Regionalization policy in Brazilian national health system (SUS)

Brazil is a federal Republic consisting of 27 states, the Federal District and 5564 municipalities all of them with political, administrative and financial autonomy. The health care system in Brazil is strongly decentralized with concurrent responsibilities among the federal entities but without a strong cooperative tradition. Currently, the regionalization of National Health Care System (SUS) is one of the major challenges for its consolidation.  In 2006, an agreement among the spheres of government named “Pact for Health” was established, within which the regionalization was recognized as an important affair to improve quality of health care and for reducing regional differences.
These research objectives are to identify the existing tensions among the federative entities, and to recognize the efforts carried out towards regionalization of health care.
The methodology in this qualitative research is a case study. In order to gather information we participated in some regular meetings and interviewed the main actors in their own settings. There were two groups one from Rondônia State (North region of Brazil) and the other was a particular region named RIDE - Integrated Region of Development of Federal District and Adjacency.
The results show that despite the advances and organizational mobilization to seek joint solutions, the regionalization process is still nascent and there are criticisms of its management and non determination of specific funding to promote it. Furthermore, finality define the priorities for action of health units and  clarification of the powers and responsibilities of the states are fundamental to negotiation and agreement, since there is a lot of competition among the three levels of government. On the other hand, it is important to establish the role of the federal government in the process, especially in funding the development of the regional policy.