Gestão em saúde para controle do câncer de colo do útero na Região de Saúde de Juazeiro, Bahia.

Abstract

This dissertation analyzes the experiences of managers in organizing assistance for Cervical Cancer (CC) control in the Juazeiro Health Region. It is a case study with a qualitative approach, produced through semi-structured interviews with managers, including municipal health secretaries, primary health care coordinators, scheduling/regulation center coordinators, and specialized network coordinators for the CC line. Data were used from a larger research project titled “Healthcare Integration and Access to Health Services in Health Regions: Cervical Cancer as a Tracer Condition for Understanding Healthcare Flows.” The study participants included 07 municipal managers, 03 regional managers, and 01 state manager. The results are organized into three categories: 1) Regional governance; 2) Primary health care in the care line for CC control; and 3) Referral for continuity of assistance for CC control. The interview analyses highlight the importance of the Regional Intergovernmental Commission (CIR) but reveal issues such as limited autonomy of health secretaries vis-à-vis the municipal executive power, power struggles over financial resources, arrangements in the offer and management of health services through consortia, and a lack of coordination between levels of care. Other challenges include the unpreparedness and high turnover of professionals, weak public-private relationships, political-party influences, underfunding of the SUS, the need to review the Agreed and Integrated Planning (Programação Pactuada e Integrada, PPI) due to difficulties in contracting providers due to outdated payment values for procedures. Additionally, there is low adherence and lack of information among women, as well as the absence of flows that ensure referral and counter-referral, insufficient provision of public services to meet demand, and difficulty accessing services, leading women to seek private services. Thus, the importance of articulating health professionals and managers for planning and managing different resources to enable adequate care for women in the service network related to CC is highlighted. Therefore, it becomes essential to ensure stable and sustainable funding for the SUS, manage agreed resources to improve access to consultations and exams, create new arrangements considering geographic access barriers, overcome fragmentation of programs, actions, and health services in primary care, and strengthen the CIR as a space for qualifying regionalization.