Resumo:
The Indigenous Health Care Subsystem (SasiSUS) was established as an integral part of the Brazilian Unified Health System (SUS) to ensure differentiated care for Indigenous populations. However, its articulation with other levels of health governance and care delivery remains institutionally fragile. This dissertation aims to analyze the interfederative articulation within SasiSUS, based on the case study of the
Paulo Afonso Base Pole, in the state of Bahia, with emphasis on governance, regional network integration, and Indigenous social participation. This is a qualitative study grounded in documental analysis of official norms, health plans, and institutional reports produced between 2019 and 2023. Data interpretation was guided by content analysis, in dialogue with critical frameworks from Collective Health. The findings
reveal that SasiSUS remains marginal to planning and interfederative negotiation instruments, showing limited inclusion in regional health governance structures, lack of formal integration mechanisms, and weak institutionalization of Indigenous social control. Operational challenges were also identified, such as high staff turnover, precarious employment conditions, and a lack of continuing education initiatives. The
study concludes that effective interfederative articulation in Indigenous health requires strengthened shared governance spaces and the active recognition of Indigenous sociocultural diversity in decision-making processes, as a condition for constructing a truly comprehensive and intercultural model of care.
