Abstract

BARATA, Luiz Roberto Barradas; TANAKA, Oswaldo Yoshimi  and  MENDES, José Dínio Vaz. In search of a decentralization process which consolidates the principles of the Unified Health System (SUS) in Brazil. Epidemiol. Serv. Saúde [online]. 2004, vol.13, n.1, pp.15-24. ISSN 1679-4974.  http://dx.doi.org/10.5123/S1679-49742004000100003.

The decentralization strategy, initiated by the Federal Constitution of 1988, is one of the public organizational directives mostly focused on the process of construction of the Unified Health System (SUS) in Brazil. This decentralization process differs from the tradition of centralized health care in Brazil, and has promoted the concept that local levels (municipalities) are the best managers of public health matters, because of their close proximity to the population compared to the state or federal levels. Although the municipalization process has made substantial progress in São Paulo State in recent years, this process results in new questions about public health. These questions about SUS relate to principles such as the universality and integrality of the system, and the equity of care. In addition, other important considerations are the evolution of SUS (still precarious in some areas), regionalization and hierarchizing principles, as well as a better definition of the state role as a manager of SUS and the responsibilities shared by the state and local levels of the Brazilian federation related to public health policy.

Keywords : health policy; Brazilian Health System; decentralization; municipalization; directives for the Unified Health System (SUS).

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