The offering of hospital services in face of the recent politico-administrative decentralisation and municipalization of health process on Brazil comes up as a challenge to local management. The production of immediate responses within a dynamic accelerated non-linear context of political incorporation of social rights given the complexity involving medico-hospital assistance leads to a necessary reflection on the potentialities and limits of the directives of the current health policy. Despite the complexity of the issue the different trajectories of the hospital services management project development in the municipalities of Santo André and Diadema innovate the responsibilities of local power to meet the conceptual and political aspects of decentralisation.
medico-hospital assistence; hospital services management; municipalization; descentralization