Regional health network in the Amazonian context: the case in Manaus, Entorno and Alto Rio Negro

Amandia Braga Lima Sousa,Paulo Henrique Dos Santos Mota,Aylene Bousquat,Luiza Garnelo

doi:10.1590/1806-9304201700s100011

Amandia Braga Lima Sousa, Paulo Henrique Dos Santos Mota + Show 2 more

Open Access

https://doi.org/10.1590/1806-9304201700s100011

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Abstract

Abstract Objectives: to analyze the dimensions of policy, structure and organization in the construction of Redes de Atenção à Saúde (RAS) (healthcare networks) in the health region of Manaus, Entorno and Alto Rio Negro, focusing on Atenção Primária à Saúde (APS) (primary healthcare) and Rede de Urgência e Emergência (RUE) (urgency and emergency network). Methods: a case study with multidimensional analysis using quantitative and qualitative approach carried out in the first semester of 2016. Results: 37 interviewed key informants, such as managers (States, Cities and Regionals), providers and civil society. The reality was marked by the difficulties in the implementation of RAS's with centralized decision-making powers of State level. Perception of insufficient human resources of limited installed capacity, particularly in the APS, with insufficient priority given to this level of care. Concentration of services in Manaus, priority for urgency and emergency actions expressed in the greatest investment in human resources and mate-rials allocated at this level of care, lack of proposals for promoting equity. Conclusions: the Region was unable to implement RAS to respond to the health demands in the region. The necessity to overcome the dependency relation with the cities and the State and to strengthen its protagonism and fulfillits roles in management network, instituting a plan capable of strengthening APS to be committed in reducing iniquities and with adequate responses in health needs.

Highlights

One of the main features in the Brazilian territory is the existence of significant regional inequalities, which expresses socially and economically
The analysis of the results shows that Rede de Urgência e Emergência (RUE) was not an effective response to integrate services in this health region, with the aggravating factor of being little integrated into Atenção Primária à Saúde (APS)
The operational analysis on Redes de Atenção à Saúde (RAS) in the region, from the perspective of the studied dimensions, emphasizing RUE and APS, indicates that the regional has not yet been able to deploy the operation of health networks at capable level of responding the demands in the health region

Summary

Introduction

One of the main features in the Brazilian territory is the existence of significant regional inequalities, which expresses socially and economically. Concerning the Amazon territory, which is the focus of this article, the main traits are the demographic rarefaction and the low techniquedensities.[1] The demographic rarefaction is not the synonymous of absence in the large urban nucleus, but the concentration of significant portion of the population in a few population nucleus associated to the great population dispersion of the Countryside in the vast territory. These most important cities are places that integrate nationally and internationally in the territory of the Country. The Decree number 7,508/11,4 deals regarding to SUS organization, the health planning, the healthcare and the interfederative articulation setting the Health Region as a central axis to accomplish these provisions

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