State management of primary health care in response to COVID-19 in Bahia, Brazil

Abstract This is an analysis of state management of Primary Health Care in response to the COVID-19 pandemic in Bahia. It is a qualitative case study with interviews with managers and regulatory documents analyzed according to the categories of government project and government capacity. State PHC proposals were debated in the Bipartite Intermanagerial Commission and in the Public Health Operational Emergency Committee. The scope of the PHC project focused on the definition of specific actions to manage the health crisis with the municipalities. The institutional support of the state to the municipalities modulated inter-federative relations and was decisive in the elaboration of municipal contingency plans, training of teams and production and dissemination of technical standards. The capacity of the state government was dependent upon the degree of municipal autonomy and the availability of state technical references in the regions. The state strengthened institutional partnerships for dialogue with municipal managers, but mechanisms for articulation with the federal level and social control were not identified. This study contributes to the analysis of the role of states in the formulation and implementation of PHC actions mediated by inter-federative relationships in emergency public health contexts.

摘要 本研究针对巴伊亚州应对新型冠状病毒肺炎（COVID-19）疫情的初级卫生保健（Primary Health Care，PHC）州级治理工作展开分析。本研究采用质性案例研究方法，对相关管理人员开展访谈，并依据政府项目与政府能力两大分析维度对监管文件进行分析。巴伊亚州的初级卫生保健提案曾在双边管理委员会（Bipartite Intermanagerial Commission）与公共卫生应急运营委员会（Public Health Operational Emergency Committee）中进行研讨。该初级卫生保健项目的核心范围，在于与各市政当局共同制定应对卫生危机的专项行动方案。州政府对市政当局的制度性支持，优化了府际间的互动关系，并对市级应急计划的制定、卫生团队的培训，以及技术标准的制定与推广起到了决定性作用。州政府的治理能力，取决于各市政当局的自治程度，以及该州各区域可获得的州级技术支撑资源情况。该州加强了与市政管理人员开展对话的制度性伙伴关系，但并未发现与联邦层面开展协调以及落实社会监督的相关机制。本研究有助于分析在突发公共卫生事件背景下，州政府在通过府际关系介导的初级卫生保健行动制定与实施过程中所发挥的作用。