Implementação dos centros de especialidades odontológicas regionais no estado do Ceará, Brasil

Abstract

The pioneer experiences of the state of Ceara in the implantation of public health policies in the country, with a strong tradition in the decentralization and regionalization of the Unified Health System (UHS), have as one of their main representations the Centers of Regional Dental Specialties (CRDS). This study aimed to analyze the implementation of CRDS in Ceara, considering the factors and elements of the political-institutional and organizational context that made or favored this process. It is an evaluative research, consisting of a case study, with a qualitative approach. Secondary data (such as documents and indicators), semi-structured interviews and non-participant observation were used as research instruments. Among the main results, it was observed that the insertion of oral health in the regionalization trajectory led by the State Health Department, as planned and constructed by the actors, did that Ceara should structure its oral health policy before the launch of national guidelines and, unlike the national scenario, prioritized the implantation of Centers of Dental Specialties in a regional perspective, on a large scale and administered under the Public Health Consortium (PHC) modality. The CRDS stood out in the oral health care network, not only due to the high technological contribution and the sophisticated dental apparatus, but also due to improvements in work processes, management, quality of care and more timely access to specialties. Still, some challenges related to political interference in the presidency of some consortia, fragility in the network articulation, represented by difficulties in communication and integration with primary care and by limitations in the direct regulation of users for hospital referrals were also identified. Based on this study, it is possible to suggest that RDSs are an essential element for achieving a certain institutionality of oral health policy in that State, and the experience of Ceara contributes with important elements for discussion, improvement and sustainability of the National Policy of Oral Health, with a view to strengthening and consolidating the right to integral access to health in the UHS