[The decentralization and municipalization of health services in Säo Paulo, Brazil]. / Descentralización y municipalización de los servicios de salud en São Paulo, Brasil.

The health system in Brazil has undergone profound changes since the 1980s. In the state of São Paulo, the processes of decentralization to the municipio and regional levels, as well as integration of health services, began in 1983. This study describes the strategies adopted by the Ministry of Health of the state of São Paulo to implement these processes and create 65 regional health offices, and discusses the role of these offices in the new unified health system. It is concluded that decentralization has resulted in increased local government participation in financing the health system, that production of medical and community health services has grown, and that health indicators have improved.

[Local health systems: challenges for the 90's]. / Los sistemas locales de salud: desafíos para la década de los noventa.

This article gives a general overview of present local health systems and their possible future. It reviews the background that led the countries of the Americas to make plans to transform their national health systems and points out the key role played by local health systems in this undertaking. In addition to summarizing the basic conditions necessary for setting up a local health system, the authors define these local systems as instruments for decentralization of the State and the expression of democratic action. They consider it an imperative for the 1990s to ensure that the services are improved in terms of equity and quality, democratization and social participation, economic and social development and transformation, and efficiency and use of appropriate technology. Stress is placed on the comprehensive concept of health, well-being, and development, as well as on health promotion by the population itself, while taking into account the responsibilities that correspond to national sector agencies and to local communities.