Regional Health Planning in Brazil from the perspective of health managers: advances and challenges

Abstract The scope of this study was to analyze, from the standpoint of managers, the conformity of the process of regionalization in health in Brazil, with emphasis on the main advances and challenges. A mixed exploratory and descriptive study was conducted. In the first stage, an electronic questionnaire was given to managers from all health regions of the country. In the second stage, focus groups were staged with managers in all macro regions. A semi-structured interview was used to encourage managers to speak about the advances and main challenges of the process of regionalization. The data was analyzed using Iramuteq software, more specifically the Descending Hierarchical Classification (DHC), resulting in three main themes: the first deals with the efforts made for the regional organization at the macro level of management, with emphasis on reducing inequalities, actions and services to users; the second demonstrates the regional organization and the difficulties for the organization of the local system; the third reveals difficulties in accessing health services, especially those with greater technological complexity. The research results point to advances and challenges, involving a risk for the structuring of the regionalization process, with bureaucratic and fragmentation implications.

摘要
本研究旨在从管理者视角，分析巴西卫生区域化进程的合规性，并重点探讨其主要进展与挑战。本研究采用探索性与描述性混合研究设计。第一阶段，向巴西所有卫生区域的管理者发放电子问卷；第二阶段，针对所有宏观区域的管理者开展焦点小组座谈。研究采用半结构化访谈，引导管理者围绕区域化进程的进展与核心挑战展开讨论。研究使用Iramuteq软件，依托分层递阶分类法（Descending Hierarchical Classification, DHC）对数据进行分析，最终提炼出三大核心主题：其一为宏观管理层面的区域化组织工作，重点涵盖缩小卫生服务差距、面向服务对象的相关举措与服务供给；其二围绕区域化组织及本地卫生系统搭建过程中面临的困境展开；其三则揭示了卫生服务获取层面的障碍，尤其是技术复杂度较高的医疗服务。研究结果同时指出了当前区域化进程的进展与挑战，其存在的官僚化与碎片化问题或将对区域化进程的体系化构建构成风险。