Decentralization of health services: analytical dimensions

• Autor(a) principal: Teixeira, Sonia Maria Fleury
• Data de Publicação: 1990
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Revista de Administração Pública
• Texto Completo: https://periodicos.fgv.br/rap/article/view/9052
• topic: centralism; democratization; decentralization; health services.; centralismo; democratización; descentralización; servicios de salud.; centralismo; democratização; descentralização; serviços de saúde.

The article deals with the analytical dimensions comprised within the scope of health service's decentralization. The writer comments, to star with, on the structural character of Latin American centralization, trying thus to identify obstacles to be probably faced by the present demand for decentralization felt in the regional sphere. She goes further to establish positively that if the circumstantial factors inherent to the economic crisis and the process of democratization jointly contribute to indicate the necessity of decentralization of public policies, these very determinants come mutually into conflict as regards the limits and objectives of the proposal for decentralization, since the latter has its own set of problems, circumscribed to questions of distribution of power and to the definition of competence between different governmental spheres. Starting from her examination of a specific bibliography, the author presents a list of prerequisites for a convenient development of the decentralization process, at the same time calling attention to a few evitable risks and underlining the necessity of a flexible decentralization project, to be gradually applied and susceptible of periodical revisions. The organization of health services in Latin America is a subject exhaustively examined, its shows a certain definitive pattern, of which the more striking feature is a multiplicity of agencies and institutions acting in a disordinate manner, very often operating with duplicity of efforts. The question defined as the goal guaranteeing "health for all in the year 2000" presents itself as a proposal of change in the actual and really chaotic situation prevailing in health services. It foresees the institution of national decentralized systems of health and the writer describes some forms for its implementation, pointing out that during the last decade such proposal has been object of serious analyses, in an attempt to avoid ordinary mistakes, partly due to the repeated choices coming from central "bases", always altering the original proposal. The results from the establishment of national systems of health are a corollary of the impossibility to fragment the organic texture of its components, thus entailing the incapacity to accomplish previously fixed objectives and goals. The proposal for changing the condition of health of the population can not be seen as a more alteration in the administrative framework. The author ends by considering the role of planning, that she presents as fundamental in the strategic definition of decentralization, as well as in the phase of its implementation