Regional-based Integrated Healthcare Network policy in Brazil: From formulation to practice

Ingrid Vargas, Amparo Susana Mogollón-Pérez, Jean Pierre Unger, Maria Rejane Ferreira Da-Silva, Pierre De Paepe, María Luisa Vázquez

    Resultado de la investigación: Contribución a RevistaArtículo

    19 Citas (Scopus)

    Resumen

    © 2014 Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.Background Regional-based Integrated Healthcare Networks (IHNs) have been promoted in Brazil to overcome the fragmentation due to the health system decentralization to the municipal level; however, evaluations are scarce. The aim of this article is to analyse the content of IHN policies in force in Brazil, and the factors that influence policy implementation from the policymakers' perspective. Methods A two-fold, exploratory and descriptive qualitative study was carried out based on (1) content analysis of policy documents selected to meet the following criteria: legislative documents dealing with regional-based IHNs; enacted by federal government; and in force, (2) semi-structured individual interviews were conducted to a theoretical sample of policymakers at federal (eight), state (five) and municipal levels (four). Final sample size was reached by saturation of information. An inductive thematic analysis was conducted. Results The results show difficulties in the implementation of IHN policies due to weaknesses that arise from the policy design and the performance of the three levels of government. There is a lack of specificity as to the criteria and tools for configuring and financing IHNs that need to be agreed upon between involved governments. For their part, policymakers emphasize the difficulty of establishing agreements in a health system with disincentives for collaboration between municipalities. The allocation of responsibilities that are too complex for the capacity and size of the municipalities, the abandonment of essential functions such as network planning by states and the strategic role by the Ministry, the 'invasion' of competences among levels of government and high political turnover are also highlighted. Conclusions The implementation of regional-based IHN policy in Brazil is hampered by the decentralized organization of the health system to the municipal level, suggesting the need to centralize certain functions to regional structures or states and to define better the role of the government levels involved.
    Idioma originalEnglish (US)
    Páginas (desde-hasta)705-717
    Número de páginas13
    PublicaciónHealth Policy and Planning
    DOI
    EstadoPublished - ene 1 2015

    Huella dactilar

    Brazil
    Delivery of Health Care
    Health
    Healthcare Financing
    Tropical Medicine
    Federal Government
    Policy Making
    Politics
    Hygiene
    Sample Size
    Mental Competency
    Motivation
    Organizations
    Interviews

    Citar esto

    Vargas, Ingrid ; Mogollón-Pérez, Amparo Susana ; Unger, Jean Pierre ; Da-Silva, Maria Rejane Ferreira ; De Paepe, Pierre ; Vázquez, María Luisa. / Regional-based Integrated Healthcare Network policy in Brazil: From formulation to practice. En: Health Policy and Planning. 2015 ; pp. 705-717.
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    title = "Regional-based Integrated Healthcare Network policy in Brazil: From formulation to practice",
    abstract = "{\circledC} 2014 Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.Background Regional-based Integrated Healthcare Networks (IHNs) have been promoted in Brazil to overcome the fragmentation due to the health system decentralization to the municipal level; however, evaluations are scarce. The aim of this article is to analyse the content of IHN policies in force in Brazil, and the factors that influence policy implementation from the policymakers' perspective. Methods A two-fold, exploratory and descriptive qualitative study was carried out based on (1) content analysis of policy documents selected to meet the following criteria: legislative documents dealing with regional-based IHNs; enacted by federal government; and in force, (2) semi-structured individual interviews were conducted to a theoretical sample of policymakers at federal (eight), state (five) and municipal levels (four). Final sample size was reached by saturation of information. An inductive thematic analysis was conducted. Results The results show difficulties in the implementation of IHN policies due to weaknesses that arise from the policy design and the performance of the three levels of government. There is a lack of specificity as to the criteria and tools for configuring and financing IHNs that need to be agreed upon between involved governments. For their part, policymakers emphasize the difficulty of establishing agreements in a health system with disincentives for collaboration between municipalities. The allocation of responsibilities that are too complex for the capacity and size of the municipalities, the abandonment of essential functions such as network planning by states and the strategic role by the Ministry, the 'invasion' of competences among levels of government and high political turnover are also highlighted. Conclusions The implementation of regional-based IHN policy in Brazil is hampered by the decentralized organization of the health system to the municipal level, suggesting the need to centralize certain functions to regional structures or states and to define better the role of the government levels involved.",
    author = "Ingrid Vargas and Mogoll{\'o}n-P{\'e}rez, {Amparo Susana} and Unger, {Jean Pierre} and Da-Silva, {Maria Rejane Ferreira} and {De Paepe}, Pierre and V{\'a}zquez, {Mar{\'i}a Luisa}",
    year = "2015",
    month = "1",
    day = "1",
    doi = "10.1093/heapol/czu048",
    language = "English (US)",
    pages = "705--717",
    journal = "Health Policy and Planning",
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    Regional-based Integrated Healthcare Network policy in Brazil: From formulation to practice. / Vargas, Ingrid; Mogollón-Pérez, Amparo Susana; Unger, Jean Pierre; Da-Silva, Maria Rejane Ferreira; De Paepe, Pierre; Vázquez, María Luisa.

