Federalismo e o SUS: um estudo sobre as mudanças dos padrões de governabilidade no Rio de Janeiro

Abstract

The changes in the governmental patterns, in the field of health, in the federal states, in the 90's, as a result of the implementation of the new constitution, occur four distinct but independent issues: in the first, the governmental instances recover autonomy and undertake new roles, as a result of descentralization of policies; in the second there is an improvement of the financing mechanisms; the third deals with the creation of a health system single directed by government level; in the fourth, a change in the assistance model takes place. The history and the degree of accumulated knowlwdge in each issue, as well as the limitations imposed to the sub-national government instances by the federal government economic policy in this decade, together with the political and socio-cultural background of each state of the federation, have produced various levels of transformation scenarios. The Rio de Janeiro State Health Secretariat takes over new accountabilities, with the responsability of organizing the Unified Health System, without having solved the organizational dificulties inherited from the fusion of the Rio de Janeiro and the Guanabara staes, when the assistance profile assumes a new format. The challenge of adjusting to to the new roles, responding to assistance demands within territorial limits, as well as the construction of national sanitary standards with the Ministry of Health, in the middle of tensions and conflicts resulting from a federal structure also under construction, give an idea of the political organizational complexity of health in the State of Rio de Janeiro.