Changes in regional management strategies in coping with the COVID-19 pandemic and its implications in the health regions of the "Project to strengthen state health management in the state of São Paulo"

Abstract

The Covid-19 pandemic has called into check the entire framework of economic policies of the past 40 years, challenging broad responses from the state and social protection policies. In this context, health systems, in their different organizational models, responded more or less quickly and effectively to health needs. All suffered the risks of exhaustion of available resources, either by the abrupt increase in demand, as well as by the progressive loss of self-sufficiency of supplies (medicines, equipment and other materials) and health professionals (mainly doctors and nurses), or by conflicts between political and governmental authorities. In the case of emerging countries, the answers are more difficult, both due to the immaturity or limitations of their social protection systems - including health - as well as the weakness of their economies and the immense inequalities of income and living conditions among their inhabitants - which are evidenced in the context of crisis, both in terms of the provision of services, as well as in the disease's own espraiando. The Brazilian case does not escape the general rule, but, unlike most of these countries, presents a universal model of social protection, established in the Federal Constitution of 1988. However, data updated for Brazil reach more than 4 million confirmed cases and exceed 128,000 deaths (09/09/2020).This project aims, in view of the new pandemic situation of COVID-19, to analyze the responses implemented in health regions under intervention carried out by the SES-SP, in order to strengthen the state health management in five regions, namely, the Metropolitan Region of Campinas, the Ribeira Valley, the North Coast, Itapeva and the Jurumirim Valley. This initiative was designed and planned to contribute to the improvement of the population's health conditions, through the structuring of care according to the RRAS model and also aiming to expand access quality and comprehensiveness of services. For this, the proposed project also has as specific objectives, briefly: i) to identify the behavior of the indicators of evolution of COVID-19 in the 17 RRAS and compare with the epidemiological situation of the five regions of the Project of Strengthening the State Health Management, in the period from January 2020 to December 2021; ii) identify the intervening factors of this result and the changes related to the political dimensions, structure and organization of the networks, constituent components of the previous analysis performed and baseline of the study, and which were altered in the scenario of the COVID-19 pandemic. On the other hand, changes in the profile of contractualizations, regulation and flow of professionals and patients will be identified and analyzed, as well as an indicator of effectiveness based on epidemiological results found in the 5 regions. As a methodological contribution, this is a study with a design of quantitative and qualitative methods using secondary sources of available database, documentary analysis and the use of empirical data through regional workshops, questionnaires and interviews with key informants in the five health regions of the State of São Paulo object of the study. The regional issue in the policies developed by the SUS has been little studied in its complexity and with a more systemic view. The main contribution of the study is the establishment of parameters for the better understanding and improvement of regional and network management and the reduction of the fragmentation of care ensuring the integrality of actions and the improvement of access to the different levels of assistance in the SUS. (AU)