Coap and SUS Regionalization: the various implementation patterns in the Brazilian states

Ouverney, Assis Mafort; Ribeiro, José Mendes; Moreira, Marcelo Rasga

doi:10.1590/1413-81232017224.03002017

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ARTICLE • Ciênc. saúde colet. 22 (4) • Apr 2017 • https://doi.org/10.1590/1413-81232017224.03002017 copy

Coap and SUS Regionalization: the various implementation patterns in the Brazilian states

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This paper analyzes the implementation process of the Public Action Organizational Contract (Coap) and its impacts on state agendas of SUS regionalization, comparing the different institutional reactions of the states to the strategy proposed by Decree 7.508/11. The comparison of developing dynamics of state agendas took as reference a normative baseline structured in eight strategic political-institutional moments in the implementation of the Coap in accordance with the logic defined in Decree 7.508/11. We collected data through a questionnaire containing 35 questions (1 open, 25 closed and 9 mixed) and extensive documentary research in 2013 and 2014 in all states, except for the Federal District. Results showed that state agendas were distributed around three differentiated developing patterns: six states maintained greater distance from the national agenda established by Decree 7.508/11, engaging in a very fragmented way; 12 states engaged in the Coap agenda, selectively focusing on specific moments or stages, strengthening the process they have been developing; and 10 states maintained greater performance regularity during the eight moments of the Coap implementation cycle.

Unified Health System; Federalism; Decentralization; Regionalization and Coap

Moments	Variable		Description of variable
Construction of a state COAP covenant	Formalization of COAP SG	1	There is a steering group established through a formal and legal instrument
	Operation of COAP SG	2	The steering group has periodic meetings
	COAP Regional Meetings	3	There were meetings of presentation and discussion of the COAP in the health regions
	COAP’s Formalization at SGEP	4	The SES held a formal meeting and/or presented a document to the SGEP Secretary stating its intention to sign the COAP
	COAP Agreement in the CIB	5	There have been official debates on the state agenda for the implementation of COAP in the CIB
Reconfiguration of Health Regions	Reconfiguration of Health Regions	6	The SES conducted a process of evaluation and improvement of the design of health regions
Establishment of CIRs	CIRs Internal Rules	7	CIRsinternal rules available
Establishment of CIRs	XIR Structure	8	Executive secretariats and technical chambers / working groups in place in the CIRs
Integrated Planning	Health Map	9	Conducting discussions on the health map in CIB
	State Health Plan	10	State health plan for the period 2012/2015 available
	State Health Plan	11	State health plan for the period 2012/2015 approved by the CES
	Integrated and Agreed Agenda	12	Discussion and definition of agreed and integrated program in CIB
	Annual Health Agenda	13	SES concluded the preparation of the 2014annual health program
	Annual Health Agenda	14	The 2014 annual health program has been approved by the CES
	Guidelines, Objectives, Targets and Indicators Agreement	15	Significant volume of municipalities that completed the process of agreeing the goals, according to national guidelines, objectives and indicators, in the period 2013 and 2014 (regions accompanied by the sponsors)
Executive Responsibilities	Discussion of COAP in the CES	16	The COAP was discussed at a CES meeting
	National Health Card	17	Discussion about SUS national card is ongoing in CIB
	Access Regulation Policy	18	State policy of access regulations discussed and agreed in the CIB in place
	Thematic Networks	19	Ongoing meetingsdiscussing plans for the implementation of thematic networks in CIB
Budgetary-Financial Responsibilities	New Investments: discussion in the CIB	20	Presentation of discussion in the CIB about the need for new investments by the state manager
Monitoring and evaluation Responsibilities	Monitoring and evaluation Strategy	21	A policy to monitor and evaluate the goals agreed by state and municipal managersis in place
Processing and Signing the COAP	Signing the COAP	22	Procedure and signature of the COAP by a set of regions in the State

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[1] Collaborations

AM Ouverney, JM Ribeiro and MR Moreira participated equally in all stages of preparation of the article.