Challenges for regionalizing surveillance in the perception of managers of health regions in Brazil

Abstract

The article aims to describe the perception of managers about the challenges of regionalization of Health Surveillance (HS) in six health regions in Brazil. A qualitative exploratory approach was adopted with data from semi-structured interviews, with a road map elaborated from previously defined categories of analysis, applied to six state managers of surveillance. Convergences and divergences were identified between regions based on the interviewees' discourses, examined through the thematic content analysis technique. The results showed that the regionalization of surveillance is influenced by the local context, it walks asymmetrically, with the states leading the process, but with few strengthening strategies. Among the challenges for its consolidation, there were difficulties in the appropriation of spaces for co-ordination and co-management, with little participation of HS in the discussion guidelines of the Regional Interagency Committee; in the integration of surveillance and basic care actions; in the performance of surveillance in health care networks; in addition to the lack of regulations regulating regional financing. Although the identified convergences indicate a way to implement the regionalization of the HS, the contradictions between the legitimized as desirable and the one established as practice represent concrete limits to the realization of regionalization.