Abstract
The Public Health Action Organizational Contract (COAP) / Decree 7.508/2011 aimed to seal health agreements made between federated entities to promote the cooperative governance and management of Health Regions. A qualitative study was carried out adopting a hermeneutic approach to understand state health managers' perceptions of the elaboration and effects of the COAP in the State of Ceará. Open-ended interviewees and documental analysis were conducted. It was observed that the COAP led to the strengthening of regionalization in the government sphere; institutional gains through the implementation of ombudsmen and the National System of Pharmaceutical Care Management; increased information about the state health system's workforce; and health budget transparency. The following problems were (re)visited: institutional weakness in the operation of the network; limited state capacity for regulation of care; and underfunding. Regional governance was restricted to the government sphere, coordinated by the state, and was characterized by a predominantly bureaucratic and hierarchical governance structure. The COAP inaugurated a contractual interfederative model of regionalization, but revealed the institutional weaknesses of the SUS and its lacks of capacity to fulfill its principles as the structural problems of the three-tiered model go unaddressed.
Highlights
The Public Health Action Organizational Contract (Contrato Organizativo de Ação Pública da Saúde - COAP), prescribed by Decree 7.508/20111, provides the legal framework for the cooperative governance and management[2,3] of the Unified Health System (Sistema Único de Saúde - SUS), strengthening the logic behind Brazil’s health care federalism[4,5]
The Public Health Action Organizational Contract (COAP) / Decree 7.508/2011 aimed to seal health agreements made between federated entities to promote the cooperative governance and management of Health Regions
The COAP is a plurilateral health agreement between federated entities that sets out responsibilities and functions that are defined through a process of integrated planning of health actions and services at Health Region (Regiões de Saúde - RS) level
Summary
The Public Health Action Organizational Contract (Contrato Organizativo de Ação Pública da Saúde - COAP), prescribed by Decree 7.508/20111, provides the legal framework for the cooperative governance and management[2,3] of the Unified Health System (Sistema Único de Saúde - SUS), strengthening the logic behind Brazil’s health care federalism[4,5]. The COAP is a plurilateral health agreement between federated entities that sets out responsibilities and functions that are defined through a process of integrated planning of health actions and services at Health Region (Regiões de Saúde - RS) level. The contract outlines organizational processes and flows and the operation of the system and the commitments and targets of the different spheres of management of the SUS as to ensuring the right to health[1]. Certain authors[7,8] have problematized the lack of a regional health authority, discussing the most appropriate institutional arrangements for managing the equipment used in the health region, while others[5] suggest possible ways to overcome these limitations through regional management models based on the COAP
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