The process of implementation of emergency care units in Brazil

Authors

  • Gisele O’Dwyer Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Departamento de Administração e Planejamento em Saúde
  • Mariana Teixeira Konder Universidade Estadual do Rio de Janeiro. Faculdade de Ciências Médicas. Departamento de Clínica Médica
  • Luciano Pereira Reciputti Fundação Oswaldo Cruz. Iniciação Científica. Escola Nacional de Saúde Pública. Departamento de Administração e Planejamento em Saúde
  • Mônica Guimarães Macau Lopes Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas e Estratégicas
  • Danielle Fernandes Agostinho Fundação Oswaldo Cruz. Iniciação Científica. Escola Nacional de Saúde Pública. Departamento de Administração e Planejamento em Saúde
  • Gabriel Farias Alves Fundação de Apoio à Pesquisa do Estado do Rio de Janeiro Iniciação Científica. Escola Nacional de Saúde Pública. Departamento de Administração e Planejamento em Saúde

DOI:

https://doi.org/10.11606/S1518-8787.2017051000072

Keywords:

Emergency Medical Services, Manpower. Health Manager. Health Services Administration. Resources Management. Health Management. Health Policy.

Abstract

OBJECTIVE: To analyze the process of implementation of emergency care units in Brazil. METHODS: We have carried out a documentary analysis, with interviews with twenty-four state urgency coordinators and a panel of experts. We have analyzed issues related to policy background and trajectory, players involved in the implementation, expansion process, advances, limits, and implementation difficulties, and state coordination capacity. We have used the theoretical framework of the analysis of the strategic conduct of the Giddens theory of structuration. RESULTS: Emergency care units have been implemented after 2007, initially in the Southeast region, and 446 emergency care units were present in all Brazilian regions in 2016. Currently, 620 emergency care units are under construction, which indicates expectation of expansion. Federal funding was a strong driver for the implementation. The states have planned their emergency care units, but the existence of direct negotiation between municipalities and the Union has contributed with the significant number of emergency care units that have been built but that do not work. In relation to the urgency network, there is tension with the hospital because of the lack of beds in the country, which generates hospitalizations in the emergency care unit. The management of emergency care units is predominantly municipal, and most of the emergency care units are located outside the capitals and classified as Size III. The main challenges identified were: under-funding and difficulty in recruiting physicians. CONCLUSIONS: The emergency care unit has the merit of having technological resources and being architecturally differentiated, but it will only succeed within an urgency network. Federal induction has generated contradictory responses, since not all states consider the emergency care unit a priority. The strengthening of the state management has been identified as a challenge for the implementation of the urgency network.

Published

2017-12-04

How to Cite

O’Dwyer, G., Konder, M. T., Reciputti, L. P., Lopes, M. G. M., Agostinho, D. F., & Alves, G. F. (2017). The process of implementation of emergency care units in Brazil. Revista De Saúde Pública, 51, 125. https://doi.org/10.11606/S1518-8787.2017051000072

Issue

Section

Original Articles