{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T17:51:58Z","timestamp":1759513918904},"reference-count":33,"publisher":"FapUNIFESP (SciELO)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cad. Sa\u00fade P\u00fablica"],"published-print":{"date-parts":[[2007,2]]},"abstract":"<jats:p>A compreens\u00e3o das repercuss\u00f5es do processo de des-centraliza\u00e7\u00e3o da sa\u00fade no Brasil requer a realiza\u00e7\u00e3o de investiga\u00e7\u00f5es com enfoques diferenciados, visando a captar a complexidade do objeto a partir de distintos \u00e2ngulos. Assim, o presente estudo teve por objetivo estimar o grau de implanta\u00e7\u00e3o da gest\u00e3o descentralizada da sa\u00fade, discutir a influ\u00eancia das caracter\u00edsticas de governo e da gest\u00e3o em rela\u00e7\u00e3o ao grau de reorganiza\u00e7\u00e3o das pr\u00e1ticas e seus efeitos na sa\u00fade da popula\u00e7\u00e3o, por meio de cinco estudos de caso em munic\u00edpios selecionados da Bahia, Brasil. Foi elaborado um mode-lo te\u00f3rico-l\u00f3gico, correspondente \u00e0 defini\u00e7\u00e3o de uma \"imagem-objetivo\" da descentraliza\u00e7\u00e3o da sa\u00fade que orientou a elabora\u00e7\u00e3o de matriz de indicadores. O estudo revelou que a descentraliza\u00e7\u00e3o sozinha n\u00e3o explica o est\u00e1gio de organiza\u00e7\u00e3o do sistema municipal de sa\u00fade e que caracter\u00edsticas do governo revelaram-se importantes para a reorganiza\u00e7\u00e3o das pr\u00e1ticas. Os principais problemas encontrados localizavam-se na gest\u00e3o do sistema e nas pr\u00e1ticas assistenciais, revelando serem estas \u00e1reas cr\u00edticas para futuras interven\u00e7\u00f5es, principalmente no que diz respeito \u00e0 institucionaliza\u00e7\u00e3o do planejamento e da avalia\u00e7\u00e3o, bem como em rela\u00e7\u00e3o aos projetos intersetoriais.<\/jats:p>","DOI":"10.1590\/s0102-311x2007000200012","type":"journal-article","created":{"date-parts":[[2007,1,17]],"date-time":"2007-01-17T16:50:05Z","timestamp":1169052605000},"page":"355-370","source":"Crossref","is-referenced-by-count":32,"title":["An\u00e1lise da implanta\u00e7\u00e3o da gest\u00e3o descentralizada em sa\u00fade: estudo comparado de cinco casos na Bahia, Brasil"],"prefix":"10.1590","volume":"23","author":[{"given":"Ligia Maria","family":"Vieira-da-Silva","sequence":"first","affiliation":[{"name":"Universidade Federal da Bahia,  Brasil"}]},{"given":"Zulmira M. Ara\u00fajo","family":"Hartz","sequence":"additional","affiliation":[{"name":"Funda\u00e7\u00e3o Oswaldo Cruz,  Brasil; Groupe de Recherche Interdisciplinaire en Sant\u00e9,  Canad\u00e1; Universit\u00e9 de Montreal,  Canad\u00e1"}]},{"given":"S\u00f4nia Cristina Lima","family":"Chave","sequence":"additional","affiliation":[{"name":"Universidade Federal da Bahia,  Brasil"}]},{"given":"Gerluce Alves Pontes da","family":"Silva","sequence":"additional","affiliation":[{"name":"Universidade Federal da Bahia,  Brasil"}]},{"given":"Jairnilson Silva","family":"Paim","sequence":"additional","affiliation":[{"name":"Universidade Federal da Bahia,  Brasil"}]}],"member":"530","reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.socscimed.2003.10.013","article-title":"Decentralization and public services: the case of immunization","volume":"59","author":"Khaleghian P","year":"2004","journal-title":"Soc Sci Med","ISSN":"http:\/\/id.crossref.org\/issn\/0037-7856","issn-type":"print"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1002\/hpm.624","article-title":"Myths and realities about decentralization of health systems","volume":"16","author":"Huff-Rouselle M","year":"2001","journal-title":"Int J Health Plann Manage","ISSN":"http:\/\/id.crossref.org\/issn\/0749-6753","issn-type":"print"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/S0168-8510(01)00220-2","article-title":"Social and political factors influencing the functioning of regional health boards in British Columbia (Canada)","volume":"61","author":"Frankish CJ","year":"2002","journal-title":"Health Policy","ISSN":"http:\/\/id.crossref.org\/issn\/0168-8510","issn-type":"print"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1332\/030557390782454468","article-title":"Implementing