Análise política da gestão regional da rede de oncologia de uma macrorregião de saúde do estado da Bahia.

Abstract

The organization of regionalized and integrated networks has been used as a strategy to optimize resources, improving efficiency and effectiveness in the provision of health services. Care networks have foundations on the construction of health territories that go beyond the municipal boundaries, calling for intergovernmental articulation strategies. At the same time, there has been a diversification of arrangements in the supply and management of health services with different configurations between the public and private sectors. The management of the network demands, therefore, articulations of a political nature. A political analysis of the regional management of a health care network was carried out with respect to the analysis of the decision-making processes on the implementation of the oncology network in the Southwestern Health Macro-region of the State of Bahia. This is a case study supported by Bourdieu's reflexive sociology that combined semi-structured interviews, document analysis and systematic observation of the meetings of the CIR and the Southwest Macro-regional Committee for Chronic Diseases and secondary data analysis. The empirical data were analyzed from the triangulation of the collection techniques collated with the theoretical framework of the study. Medium and high complexity care in oncology in the Southwest Macro-region is provided by the services of two UNACON, one public and the other private, located in the pole city; an oncologic specialties ambulatory that serves only two of the five health regions; and three Regional Health Polyclinics. Regional management was constituted as an inter-field space formed by the bureaucratic, political, and economic fields, the latter represented by the private sector contracted to the SUS. Network management was partially carried out in the formally established deliberative spaces, especially in the CIR of the Vitória da Conquista health region and in the Committee. However, the decision-making process was also defined by unilateral deliberations of the executive power of the pole municipality, by means of political-partisan criteria disregarding the collective decisions agreed in deliberative spaces, showing in this way the fragility of the CIR. The main issues at stake were the disputes over financial resources that accentuated the conflicts between managers, the bureaucratic field, and the private sector. The existence of different management models of service providers intensified the challenges of building an integrated network. The decision-making processes favored the participation of federal managers and service providers, with the absence of civil society, health professionals, and little participation of social control, leading to management restricted to the bureaucratic structures of the state. Decisions were mainly determined by agents of the bureaucratic field who accumulated greater health and bureaucratic capital, and by the influence of the economic field through the use of social capital by the private sector. These were the most determinant capitals that conferred greater power of articulation to the agents in the analyzed period. The dominant point of view concerning the organization of the oncology network was based on the flexibility of the SUS guidelines, through arrangements with the private sector as a way to guarantee the user's access to the care network. Although some agents with high capital in the health area defended a comprehensive and equitable oncology network, this stance was weakened in favor of the logic of accommodating market interests. The evidences pointed out that the bureaucratic field has reproduced the historical model of traditional Public Health.