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AIM: To foster equity and make health systems economically and environmentally more sustainable, Responsible Innovation in Health (RIH) calls for policy changes advocated by mission-oriented innovation policies. These policies focus, however, on instruments to foster the supply of innovations and neglect health policies that affect their uptake. Our study's aim is to inform policies that can support RIH by gaining insights into RIH-oriented entrepreneurs' experience with the policies that influence both the supply of, and the demand for their innovations. METHODS: We recruited 16 for-profit and not-for-profit organisations engaged in the production of RIH in Brazil and Canada in a longitudinal multiple case study. Our dataset includes three rounds of interviews (n = 48), self-reported data, and fieldnotes. We performed qualitative thematic analyses to identify across-cases patterns. FINDINGS: RIH-oriented entrepreneurs interact with supply side policies that support technology-led solutions because of their economic potential but that are misaligned with societal challenge-led solutions. They navigate demand side policies where market approval and physician incentives largely condition the uptake of technology-led solutions and where emerging policies bring some support to societal challenge-led solutions. Academic intermediaries that bridge supply and demand side policies may facilitate RIH, but our findings point to an overall lack of policy directionality that limits RIH. CONCLUSION: As mission-oriented innovation policies aim to steer innovation towards the tackling of societal challenges, they call for a major shift in the public sector's role. A comprehensive mission-oriented policy approach to RIH requires policy instruments that can align, orchestrate, and reconcile health priorities with a renewed understanding of innovation-led economic development.

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The LARIISA collaborators group has been conducting research and development of technological solutions to support decision-making in health systems since 2009. GISSA, a cloud system resulting from the scientific and technological evolution of the LARIISA project, is among the solutions produced. This paper aims to describe the developing trend of GISSA©, a technological tool supporting the Family Health Strategy in northeastern Brazil, pointing out challenges, paths, and potentialities. This is a descriptive and exploratory study, based on secondary sources from the IBGE, INMET, SINAN, SIM, and SINASC, with quantitative analysis based on machine-learning techniques applied to create digital health microservices. Operating in the northeast and southeast regions, GISSA© provides information that qualifies health managers' decision-making process, improving the municipal health system's management.

O grupo de colaboradores do LARIISA realiza pesquisa e desenvolvimento de soluções tecnológicas para apoio à tomada de decisão em sistemas de saúde desde 2009. Dentre as soluções produzidas está o GISSA®, sistema em nuvem resultado da evolução científica e tecnológica do projeto LARIISA. O objetivo do presente artigo é descrever a trajetória de evolução do GISSA®, ferramenta tecnológica que apoia a Estratégia de Saúde da Família no nordeste do Brasil, apontando desafios, caminhos e potencialidades. Trata-se de um estudo descritivo e exploratório, baseado em fontes secundárias do IBGE, INMET, SINAN, SIM e SINASC, com análise quantitativa a partir de modelos de aprendizagem de máquina aplicados na criação de microserviços em saúde digital. Operando nas regiões nordeste e sudeste, o GISSA® disponibiliza informações que qualificam o processo de tomada de decisão de gestores de saúde e, consequentemente, contribui para aperfeiçoar a gestão do sistema de saúde municipal.

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Resumo O grupo de colaboradores do LARIISA realiza pesquisa e desenvolvimento de soluções tecnológicas para apoio à tomada de decisão em sistemas de saúde desde 2009. Dentre as soluções produzidas está o GISSA®, sistema em nuvem resultado da evolução científica e tecnológica do projeto LARIISA. O objetivo do presente artigo é descrever a trajetória de evolução do GISSA®, ferramenta tecnológica que apoia a Estratégia de Saúde da Família no nordeste do Brasil, apontando desafios, caminhos e potencialidades. Trata-se de um estudo descritivo e exploratório, baseado em fontes secundárias do IBGE, INMET, SINAN, SIM e SINASC, com análise quantitativa a partir de modelos de aprendizagem de máquina aplicados na criação de microserviços em saúde digital. Operando nas regiões nordeste e sudeste, o GISSA® disponibiliza informações que qualificam o processo de tomada de decisão de gestores de saúde e, consequentemente, contribui para aperfeiçoar a gestão do sistema de saúde municipal.

