Regionalização e justiça territorial nas políticas da região de saúde de Salvador

Abstract

This study sought to understand whether the regionalization of health generates spatial justice in the Health Region of Salvador, investigating the Unified Health System (SUS) in two different contexts of Brazilian federalism (localism x regionalism). Spatial justice is a concept that has been built in Brazilian geography in recent decades and prioritizes several elements in the approaches. In this research, the notion of spatial justice prioritizes the territorial logic of equitable distribution of health services, aiming to fill the gap that exists in geography regarding the territorial expression of health. In this way, with localism in health, municipalities assume the leading role in carrying out the management of health policies in their territory, however, it was notable that most Brazilian municipalities do not have adequate resources and infrastructure to offer services of primary care to its population. For this reason, regionalization, a later stage that complements localism, has become a viable strategy for correcting territorial inequalities in health, through the mobilization of collective efforts of the entities involved in the provision of medium and high complexity services (MAC ), the main target of regionalization. However, without losing sight of the complexity of the processes involved in the socio-spatial dialectic of the territorialization of health, it appears that the logic of solidarity present in the SUS guidelines does not always prevail in the distribution of resources, as the asymmetries of power in the municipalities are common. influence the direction of regionalization, generating competition for scarce resources in the Health Region. Thus, the research points out that regionalization in health is a continuous and unfinished process, crossed by the political game of social forces, and their experiences cannot be unique in different territories. In this way, spatial justice becomes an analytical and political horizon that can contribute to the construction of a regionalization that helps to reduce territorial health inequalities.