Delineamento do planejamento da atenção hospitalar no SUS: análise neoinstitucional de uma região de saúde da Bahia.

Abstract

In view of the regionalization process, there is a need to organize hospital care and redefine the role of this service according to its classification (local, regional, state reference hospital) from the perspective of the hospital in a care network that meets the health needs of the population. In this aspect, planning allows for the articulation process in the territories and favors the aggregation of actions and services of different technological densities in the network, through the actions of actors and existing intuitions in the region. The general objective of the research is to analyze the planning of hospital care in a health region of Bahia, in the period between 2016 and 2019. This study is a qualitative research, based on document analysis, with the adoption of historical neoinstitutionalism as a theoretical reference, which based on the analysis of documents and organization of the study in three dimensions: institutional-formal dimension, political-institutional dimension and historicalinstitutional dimension based on the theoretical framework. In this context, it was possible to identify the actors and institutions involved in the process and the function they perform. As an important institution, the Regional Intermanagers Commission (CIR) is a negotiation arena and a decision-making space, with a political-institutional context that reflects the behavior of the actors and they affect the conduct within the institutions. Institutions are an integral part of the historical context, and their trajectory is relevant in shaping current health policies. The planning of hospital care, in spaces such as the CIR, addresses issues that involve the potentialities and difficulties in the implementation of the various thematic networks in the territory, which are punctuated in the structural design of the network, in the flow of access, in the regulation system and in the resources such as in the integrated agreed programming, guidelines are that generate conflicts and point out the difficulties in the implementation process. There are challenges in the construction of hospital care planning in the sense of accompanying and being cohesive with the Integrated Regional Planning. Therefore, this study helps to identify the psychological and powerful points of the institutions and actors that are part of regional and hospital planning, leading to a reflection on the importance of decentralizing state attributions in this area and strengthening regional instances such as the Regional Health Center and the CIR.