Abstract The LARIISA collaborators group has been conducting research and development of technological solutions to support decision-making in health systems since 2009. GISSA, a cloud system resulting from the scientific and technological evolution of the LARIISA project, is among the solutions produced. This paper aims to describe the developing trend of GISSA©, a technological tool supporting the Family Health Strategy in northeastern Brazil, pointing out challenges, paths, and potentialities. This is a descriptive and exploratory study, based on secondary sources from the IBGE, INMET, SINAN, SIM, and SINASC, with quantitative analysis based on machine-learning techniques applied to create digital health microservices. Operating in the northeast and southeast regions, GISSA© provides information that qualifies health managers' decision-making process, improving the municipal health system's management.

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This article is a conceptual essay aimed at supporting analyses of the regionalization processes implemented in Brazil's Unified Health System, from the perspective of regional governance. The authors conducted a literature review in the social sciences, public administration, and critical geography, focusing on the concepts of governance, territorial governance, and regional governance in the debate on development. In dialogue with these contributions to the analysis of recent regulation and implementation of health sector regionalization in Brazil, with special reference to use of the Organizational Contract for Public Action (COAP) in the country's health regions, the article concludes that the research on governance as a modern approach to linking public policies highlights the timeliness of developing methodologies and critical reflection on the relevant national processes in Brazil for future health sector proposals, thereby pointing to a new stage in the improvement of the Unified Health System.

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Resumo O artigo consiste de ensaio conceitual orientado a subsidiar análises dos processos de regionalização implementados no âmbito do Sistema Único de Saúde, sob a ótica da governança regional. Para isso, realiza revisão bibliográfica de literatura das ciências sociais, da administração pública e da geografia crítica que aborda os conceitos de governança, governança territorial e governança regional no debate sobre o desenvolvimento. No diálogo com os aportes trazidos por estas contribuições para a análise da regulação e implementação recentes da regionalização setorial no país, com especial referência à implantação do Contrato Organizativo da Ação Pública nas regiões de saúde, conclui que a produção científica que vem analisando soluções de governança como forma moderna de articulação de políticas públicas oportuniza a construção de metodologias e uma reflexão crítica sobre os processos nacionais relevantes para formulações futuras setoriais, ensejando uma nova etapa de aprimoramento do SUS.

Abstract This article is a conceptual essay aimed at supporting analyses of the regionalization processes implemented in Brazil's Unified Health System, from the perspective of regional governance. The authors conducted a literature review in the social sciences, public administration, and critical geography, focusing on the concepts of governance, territorial governance, and regional governance in the debate on development. In dialogue with these contributions to the analysis of recent regulation and implementation of health sector regionalization in Brazil, with special reference to use of the Organizational Contract for Public Action (COAP) in the country's health regions, the article concludes that the research on governance as a modern approach to linking public policies highlights the timeliness of developing methodologies and critical reflection on the relevant national processes in Brazil for future health sector proposals, thereby pointing to a new stage in the improvement of the Unified Health System.

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BACKGROUND: Primary health care (PHC)-based reforms have had different results in Latin America. Little attention has been paid to the enablers of collective action capacities required to produce a comprehensive PHC approach. OBJECTIVE: To analyse the enablers of collective action capacities to transform health systems towards a comprehensive PHC approach in Latin American PHC-based reforms. METHODS: We conducted a longitudinal, retrospective case study of three municipal PHC-based reforms in Bolivia and Argentina. We used multiple data sources and methodologies: document review; interviews with policymakers, managers and practitioners; and household and services surveys. We used temporal bracketing to analyse how the dynamic of interaction between the institutional reform process and the collective action characteristics enabled or hindered the enablers of collective action capacities required to produce the envisioned changes. RESULTS: The institutional structuring dynamics and collective action capacities were different in each case. In Cochabamba, there was an 'interrupted' structuring process that achieved the establishment of a primary level with a selective PHC approach. In Vicente López, there was a 'path-dependency' structuring process that permitted the consolidation of a 'primary care' approach, but with limited influence in hospitals. In Rosario, there was a 'dialectic' structuring process that favoured the development of the capacities needed to consolidate a comprehensive PHC approach that permeates the entire system. CONCLUSION: The institutional change processes achieved the development of a primary health care level with different degrees of consolidation and system-wide influence given how the characteristics of each collective action enabled or hindered the 'structuring' processes.

