The challenge of decentralization of the Unified National Health System in large cities: the case of Sao Paulo, Brazil

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dc.contributor.authorSpedo, Sandra Maria [UNIFESP]
dc.contributor.authorTanaka, Oswaldo Yoshimi
dc.contributor.authorSilva Pinto, Nicanor Rodrigues da
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionUniversidade de São Paulo (USP)
dc.date.accessioned2018-06-15T16:39:09Z
dc.date.available2018-06-15T16:39:09Z
dc.date.issued2009-08-01
dc.description.abstractDecentralization of Brazil's Unified National Health System (SUS) still poses challenges in large cities. To characterize decentralization as an essentially political process, institutional policy variables, including local management capacity, are determinant for shaping decentralization in each context. Using the government triangle reference to evaluate management capacity, a case study was conducted with the objective of analyzing the system's decentralization in the city of Sao Paulo, Brazil's largest metropolis. An analysis of selected health system managers and administrative documents identified a trend towards focusing health management at the municipal level in 2005-2008, accompanied by dismantling of local/regional structures in the Municipal Health Secretariat, resulting in technical and policy depletion at these levels. Despite the limits of decentralization, the article emphasizes its power as an operational strategy to achieve the SUS' objectives. The article also stresses the need to resume the health decentralization process in the city of Sao Paulo, both moving towards local/regional levels and linked to the decentralization of municipal public management.en
dc.description.affiliationUniv Fed Sao Paulo, Dept Prevent Med, Escola Paulista Med, BR-04023900 Sao Paulo, Brazil
dc.description.affiliationUniv Sao Paulo, Fac Saude Publ, Sao Paulo, Brazil
dc.description.affiliationUnifespUniv Fed Sao Paulo, Dept Prevent Med, Escola Paulista Med, BR-04023900 Sao Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent1781-1790
dc.identifierhttp://dx.doi.org/10.1590/S0102-311X2009000800014
dc.identifier.citationCadernos De Saude Publica. Rio de Janeiro: Cadernos Saude Publica, v. 25, n. 8, p. 1781-1790, 2009.
dc.identifier.doi10.1590/S0102-311X2009000800014
dc.identifier.fileS0102-311X2009000800014.pdf
dc.identifier.issn0102-311X
dc.identifier.scieloS0102-311X2009000800014
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/43215
dc.identifier.wosWOS:000269122200014
dc.language.isopor
dc.publisherCadernos Saude Publica
dc.relation.ispartofCadernos De Saude Publica
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectDecentralizationen
dc.subjectHealth Managementen
dc.subjectHealth Policyen
dc.subjectSingle Health Systemen
dc.titleThe challenge of decentralization of the Unified National Health System in large cities: the case of Sao Paulo, Brazilen
dc.typeinfo:eu-repo/semantics/article
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