The regionalization of the Brazilian National Health System: proposition for performance evaluation of the Regional Health Departments of São Paulo state, Brazil

Abstract

In the last decades, the Brazilian public health has undergone major transformations, both in its model and in the performance of the State. However, due to procedural and practical deficiencies, their performance shows inefficiency in the provision of services for the population. The regionalization, as a strategy of decentralization, emerged as an alternative to solve these interfederative problems. Thus, this study aims to analyze the performance of the Brazilian National Health System regionalization strategy in São Paulo State, through the Regional Health Departments (RHD). To reach the objective, a descriptive and quantitative study was carried out, which resulted in the Regional Synthetic Indicator of Health of the State of São Paulo (RSIH/SP). A concentration of RHD with better performance was observed in the interior of São Paulo State, as well as a non-direct relation between the regions that received more resources and those that obtained better results, that is, the concepts of efficiency and effectiveness are closely related in their performance. At the end of the study, it is possible to comprehend the regionalization of health in São Paulo State in a comprehensive way, with possibilities to adapt the synthetic indicator created for other regions and to carry out more detailed studies on the performance of each level.