Territorialidades das Políticas Públicas de HIV/AIDS: descentralização e regionalização da saúde no Alto Solimões

Abstract

This thesis discusses how the decentralization and regionalization of health actions and services and their reflection on the care of people living with HIV in Benjamin Constant and Tabatinga, municipalities of Alto Solimões, Amazonas. The thesis holds that the process of decentralization and regionalization of health has the potential to create new territorialities, to print new configurations and contents to the structure of health policy management, particularly at the regional and state level. Given the complex nature of these processes and their implications at the local and regional level of health, as well as the dynamics of the HIV/AIDS epidemic in Amazonas, it was defined as a general objective of the research: to analyze in the health regions of Alto Solimões, the dynamics of decentralization, regionalization and construction of the network of attention to people living with HIV/AIDS. A bibliographical, documentary and field research on the subject was carried out, with emphasis on the qualitative research carried out through interviews with the technicians of the State Health Secretariat of Amazonas; health professionals, technicians and managers of the Municipal Health Secretariats of Benjamin Constant and Tabatinga. The reading of the data and information obtained allowed the understanding of the place as a fraction of the whole and that the place, the resources at its disposal (or not) presuppose the movement of the totality in each historical moment, which confers specificity and particularity. The research found: the mismatch in the process of decentralization and regionalization of health in the Amazon; advances in the formal aspects of the process of decentralization and regionalization of health in the state; we identify the persistence and reproduction of the centralization of actions and services in Manaus; the decentralization of actions and services of medium and high complexity is slowly moving in the state, maintaining the dependence of municipalities on the capital and hampering the consolidation of networks. It was also found that the networks, although designed, face real obstacles to their dynamism. It was also verified that, despite the obstacles, there was a devolution of assistance to people living with HIV to the municipalities studied. Rapid testing is fully deconcentrated for primary care services, CTAs, and emergency and emergency services. Regarding SAEs, it was found that these were decentralized to the municipalities, but presented difficulties in operationalization. The survey also shows the difficulties of implementing the network: in Benjamin Constant the decentralization of care to people living with HIV to basic care services happened and even though the municipal coordination still maintains some services in the SAE, it works precariously not being configured as rearguard for the other services of the municipality; in Tabatinga, primary health care professionals indicate that the decentralization of care to the person living with HIV to this level of care will occur, but people diagnosed with the virus were still being followed up at the SAE that has the potential to act as services. The study assumes importance in the understanding of health decentralization policy, incorporating the diversity of reality of the municipalities of Amazonas, articulating interests, financial resources, distribution of equipment, human resources to guarantee the right to health, with emphasis on people living with HIV .