    En: Health Policy and Planning, 01.01.2015, p. 705-717.

    Resultado de la investigación: Contribución a RevistaArtículo

    TY - JOUR

    T1 - Regional-based Integrated Healthcare Network policy in Brazil: From formulation to practice

    AU - Vargas, Ingrid

    AU - Mogollón-Pérez, Amparo Susana

    AU - Unger, Jean Pierre

    AU - Da-Silva, Maria Rejane Ferreira

    AU - De Paepe, Pierre

    AU - Vázquez, María Luisa

    PY - 2015/1/1

    Y1 - 2015/1/1

    N2 - © 2014 Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.Background Regional-based Integrated Healthcare Networks (IHNs) have been promoted in Brazil to overcome the fragmentation due to the health system decentralization to the municipal level; however, evaluations are scarce. The aim of this article is to analyse the content of IHN policies in force in Brazil, and the factors that influence policy implementation from the policymakers' perspective. Methods A two-fold, exploratory and descriptive qualitative study was carried out based on (1) content analysis of policy documents selected to meet the following criteria: legislative documents dealing with regional-based IHNs; enacted by federal government; and in force, (2) semi-structured individual interviews were conducted to a theoretical sample of policymakers at federal (eight), state (five) and municipal levels (four). Final sample size was reached by saturation of information. An inductive thematic analysis was conducted. Results The results show difficulties in the implementation of IHN policies due to weaknesses that arise from the policy design and the performance of the three levels of government. There is a lack of specificity as to the criteria and tools for configuring and financing IHNs that need to be agreed upon between involved governments. For their part, policymakers emphasize the difficulty of establishing agreements in a health system with disincentives for collaboration between municipalities. The allocation of responsibilities that are too complex for the capacity and size of the municipalities, the abandonment of essential functions such as network planning by states and the strategic role by the Ministry, the 'invasion' of competences among levels of government and high political turnover are also highlighted. Conclusions The implementation of regional-based IHN policy in Brazil is hampered by the decentralized organization of the health system to the municipal level, suggesting the need to centralize certain functions to regional structures or states and to define better the role of the government levels involved.

    AB - © 2014 Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.Background Regional-based Integrated Healthcare Networks (IHNs) have been promoted in Brazil to overcome the fragmentation due to the health system decentralization to the municipal level; however, evaluations are scarce. The aim of this article is to analyse the content of IHN policies in force in Brazil, and the factors that influence policy implementation from the policymakers' perspective. Methods A two-fold, exploratory and descriptive qualitative study was carried out based on (1) content analysis of policy documents selected to meet the following criteria: legislative documents dealing with regional-based IHNs; enacted by federal government; and in force, (2) semi-structured individual interviews were conducted to a theoretical sample of policymakers at federal (eight), state (five) and municipal levels (four). Final sample size was reached by saturation of information. An inductive thematic analysis was conducted. Results The results show difficulties in the implementation of IHN policies due to weaknesses that arise from the policy design and the performance of the three levels of government. There is a lack of specificity as to the criteria and tools for configuring and financing IHNs that need to be agreed upon between involved governments. For their part, policymakers emphasize the difficulty of establishing agreements in a health system with disincentives for collaboration between municipalities. The allocation of responsibilities that are too complex for the capacity and size of the municipalities, the abandonment of essential functions such as network planning by states and the strategic role by the Ministry, the 'invasion' of competences among levels of government and high political turnover are also highlighted. Conclusions The implementation of regional-based IHN policy in Brazil is hampered by the decentralized organization of the health system to the municipal level, suggesting the need to centralize certain functions to regional structures or states and to define better the role of the government levels involved.

    U2 - 10.1093/heapol/czu048

    DO - 10.1093/heapol/czu048

    M3 - Article

    C2 - 24963157

    SP - 705

    EP - 717

    JO - Health Policy and Planning

    JF - Health Policy and Planning

    SN - 0268-1080

    ER -