Cooperation and technical support between state and municipalities: the experience of the primary health care articulators program in São Paulo

Abstract

With the regionalization processes that took place at the end of the 1990s the states begin to resume and exercise their political role in order to face the fragmentation of the public health system. In this process, the State Health Departments, represented by CONASS, start to redefine the State's functions regarding Primary Care. In the historical performance of the State Health Department in Primary Care in São Paulo, one of the marks that was left refers to the professional expertise in this field, which, with the municipalization process, migrated to the municipalities, especially the larger ones, or redefined their action areas within the State Health Department, migrating to areas like epidemiologic and sanitary surveillance, evaluation and control areas, among others. This human capital has been partly rescued from 2009 onwards, with the Primary Care Articulators Program. The Program represents a support policy of São Paulo's State Health Department to the municipalities, prioritizing those with populations below 100 thousand inhabitants, aiming to help the municipal managers in the qualification of the Primary Care services and to strengthen this level of care in the public health system. Its object of work is the recognition of local health priorities and of the obstacles to the enhancement of primary care, in the joint construction of strategies and alternatives to face the identified problems. This paper presents the process of implementation of this program, as well as some results referring to the main fronts of performance of these professionals in the search for the qualification of Primary Care in the state.