Gestão descentralizada das políticas de saúde no Brasil: uma análise do Programa Medicamento em Casa da Bahia

Abstract

During the consolidation process of a new model for health policies in Brazil, established by the Brazilian Unified Health System (SUS), several legal and institutional actions formed a new standard for Political Administration of health in the country. Grounded on the decentralizing principles of the SUS, in 2008 the Medicine at Home Program (MEDCASA) was created, for home delivery of medicine for chronic patients and women from the family planning program, and operated through decentralized management and agreed to among the state and municipal spheres. This paper had the purpose of analyzing municipal management and administration of the Medicine at Home Program in the micro-region of Salvador/Bahia, during the period from 2008 to 2012. This is an analytical-exploratory study, with a qualitative approach, performed in the micro-region of Salvador, presenting different variables for implementation and development of the Program. The results of this paper demonstrated that, even with the responsibilities of the municipal actions of the Medicine at Home Program being taken over by the management with the signing of the Letter of Intent, there is still a great distance between the ideal conditions that the municipalities should offer for management of MEDCASA and the actual conditions recounted by the interviewed professionals. Based on these results a proposed agenda was prepared with actions that aim towards improving management and administration of the Program in the municipalities. It was possible to conclude that MEDCASA faces difficulties in the scope of decentralized management and administration, further complicated by the minimalist point of view of municipal managers and administrators in relation to Pharmaceutical Assistance in the selected municipalities.