Avanços e limites na descentralização da vigilância sanitária em três municípios do estado do Paraná no período de 1990 a 2013

Abstract

The health surveillance decentralization process in three municipalities within the state of Paraná is assessed by identifying its procedural advances and limitations, the correlations with federal, state and municipal entities, and the profiles of their personnel. A cross-sectional, quantitative, descriptive study was conducted. Thirty-seven individuals were assessed as follows: 3 from Cruzeiro do Oeste, 27 from Maringá, and 7 from Umuarama. Essential Public Health Function 6 -Strengthening of public health regulation and enforcement capacity -by The Pan American Health Organization, was used. Data collection occurred from April to May, 2013, organized into Tables on personnel profile and working processes, followed by the analysis of the 3 indicators and 53 measurements of EPHF 6 and the averages for the performance of each municipality. Results indicated prevalence of females, mostly with secondary degree education, however, the higher educated averaged 40.5 years of age and 11.8 years of employment. The final results in Cruzeiro do Oeste indicated an average of 0.59, followed by Maringá, 0.51, and Umuarama, 0.36. With respect to effectiveness, Cruzeiro do Oeste and Maringá were ranked high-intermediate and relatively performed the essential functions, whereas Umuarama was low-intermediate and did not. Relevant progress on both control of the performance of the guidelines and support of the State towards their publication was observed. Limitations are concentrated upon internal and ethical issues resulting in institutions more vulnerable to external pressure, political interference and corruption. Financial and personnel inefficiency, worsen by population growth and economical development of the cities without increasing personnel, were observed in terms of resources. The process of decentralization for basic actions did occur in the three cities, however, the complex ones were not put into effect in Cruzeiro do Oeste. Municipalization is complex and demands transparence and debate on institutional relations and partnerships. Health surveillance depends on the three entities with a clear definition of competence as the process of decentralization is not equal for all. Participation of the state is fundamental to carry out and perform the activities. The study concluded that uncertainty towards decentralization and its effectiveness, especially in smaller towns, still remains and that further expectation of the department rely on the strengthening of the National Health Surveillance Department and Municipalization by increasing the agenda on management of public health policies.