Descentralização político/administrativa e a adoção dos consórcios interfederativos de saúde na Bahia.

Abstract

The consortia-based management model has been used as an alternative for Specialized Outpatient Care (SOC) in different contexts across the country. This study aimed to analyze the adoption of this model in Bahia, with emphasis on the decision-making process and the legal and institutional strategies that enabled its implementation. This is a qualitative case study with a descriptive character, analyzing the period between 2013 and 2015, based on documentary analysis and semi-structured interviews with strategic actors. Kingdon’s Multiple Streams Framework (2003) was adopted to understand how this issue entered the political agenda of policymakers in Bahia, allowing the identification of the convergence between the problem of the care gap, the alternative of consortia-based management, and the political opportunity that enabled the opening of a window of opportunity for the adoption of the model in the state context. The results show that the adoption of the model was driven by the political leadership of the state government, in articulation with the Bahia State Department of Health (SESAB), being defined within the scope of the Bahian political conjuncture. The process was characterized by the construction of broad political consensus, supported by a narrative of intergovernmental cooperation oriented toward health regionalization, although marked by a centralized decision-making dynamic. It is concluded that the Bahian experience constitutes a hybrid arrangement, combining decentralization and centralized coordination, contributing to the strengthening of the regionalization of specialized outpatient care. Furthermore, the study contributes to the debate on health management models, federative cooperation, and the policy cycle, offering theoretical and practical inputs for the improvement of shared management models.