Pacto pela saúde na região noroeste do estado do Rio de Janeiro: desafios na adesão, contexto e perspectivas

One of the great challenges for the consolidation of the Unified Health System is the transfer of management responsibilities to municipalities. Aiming to overcome, among others, this challenge, emerges the Pact for Health with innovations in processes related to planning and health management at the federal, state, regional and municipal levels. Currently, the state of Rio de Janeiro has about 50% of municipalities with adhesion to the Pact, through the Term of Commitment of Municipal Management. For this study, we adopted the Northwest Fluminense Region, a lower percentage of adhesion when compared to other regions, formed by 14 municipalities, 13 of which have not joined the Pact, which represents an obstacle in the effective implementation of this policy in the region of the state. Thereby, we worked with the internal logic of regional managers, which allowed the recover the definition of the difficulties offered by the subjects involved in regional administration, as well as the significance and relevance that they express through their narratives, in front the process of adherence with the negotiation of responsibilities and the context in which they are immersed. For managers interviewed the greatest advances are related to the solidarity regionalization, which allowed the creation of democratic spaces of negotiation with the implementation of the Regional Collegiate of Management Northwestern Fluminense. On the other hand, the management difficulties listed, among which the contractualization and judicialization, have been widely discussed as a direct consequence of decentralization. Thus, this study allowed to identify four factors conflicting in the process of adherence, to consider: Pact for Health, responsibility, judicialization and contractualization