a meta-policy: the case of decentralisation in the Netherlands","volume":"18","author":"Hupe LP","year":"1990","journal-title":"Policy Polit"},{"key":"ref5","series-title":"Descentraliza\u00e7\u00e3o da sa\u00fade, interesses e conflitos decis\u00f3rios: o processo de decis\u00e3o nas inst\u00e2ncias colegiadas estaduais, Bahia, 1993-1998","author":"Guimar\u00e3es MCL","year":"2000"},{"key":"ref6","series-title":"Sa\u00fade, pol\u00edtica e reforma sanit\u00e1ria","author":"Paim JS","year":"2002"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1093\/heapol\/czi009","article-title":"Prevention and promotion in decentralized rural health systems: a comparative study from northeast Brazil","volume":"20","author":"Atkinson S","year":"2005","journal-title":"Health Policy Plan","ISSN":"http:\/\/id.crossref.org\/issn\/0268-1080","issn-type":"print"},{"key":"ref8","series-title":"Epidemiologia & sa\u00fade","first-page":"455","volume-title":"Reforma sanit\u00e1ria e os modelos assistenciais","author":"Paim JS","year":"2003"},{"key":"ref9","article-title":"Constitui\u00e7\u00e3o da Rep\u00fablica Federativa do Brasil","year":"1988","journal-title":"Di\u00e1rio Oficial da Uni\u00e3o"},{"key":"ref10","article-title":"Lei n. 8.080, de 19 de setembro de 1990. Disp\u00f5e sobre as condi\u00e7\u00f5es para a promo\u00e7\u00e3o, prote\u00e7\u00e3o e recupera\u00e7\u00e3o da sa\u00fade, a organiza\u00e7\u00e3o e o funcionamento dos servi\u00e7os correspondentes e d\u00e1 outras provid\u00eancias","year":"1990","journal-title":"Di\u00e1rio Oficial da Uni\u00e3o"},{"key":"ref11","article-title":"Lei n. 8.142, de 28 de dezembro de 1990. Disp\u00f5e sobre a participa\u00e7\u00e3o da comunidade na gest\u00e3o do Sistema \u00danico de Sa\u00fade (SUS) e sobre as transfer\u00eancias intergovernamentais de recursos financeiros na \u00e1rea da sa\u00fade e d\u00e1 outras provid\u00eancias","year":"1990","journal-title":"Di\u00e1rio Oficial da Uni\u00e3o"},{"key":"ref12","series-title":"Norma Operacional B\u00e1sica do Sistema \u00danico de Sa\u00fade\/NOB-SUS 96","year":"1997"},{"key":"ref13","article-title":"Portaria MS\/GM n. 95. Regionaliza\u00e7\u00e3o da assist\u00eancia \u00e0 sa\u00fade: aprofundando a descentra-liza\u00e7\u00e3o com eq\u00fcidade no acesso. Norma Operacional da Assist\u00eancia \u00e0 Sa\u00fade NOAS-SUS 01\/01","year":"2001","journal-title":"Di\u00e1rio Oficial da Uni\u00e3o"},{"key":"ref14","series-title":"Os atalhos da mudan\u00e7a na sa\u00fade do Brasil: Servi\u00e7os em n\u00edvel local: uma an\u00e1lise comparativa (nove estudos de casos)","first-page":"19","volume-title":"Cama\u00e7ari","author":"Vieira-da-Silva LM","year":"1989","edition":"1"},{"key":"ref15","series-title":"A descentraliza\u00e7\u00e3o das a\u00e7\u00f5es de sa\u00fade no munic\u00edpio: o caso de Cama\u00e7ari","author":"Vieira-da-Silva LM","year":"1990"},{"key":"ref16","series-title":"Descentraliza\u00e7\u00e3o do Sistema \u00danico de Sa\u00fade: trilhando a autonomia municipal","author":"Heimann LS","year":"2000"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1590\/S0102-311X2002000700014","article-title":"Mudan\u00e7as significativas no processo de descentraliza\u00e7\u00e3o do sistema de sa\u00fade no Brasil","volume":"18 Suppl","author":"Viana ALd'A","year":"2002","journal-title":"Cad Sa\u00fade P\u00fablica"},{"key":"ref18","first-page":"822","article-title":"Back to basics: does decentralization improve health system performance? Evidence from Cear\u00e1 in north-east Brazil","volume":"82","author":"Atkinson S","year":"2004","journal-title":"Bull World Health Organ","ISSN":"http:\/\/id.crossref.org\/issn\/0042-9686","issn-type":"print"},{"key":"ref19","series-title":"Theory - driven evaluations","author":"Chen H","year":"1990"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1590\/S1413-81231999000200008","article-title":"Avalia\u00e7\u00e3o do processo de des-centraliza\u00e7\u00e3o das a\u00e7\u00f5es de sa\u00fade","volume":"4","author":"Vieira-da-Silva LM","year":"1999","journal-title":"Ci\u00eanc