The model adopted by the State for the organization of the cancer care network was the .. Decreto n° de 28 de junho de Brasília. But as can be seen in the in the Greater ABC region of São Paulo, for example, the political side of this Most recently, in June , Decree nº 7,, regulating Law nº /90 dealing with the .. Decreto nº , de 28 de junho de
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An outpatient care facility, a rehabilitation center, and an outpatient pharmacy for patients under treatment as well as a referral center for palliative care were installed in an out-of-the-way facility 50 kilometers away.
The current situation suggests a model which integrates the network of municipal systems in a specific region, as is the case in the Greater ABC area, which has a low level of integration. A set of institutions has been organized into networks to manage this model.
The multiplicity of social and institutional interests to be included in the agenda for the sector mobilizes different techno-bureaucratic groups in defence of projects and actions aimed at different segments or groups of the population, and the priorities are not always defined based on rational criteria or needs.
Finally, defining the interfaces of the strategy for regulating health care as a process of planning, programming and other control and evaluation instruments Ibanhes and col.
The managers needed to describe how organization and responsibility would be allotted at all levels of care, considering all of the components of the network of care for people with chronic diseases in the thematic dfcreto of cancer [i.
The latter is concerned with coordination, relationships and leadership based on the social players, something which does not occur in the Greater ABC area due to the “power games” existing between them, meaning there is great difficulty 201 its operation, as one municipality will not cede its interests to others. The examples of projects presented in this article reinforce the idea that specialized hospitals should 5708 more actively in the discussions and elaboration of public health policies and, in this way, may participate in health care networks in a role that goes beyond the care of acute chronic conditions, contributing to the development of clinical management technologies and alternative processes.
Table 1 summarizes each of these publications 14 – In the Greater ABC area, citizens from other municipalities are considered “invaders” seeking health care services, especially primary health care services. But we cannot view regionalization solely as a guarantee of efficiency and quality.
For the interviewee from the ABC Foundation there is an ” optimism in advances in consolidating this space of inter-federative management, considering that recent health care policies have included the CGR as a space for formulating and executing its actions “. The coexistence of the specialists of the Reference Committee on Oncology with the technicians of the Health Department, the managers of the system, showed on the one hand the need for this approach to establish technical parameters to support the decisions and organization of services.
These deadlocks are present in the Greater ABC region, which make regional health care cohesion difficult.
Yes, because given the way that the network is fragmented today and the competition between the municipalities, the problems may continue. The role of the state is not only to open a social organization in the region for medium and complex treatment but also to support the municipalities decrsto, as it is they who, in fact, manage the health care systems in a region.
Therefore, regulation is aimed at providing care alternatives more appropriate to the needs of the citizen, in an even, orderly, timely and qualified fashion. According to Viana and collaboratorsstrengthening the control and assessment functions of SUS managers should concentrate mainly on the following dimensions: Thus, constituting a CGR is a step in the SUS regionalization process which, in order to work properly, requires that the planning, regulation, programming and action be coordinated between the managers and be effective and permanent.
However, it does not clarify how to structure it at level accessible to the citizen. There can be no regional health care system without the presence of the state sphere. They are seen as “aliens” or foreigners who affect monthly and yearly health care indicators.
For Oliveirathe regional health care system reconstructs the health care services on an appropriate scale by grouping together, into a cooperative system, a group of municipalities.
Organization of the cancer network in SUS: evolution of the care model
Deadlocks in the process of health regionalization: In the past 15 years, cancer has gone from the third- to second-leading cause of death in the state and has shown a gradual increase in the number of new cases. The Greater ABC area has an average of 1. Another is defining a regionalization strategy which outlines the responsibilities and roles of the various municipalities and the inclusion of diverse care units in the network.
In this way, the CGR is configured as a permanent space of agreement, co-management and decision making, through the identifying and defining priorities and agreeing solutions for the organization of an integrated, problem solving regional network of health care actions and services Brasil, Together with the DRSs, the CGRs are responsible for altering directives, objectives, aims and indicators, according to the reality and peculiarities of the local areas.
The abolition of the DUR II made it difficult to view health care in that catchment area as a regional question, as it competed with the coordination of health care actions developed at a local level. In seeking to encourage cooperation with regards health care policies in a region, the DRS are relevant.
Regionalization involves the entities organized within this fabric, such as the health care districts and regions, in intra-municipal and inter-municipal designs or even bordering health care regions, able to be administered under a regime of co-management. The abolition of the DIR II, which had been responsible for the Greater ABC region, and for its transfer to the state capital, now in the form of the DRS I, seemed to be a step backwards in the search for more efficacy in health care activities in the Greater ABC area and, consequently, for improvements in the concept of the health care region, as recommended by the SUS.
Inthe National Cancer Service SNC was created to organize, guide and control the anticancer campaign at the national level. The workforce consisted of 3, employees, of whom were physicians and were service providers from third-party companies in the areas of concierge, security, reception, nutrition, hygiene and cleaning, IT and building maintenance.
However, this Decree and its regulations do not explain the levels of the regionalization network, although they indicate the need to create health care networks. As regards the health care region, it is necessary to consolidate regionalization not simply based on norms, but based primarily on practice, on the scope of actions and services and on respective responsibility.
This article intends to reflect on the process of regionalization from an administrative and political point of view, highlighting issues of local autonomy due to the process of municipalization. Data were collected between April and December The number of health departments and health boards in the region may help to illustrate the situation as of It is the only SES hospital dedicated to the treatment of adult patients with cancer all types in the SUS, with two years of activity.
Thus, there is a need for all health professionals to act in an integrated manner. These organs aimed to coordinate and articulate health care planning and actions developed in the respective regions according to the policies and directives of the Department of Health.
Organization of the cancer network in SUS: evolution of the care model
The primary objective of developing such strategies and regulatory mechanisms has to be compatible with the introduction of innovations and “entrepreneurship” in the functioning of the health care systems in a given region, it falling to the state to guarantee better results.
We can see that the issue of politics that colored the region in the s and s may be the same thing which prevented coordinated actions in the health care sector in the last decade. In the majority of cases, less than 201 of the sum is dedicated to improvements, with the majority being spent on upkeep of the SUS network, according to Sanches a, c.
A regionalized system should still be capable of coordinating the various fields of health care in a specific territory in a coordinated way, aiming to ensure the comprehensiveness of the actions and of the access to health care services. Although we have observed evolution in dexreto regulation of cancer care in SUS, there are still many challenges for the establishment of the Oncology Network in the integrated care model.
Recently, under the influence edcreto the Shortell model, the concept by Mendes has become the basis for the guidelines of the SUS organization in Health Care Networks 4.
It also reduces extremely high social costs, imposed by the long journeys Xecreto users outside of these regions have to make.
Specific health education program for children and adolescents. These activities were structured to provide comprehensive care to adult cancer patients at all stages of treatment and for all of their needs, including palliative care when necessary We also know that the processes should be made viable through financial and administrative mechanisms. Inwith the definition of the oncology care line of the National Policy on Cancer Care, which was an important component of the establishment of a clinic management culture, the establishment of a deadline for the end of isolated chemotherapy and radiotherapy services in the Portaria SAS No.
Author information Article notes Copyright and License information Disclaimer. Gerschman affirms that this is a recurring issue in some areas of health due to the municipalization of the SUS having appeared as an option for decentralizing health care activities at the beginning of the s. The role of the state has become fundamentally important for municipalities which do not have sufficient autonomy to become independent of state government.