Governance of medium complexity health actions and services in a health region

Abstract

The study aimed at analyzing actors, spaces and challenges faced in the governance of actions and services of medium complexity health (ASMC) in a health region. A qualitative study, developed through interviews with public health managers, a representative of the State Health Manager, the regional supporter of NN and the director of the Intermunicipal Health Consortium. The results allowed to classify the actors in government and market. The meetings of the Regional Interagency Commissions were highlighted as possible spaces for ASMC governance. Among the challenges are: the lack of solidarity and sharing of responsibilities between federative entities; the fragility of the municipal entity in relation to the other actors involved in governance; the political interference of deputies with the state manager. ASMC governance presents itself as a great game, permeated by competitive relationships and conflicts.