Care integration in a health region: a paradox between regional needs and local interests

Abstract

This study aims to identify and analyze the development of regional strategies for care integration in the context of health regions, with special focus on the role of Primary Health Care (PHC). It was analyzed the minutes and observed the meetings of the Regional Intermanagers Commission (CIR) in a period of one year and also eleven interviews with municipal, regional, and state managers of Bahia, Brazil. The results indicate that PHC is an uncommon topic in the discussions of CIR, although the health region faces problems in common with other regions of Bahia and Brazil, such as the predatory dispute for doctors and poor coordination of care. The goal of forming Health Care Networks, coordinated by PHC, is still a distant goal against the urgent need to ensure access to specialized and urgency/emergency care in the health region, an issue that dominated the discussions of CIR, and PHC was limited only to city boundaries.