Prevention and promotion in decentralized rural health systems: a comparative study from northeast Brazil.
Health Policy Plan
; 20(2): 69-79, 2005 Mar.
Article
em En
| MEDLINE
| ID: mdl-15746215
Policies to reform health care provision often combine the organizational restructuring of decentralization with ideological restructuring through a new model of health care that gives greater weight to prevention and promotion. Decentralization provides a discretionary space to the local health system to define and develop its own activities. The central policy aim to shift the model of health care therefore must rely on incentives rather than directives and is likely to result in variation at local levels in the extent and mode of its implementation. The local processes affecting variation in local implementation of policies for prevention and promotion have not been studied in a developing country. This study does so by comparing two rural health systems with different levels of prevention and promotion activities in one of the poorest regions of Brazil, Ceará State in the northeast. The health system with greater activities of prevention and promotion also has a more advanced stage of decentralization, but this is in combination with many other, interacting influences that differentiate the two health systems' ability to adopt and implement new approaches. While beyond the scope of this paper to detail options for regional and national managers to encourage the adoption of a greater focus on prevention and promotion, it is clear that strategies needs to target not only the vision and actions of local health system staff, but critically also the expectations of the local population and the attitudes of local government.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Serviços Preventivos de Saúde
/
Serviços de Saúde Rural
/
Promoção da Saúde
Tipo de estudo:
Prognostic_studies
Limite:
Humans
País/Região como assunto:
America do sul
/
Brasil
Idioma:
En
Revista:
Health Policy Plan
Assunto da revista:
PESQUISA EM SERVICOS DE SAUDE
/
SAUDE PUBLICA
Ano de publicação:
2005
Tipo de documento:
Article
País de publicação:
Reino Unido