O apoio institucional no Sistema Único de Saúde (SUS): os dilemas da integração interfederativa e da cogestão / Institutional support within Brazilian Health System (SUS): the dilemmas of integration between federal states and comanagement / El apoyo institucional en el Sistema Brasileño de Salud (SUS): los dilemas de la integración entre las unidades de la federación y la cogestión

Este estudo objetivou compreender a formulação do apoio institucional pelo Ministério da Saúde (MS) e como essa estratégia do método da roda vem sendo incorporada ao discurso oficial da gestão federal do SUS. O estudo se situa na categoria de pesquisa qualitativa. Analisamos documentos oficiais, diretrizes nacionais, cadernos de formação e políticas do MS. Identificamos dilemas, dificuldades e limites que os gestores do SUS vivenciam, cotidianamente, ao buscarem estratégias de mudança da lógica tradicional de governo (racionalidade gerencial hegemônica), seja na gestão democrática e participativa, ou na relação entre entes federados. A partir dos documentos analisados, pode-se supor um desejo de mudança por parte desses gestores, visto a consistência teórico-política adequada a isso. Entretanto, apresentam contradições, mostrando dificuldade de integração entre as áreas do MS e deste com os gestores descentralizados (estados e municípios)...

This study aimed to understand how institutional support was formulated by the Ministry of Health and how this strategy of a round-table method has been incorporated into the official discourse of the federal management of SUS. This study is categorized as qualitative research. We analyzed official documents, national guidelines, training booklets and policies of the Ministry of Health. We identified dilemmas, difficulties and limits that SUS managers experience daily while seeking strategies to change the traditional logic of government (hegemonic managerial rationality), either through democratic and participative management or in the relationship between federal entities. From the documents analyzed, it may be supposed that these managers have a desire for change, given that the political-theoretical consistency is appropriate for this. However, the documents present contradictions and show the difficulty of integration between areas of the Ministry of Health and between this ministry and the decentralized managers (states and municipalities)...

El objetivo de este estudio fue comprender la formulación de apoyo institucional por parte del Ministerio de Salud (MS) y de como esa estrategia del método de la rueda se ha incorporado en el discurso oficial de la gestión federal del SUS. El estudio se sitúa en la categoría de investigación cualitativa. Analizamos los documentos oficiales, las directrices nacionales, los cuadernos de formación y políticas del MS. Identificamos dilemas, dificultades y límites vividos cotidianamente por los gestores del SUS, al buscar estrategias de cambio de la lógica tradicional de gobierno (racionalidad gerencial hegemónica), tanto en la gestión democrática y participativa como en la relación entre los entes de la federación. A partir de los documentos analizados es posible suponer un deseo de cambio por parte de esos gestores, considerando la consistencia teórico-política adecuada a ello. No obstante, presentan contradicciones, mostrando la dificultad de integración entre las áreas del MS y de él con los gestores descentralizados (estados y municipios)...

Toward greater inclusion: lessons from Peru in confronting challenges of multi-sector

Despite widespread enthusiasm for broader participation inhealth policy and programming, little is known about theways in which multi-sector groups address the challengesthat arise in pursuing this goal. Based on the experience ofPeru’s National Multi-sector Health Coordinating Body(CONAMUSA), this article characterizes these challengesand identifies organizational strategies the group has adoptedto overcome them. Comprising nine government ministries,nongovernmental organizations, academia, religious institutions,and international cooperation agencies, CONAMUSAhas faced three principal challenges: 1) selecting representatives,2) balancing membership and leadership across sectors,and 3) negotiating role transition and conflict. In response,the group has instituted a rotation system for formal leadershipresponsibiliti es, and professionalized management functions;created electoral systems for civil society; and developedconflict of interest guidelines. This case study offers lessonsfor other countries trying to configure multi-sector groups,and for donors who mandate their creation, tempering unbridledidealism toward inclusive participation with a dose ofhealthy realism and practical adaptation.

A pesar del entusiasmo generalizado por la mayor participaciónen las políticas y programas sanitarios, poco sesabe sobre las formas de afrontar los retos que se planteanen la consecución de este objetivo por parte de los gruposmultisectoriales. Este artículo parte de la experiencia de laCoordinadora Nacional Multisectorial en Salud del Perú(CONAMUSA) para caracterizar dichos retos e identificarlas estrategias de organización que ha adoptado el grupo afin de superarlos. CONAMUSA, formada por nueve ministeriosdel gobierno, organizaciones no gubernamentales, institucionesacadémicas, organizaciones religiosas y agenciasde cooperación internacional, se ha enfrentado con tres retosfundamentales: 1) elegir a los representantes, 2) encontrarel equilibrio entre la representación de los miembros y elliderazgoen los distintos sectores y 3) negociar el cambio deroles y los conflictos. Para responder a estos retos el grupoha establecido un sistema rotatorio para las responsabilidadesformales de liderazgo y ha profesionalizado las funcionesde gestión, se han creado sistemas electorales para lasociedad civil y se han elaborado pautas para los conflictosde intereses. Este estudio de casos aporta lecciones para otrospaíses que estén tratando de configurar grupos multisectoriales,así como para los organismos de ayuda que dirigen sucreación, suavizando los idealismos extremos con una dosisde realismo saludable y de adaptación práctica para lograruna participación inclusiva.

Referral system in the Asir region, Saudi Arabia: knowledge, attitude and practice of physicians working in urban areas-a comparative study of governmental and private health sectors

A comparative study of knowledge, attitude and practice regarding referral system was undertaken among all governmental primary health care and private dispensary physicians [56 and 50 respectively] in Abha and Kamis, Asir Region. Results show that knowledge about referral is adequate in both groups, but the attitudes and practice of both groups need to be positively modified specially among the private sector physicians. The paper recommends more orientation programs for both groups of physicians and urges the private sector physicians to be more involved in Ministry of Health training programs and activities. Cooperation in referral between the private sector and government hospitals is seen as one way of improving health care in Saudi Arabia