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Identificar las lagunas de conocimiento y las necesidades de investigación de los procesos de colaboración entre médicos de familia y especialistas. Métodos: Revisión tradicional de la literatura empírica sobre la colaboración profesional entre médicos publicada entre 1990 y 2012. Resultados: Veintiséis artículos fueron finalmente incluidos. En los trabajos revisados, el concepto de colaboración aparece poco claro y rara vez definido. La evidencia empírica disponible parece indicar que los médicos de familia se muestran más predispuestos a la colaboración que los especialistas, y alegan dos razones principales para ello: adquirir más conocimientos y fomentar el respeto mutuo. Por su parte, los especialistas tienden a no considerar a los generalistas como sus iguales, y si colaboran con ellos, lo hacen para formarlos y conseguir una mejor gestión del flujo de pacientes. Diversos factores de orden individual, organizativo e institucional parecen ejercer una influencia sobre la dinámica de colaboración entre generalistas y especialistas. Sin embargo, los resultados observados son poco concluyentes. Conclusiones: A pesar de su reconocida relevancia, la colaboración entre médicos de familia y especialistas es un proceso extremadamente complejo y no muy conocido. Para su mayor comprensión, se necesitan trabajos empíricos más exhaustivos que contemplen diferentes niveles de análisis y examinen en profundidad diversas dinámicas de acción de los actores implicados...

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Este artigo aborda o tema da avaliação sob as perspectivas do potencial em promover transformações nas organizações, das condições à sua institucionalização e das estratégias a serem utilizadas com este fim. Parte das premissas da crença em 'mudar situações', da contribuição à 'compreensão da realidade', e dos 'sentidos dos atores' sobre a tomada de decisão. Embasa a abordagem na emergência de um novo profissionalismo na gestão dos serviços e organizações; na complexidade crescente dos problemas e no papel das 'redes' e sua relação com a governança, ressaltando a legitimidade que a avaliação necessita para influenciar decisões. Destaca três tipos de avaliação no plano da prática e do conhecimento: orientada para as metas, baseada na teoria e a que privilegia a perspectiva participativa e, reflete sobre a incapacidade de resposta aos problemas ao se utilizar apenas um tipo de avaliação. Apresenta como desafios à sua institucionalização: capacidades para realizar a avaliação, estratégia sólida de difusão dos resultados e capacidades à sua utilização. Finaliza constatando que a institucionalização da avaliação supõe mudanças importantes no uso do poder para tomar decisões nas administrações públicas e recomenda o questionamento permanente das possibilidades que os trabalhos dos avaliadores têm de serem utilizados corretamente e sobre os seus benefícios para a sociedade e as instituições.

This article approaches the subject of evaluation under the perspectives of a potential to promote changing in organizations, of its institutionalization conditions and strategies to be used. It begins with the assumption of belief 'to change situation', of the contribution to 'reality understand' and of the 'actors senses' about decision making. This approach is supported by the rising of a new professionalism in services and organizations management; in the increased complexity of problems and in the role of 'networks' and its relationship with governance. It emphasizes the legitimacy needed by evaluation to influence decisions. It points out three types of evaluations by means of practice and knowledge: goaloriented evaluation, theory-driven evaluation and that with participatory perspective and discuss about the incapacity to solve problems when using only one type of evaluation. As challenges to its institutionalization, it presents: capacity to carry out evaluation, consistent strategy for results publicizing and use capacity. The article ends taking into account that the institutionalization of evaluation presumes important changing in the use of power to decision making in public administration. It recommends a permanent debate of the possibilities of correct use of evaluators work and about its benefits for society and institutions.

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