Sa\u00fade Coletiva"},{"key":"ref21","series-title":"Applications of case study research","first-page":"77","volume-title":"Case study designs for evaluating high-risk youth programs: the program dictates the design, in applications of case study research","author":"Yin RK","year":"1993"},{"key":"ref22","series-title":"Avalia\u00e7\u00e3o em sa\u00fade: dos modelos te\u00f3ricos \u00e0 pr\u00e1tica na avalia\u00e7\u00e3o de programas e sistemas de sa\u00fade","first-page":"207","volume-title":"Metodologia para an\u00e1lise da implanta\u00e7\u00e3o de processos relacionados \u00e0 descentraliza\u00e7\u00e3o da aten\u00e7\u00e3o \u00e0 sa\u00fade no Brasil","author":"Vieira-da-Silva LM","year":"2005"},{"key":"ref23","first-page":"97","article-title":"Program evaluation in the absence of goals: a comprehensive approach to the evaluation of a population-based breast cancer screening program","volume":"(9)","author":"Mercer SL","year":"2005","journal-title":"Canadian Journal of Program Evaluation","ISSN":"http:\/\/id.crossref.org\/issn\/0834-1516","issn-type":"print"},{"key":"ref24","series-title":"Avalia\u00e7\u00e3o em sa\u00fade: dos modelos te\u00f3ricos \u00e0 pr\u00e1tica na avalia\u00e7\u00e3o de programas e sistemas de sa\u00fade","first-page":"41","volume-title":"Uso de modelos te\u00f3ricos na avalia\u00e7\u00e3o em sa\u00fade: aspectos conceituais e operacionais","author":"Medina MG","year":"2005"},{"key":"ref25","series-title":"Pol\u00edtica, planejamento e governo","author":"Matus C","year":"1993"},{"key":"ref26","series-title":"Methods of deriving the criteria, in explorations in quality assessment and monitoring","author":"Donabedian A","year":"1982"},{"key":"ref27","first-page":"1115","article-title":"The seven pillars of quality","volume":"114","author":"Donabedian A","year":"1990","journal-title":"Arch Pathol Lab Med","ISSN":"http:\/\/id.crossref.org\/issn\/0003-9985","issn-type":"print"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1056\/NEJM197301252880406","article-title":"Assessing healthy quality: the case for tracers","volume":"288","author":"Kessner M","year":"1990","journal-title":"N Engl J Med","ISSN":"http:\/\/id.crossref.org\/issn\/0028-4793","issn-type":"print"},{"key":"ref29","series-title":"Avalia\u00e7\u00e3o em sa\u00fade: dos modelos te\u00f3ricos \u00e0 pr\u00e1tica na avalia\u00e7\u00e3o de programas e sistemas de sa\u00fade","first-page":"65","volume-title":"Confer\u00eancia de consenso sobre a imagem-objetivo da descentraliza\u00e7\u00e3o da aten\u00e7\u00e3o \u00e0 sa\u00fade no Brasil","author":"Souza LEPF","year":"2005"},{"key":"ref30","first-page":"242","article-title":"El analisis prospectivo de la educaci\u00f3n m\u00e9dica en Am\u00e9rica Latina","volume":"22","author":"Ferreira JR","year":"1988","journal-title":"Educ M\u00e9d Salud"},{"key":"ref31","series-title":"Avalia\u00e7\u00e3o em sa\u00fade: dos modelos conceituais \u00e0 pr\u00e1tica na an\u00e1lise da implanta\u00e7\u00e3o de programas","first-page":"49","volume-title":"An\u00e1lise da implanta\u00e7\u00e3o de programas","author":"Denis JL","year":"2005"},{"key":"ref32","series-title":"Informa\u00e7\u00f5es em sa\u00fade"},{"key":"ref33","series-title":"Censos demogr\u00e1ficos e contagem populacional para os anos intercensit\u00e1rios, estimativas preliminares dos totais populacionais, estratificadas por idade e sexo pelo MS\/SE\/Datasus"}],"container-title":["Cadernos de Sa\u00fade P\u00fablica"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/pdf\/csp\/v23n2\/12.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2017,5,25]],"date-time":"2017-05-25T17:18:45Z","timestamp":1495732725000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0102-311X2007000200012&lng=pt&tlng=pt"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,2]]},"references-count":33,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2007,2]]}},"alternative-id":["S0102-311X2007000200012"],"URL":"https:\/\/doi.org\/10.1590\/s0102-311x2007000200012","relation":{},"ISSN":["0102-311X"],"issn-type":[{"value":"0102-311X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,2]]}}}