Abstract
Objective: To evaluate the way Primary Health Care financing occurs in Brazil, reflecting on the existing advances and obstacles. Method: This is an integrative review carried out in the period of June and July 2016. The search was conducted in the electronic databases Latin American and Caribbean Center on Health Sciences Information (BIREME) database and Scientific Electronic Library Online (SciELO), using as descriptors health and The eligibility criteria of the study were Brazilian scientific articles, indexed in the period from 1994 to 2016, written in English, Portuguese or Spanish, and being available in full text. Publications in the thesis, dissertation and book chapter format, those not related to the research topic, as well as those dealing with studies on financing carried out outside Brazil, were excluded. Results: The search resulted in 290 publications. After applying the inclusion and exclusion criteria, 15 articles were obtained, from which two thematic categories emerged: Underfinancing: a challenge for PHC and Decentralization and obstacles to financing. Conclusion: The findings of this review identified different obstacles to the financing and establishment of policies for the improvement of primary health care in the country, pointing out that transfers and allocations of resources should be analyzed in a more discerning and reflective manner. The articles examined present as the main problems faced in financing: insufficient funds, the need to establish clearer parameters for intergovernmental transfers, the development of a management that understands and interact with the local difficulties, and the greater autonomy of the municipalities in setting priorities in counterpart to financing directed at specific programs.
Highlights
Analisar a evolução do gasto e do financiamento da atenção à saúde no país, as prioridades e as estratégias de financiamento e relacionar a Norma Operacional Básica de 1996 com a política de transferência de recursos para os municípios, adotada pelo governo federal
Uma pesquisa realizada no estado do Mato Grosso evidenciou que, do ponto de vista financeiro, os municípios matogrossenses ainda dependem grandemente dos recursos vindos de outras instâncias intergovermentais, sendo essa dependência maior entre os municípios com menos de 20.000 habitantes, mas também sendo significativa nos municípios de médio e grande porte(18)
Os artigos avaliados apresentam como principais problemas enfrentados no financiamento: insuficiência de verba, necessidade de serem estabelecidos parâmetros mais claros para os repasses intergovernamentais, criação de uma gestão que entenda e dialogue com as dificuldades locais e maior autonomia dos municípios na definição de prioridades em contrapartida aos financiamentos destinados ao custeio de programas específicos
Summary
A descentralização promoveu maior participação política dos municípios na tomada de decisão sobre as prioridades da saúde local e favoreceu novos mecanismos de financiamento e transferência de responsabilidades pela execução direta de serviços de saúde, principalmente os da atenção primária(2). Analisar a evolução do gasto e do financiamento da atenção à saúde no país, as prioridades e as estratégias de financiamento e relacionar a Norma Operacional Básica de 1996 com a política de transferência de recursos para os municípios, adotada pelo governo federal.
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