ANA LUIZA D AVILA VIANA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Medicina Preventiva, Faculdade de Medicina - Docente
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina
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- Regionalização e acesso à saúde nos estados brasileiros: condicionantes históricos e político-institucionais(2012) LIMA, Luciana Dias de; VIANA, Ana Luiza d'Avila; MACHADO, Cristiani Vieira; ALBUQUERQUE, Mariana Vercesi de; OLIVEIRA, Roberta Gondim de; IOZZI, Fabiola Lana; SCATENA, Joao Henrique Gurtler; MELLO, Guilherme Arantes; PEREIRA, Adelyne Maria Mendes; COELHO, Ana Paula SantanaThis article examines the healthcare regionalization process in the Brazilian states in the period from 2007 to 2010, seeking to identify the conditions that favor or impede this process. Referential analysis of public policies and especially of historical institutionalism was used. Three dimensions sum up the conditioning factors of regionalization: context (historical-structural, political-institutional and conjunctural), directionality (ideology, object, actors, strategies and instruments) and regionalization features (institutionality and governance). The empirical research relied mainly on the analysis of official documents and interviews with key actors in 24 states. Distinct patterns of influence in the states were observed, with regionalization being marked by important gains in institutionality and governance in the period. Nevertheless, inherent difficulties of the contexts prejudice greater advances. There is a pressing need to broaden the territorial focus in government planning and to integrate sectorial policies for medium and long-term regional development in order to empower regionalization and to overcome obstacles to the access to healthcare services in Brazil.
- Federalism and health policy: the intergovernmental committees in Brazil(2014) MACHADO, Cristiani Vieira; LIMA, Luciana Dias de; VIANA, Ana Luiza d'Avila; OLIVEIRA, Roberta Gondim de; IOZZI, Fabiola Lana; ALBUQUERQUE, Mariana Vercesi de; SCATENA, Joao Henrique Gurtler; MELLO, Guilherme Arantes; PEREIRA, Adelyne Maria Mendes; COELHO, Ana Paula SantanaOBJECTIVE: To analyze the dynamics of operation of the Bipartite Committees in health care in the Brazilian states. METHODS: The research included visits to 24 states, direct observation, document analysis, and performance of semi-structured interviews with state and local leaders. The characterization of each committee was performed between 2007 and 2010, and four dimensions were considered: (i) level of institutionality, classified as advanced, intermediate, or incipient; (ii) agenda of intergovernmental negotiations, classified as diversified/restricted, adapted/not adapted to the reality of each state, and shared/unshared between the state and municipalities; (iii) political processes, considering the character and scope of intergovernmental relations; and (iv) capacity of operation, assessed as high, moderate, or low. RESULTS: Ten committees had advanced level of institutionality. The agenda of the negotiations was diversified in all states, and most of them were adapted to the state reality. However, one-third of the committees showed power inequalities between the government levels. Cooperative and interactive intergovernmental relations predominated in 54.0% of the states. The level of institutionality, scope of negotiations, and political processes influenced Bipartite Committees' ability to formulate policies and coordinate health care at the federal level. Bipartite Committees with a high capacity of operation predominated in the South and Southeast regions, while those with a low capacity of operations predominated in the North and Northeast. CONCLUSIONS: The regional differences in operation among Bipartite Interagency Committees suggest the influence of historical-structural variables (socioeconomic development, geographic barriers, characteristics of the health care system) in their capacity of intergovernmental health care management. However, structural problems can be overcome in some states through institutional and political changes. The creation of federal investments, varied by regions and states, is critical in overcoming the structural inequalities that affect political institutions. The operation of Bipartite Committees is a step forward; however, strengthening their ability to coordinate health care is crucial in the regional organization of the health care system in the Brazilian states.
- Tipologia das regiões de saúde: condicionantes estruturais para a regionalização no Brasil(2015) VIANA, Ana Luiza D´Ávila; BOUSQUAT, Aylene; PEREIRA, Ana Paula Chancharulo de M.; UCHIMURA, Liza Yurie Teruya; ALBUQUERQUE, Mariana Vercesi de; MOTA, Paulo Henrique dos Santos; DEMARZO, Marcelo Marcos Piva; FERREIRA, Maria PaulaThe socioeconomic development, supply and complexity of health actions and services in a regional context may be considered structural constraints to the success of the current process of health care regionalization in Brazil. The main objective of this study is to identify the structural determinants of the regionalization process by building a typology of health regions in Brazil. A typology of Brazilian health regions was developed from available secondary data sources. The dimensions and groups that form the typology were identified through factor analysis and cluster analysis. The type of service provider both for out and inpatients was also identified. Results: the regions were classified into five independent groups according to their socioeconomic profile and characteristics of the health service supply. The characterization of Brazilian health regions through the typology demonstrates high levels of heterogeneity throughout Brazil, and the complex organization of the regional health systems. The proposed typology could contribute to future research and better understanding of this complex and contradictory scenario, supporting the urgently required development of integrated regional public policies that simultaneously involve economic and social development and the strengthening of regional spaces of governance in order to promote the organization of regional health systems grounded on the principles of the SUS (Brazilian National Health System), under a shared, joint management with the objective of ensuring the universal right to health.