Advances in regional planning: Strengthening planning for regional issues. Active participation of state regional unit in the discussion venues (GC and CIR). Emphasis on discussion with local councils. Preparation of a regional plan. |
Advances in regional planning: Strengthening interstate regional planning and perspective. Scale-up of articulation and integration between states. Greater knowledge of the region and alignment of strategies required. Qualification of municipal managers. Hardships in providing greater capillary definitions - multiple settings (CIR, CES, CMS) considering the 3 states. Elaborating the “Guidelines, objectives and targets” and proposed regulations for interstate CIR. Awaiting CIBs’ approval and CIT guidance. |
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Care Networks Organization
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Prioritized thematic networks: RUE and “Cegonha” (“Stork’, mother and child health program). |
Prioritized thematic networks: RUE and Cancer Care Network. |
Prioritized thematic networks: RAPS, “Cegonha”. RUE and Cancer Care Network. |
| Effort to articulate guidelines of the regionalization and implementation of the RAS (Decree and ordinances) to the design of the project. QualiSUS as a driver and mobilizer of the RAS discussion, favoring the strengthening of institutional capacity. |
Effort to articulate guidelines of the regionalization and implementation of the RAS (Decree and ordinances) to reflect the region and the necessary planning. QualiSUS as facilitator and mobilizer of these discussions, regional vision and relationship of interdependence among the entities. |
Region with three state public administrations - Different timings and movement in implementation, according to the order of priority given by state management and its institutional capacity. |
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Initiatives: Conforming regulatory complex and SAMU - organization of flows, including PHC, among the points of care according to RAS. Agreement of references. Structuring of diagnostic support. |
Initiatives: Advances in RUE, articulated to the role of PHC in this network, Cancer Network and therapeutic diagnostic support. Updating protocols. Regulatory Complex. Articulation between the RAS plans and Project purposes – complementary actions. |
Initiatives: Advances in the Cancer Network that, together with the Regulation, stimulated discussions on the organization of networks: systems integration by the lines of care – protocol and service organization. Previous organization of two RAS in the municipalities of reference favored the synergy of integration efforts with the project objectives. |
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Planning and management tools: Situational diagnosis, based on municipal priorities. Map of the health region and identification of regional needs. Regional Plan. RAS action plans. Definition of flows, Management agreement, management reports and municipal health plans. |
Planning and management tools: Diagnosis: epidemiological profile and gaps in the provision of services. Action Plans, Multiannual Plan, management reports and PDR, PDI and State Monitoring System based on SISPACTO. |
Planning and management tools: Diagnosis (population profile, service infrastructure, logistics and patient flow). Mapping the regional service network and its gaps. Seeking intersection of health problems and needs in the region. |
| Organização das Redes de Atenção |
| Alto Solimões |
Belém |
Topama |
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Indigenous Health - Integration of primary care and RUE (with the definition of flows between the points of care) with the Indigenous Districts. Sharing resources.
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Does not apply |
Indigenous Health. It placed the responsibility of the managers for this subsystem on the agenda. However, fragmentation remains. |
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Co-financing and sustainability
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Definition of responsibilities in the organization of the RAS - Action plans and statement of acceptance. |
Definition of responsibilities in the organization of the RAS - Plans of action, statement of acceptance, articulation between tools such as Management Agreements, Management Reports and Multiannual Programming. PDR and PES review. |
Definition of responsibilities in the organization of RAS - Management agreements, statement of acceptance, protocols and defined flows, interstate regulations and CIR agreements. |
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Co-financing of SES and SMS, provided for in the statement of acceptance to networks and CIR agreements. |
Co-financing provided for in the statement of acceptance to networks and CIR agreements. SES - medium and high complexity financing - own structure and co-financing of other levels / structure. |
Co-financing provided for in the statement of acceptance to networks and CIR agreements. Difficulties in achieving the agreements and decisions defined in the GC meetings. |
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Strategies: establishing the public consortium – ASAVIDA aiming at facilitating regional health management, reducing costs and expanding healthcare. |
Strategies: SES co-financing ordinance PHC. Negotiations for an integrated state regulation center. Interagency agreements with goals and indicators plan – evaluations once every four months. PHC planning with workshops and training for technicians and managers. Including actions in the action plans. Negotiating inclusion in municipal budgets of their counterparts. Indicating technicians responsible for monitoring the processes. |
Strategies: Interstate Collegiate that ensures discussions provided with the Project and the Guidelines for the region. Validating Interstate Regulations. Continuity of the guiding group, with definition of meetings schedule. Keeping technical areas integrated. The emptying of the COAP discussion was flagged as an element that indicates the difficulty of sharing resources and responsibilities and ensuring sustainability to decisions. |
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Intersectoral coordination: Regional Development Program (PRODERAM) |
Intersectoral coordination: incipient |
Intersectoral coordination: hardships. |
