Parcerias com o setor privado em serviços de saúde e inovações na gestão da atenção básica: o caso da rede municipal de Suzano, SP
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This research’s aim is to evaluate how favorable has been the implementation of health policies at the municipal level in Brazil. This evaluation is done by portraying the process of outsourcing part of the Primary Health system of a mediumsized municipality, Suzano, in the state of São Paulo. This outsourcing was done through a partnership (Convênio) signed between the municipal government and a private not-for-profit organization, a type of firm called Organização Social de Saúde (OSS). Public-private contracts in health services have been one of the most widespread policies undertaken by the Brazilian Universal Health System (SUS) since its inception in 1990; however, there are few studies that assess the its impact on health indicators and access to health services. This deficiency is due to the lack of understanding on the various types of interaction between the health system and the social actors and institutions that are involved in its implementation and management. This study was carried out as follows: (1) bibliographic research on public-private partnerships in the Brazilian Basic Health Care system; (2) inquiries with public managers from Suzano’s Municipal Health Office (SMS); (3) 19 semi-structured interviews with managers, doctors and nurses from 12 municipal basic health units; (4) interviews with administrators from the SMS. These 12 units were selected because they reflect the diversity of a medium-sized city’s neighbourhoods, social groups and health needs - to which the city’s fairly sophisticated health system attends with above-the-average competence. This study found that, although there are obstacles and missed targets, the Brazilian Universal Health System has a very positive recurring pattern: the federal level reforms that have been progressively implemented since 1990 have been mostly based on accurate assessments about SUS’ problems and, slowly but surely, have carried out positive transformations in the Brazilian health system.