The Pact for the health in the twin-cities of the border of the Brazil with Argentina and Uruguay

1. The Pact for the health in the twin-cities of the border of the Brazil with Argentina and Uruguay Lislei Teresinha Preuss Support received from CAPES and the work presented for participation in the event

2. Discusses on implementation and uptake of the Pact for Health under the Brazilian Unified Health System (SUS) approach, by local health systems of the twin-cities at the border of the Brazilian Rio Grande do Sul (RS) State with Argentina and Uruguay. Support received from CAPES and the work presented for participation in the event

4. The objective of the study was to evaluate the process of implementation of the Pact for Health in this region. Support received from CAPES and the work presented for participation in the event

5. The Pact for Health, in its three components - Pact for life, Pact for the Sustainability of SUS, and Pact for Management, is considered a major breakthrough in the management and relations between the federal, state and municipal governments. Support received from CAPES and the work presented for participation in the event

6. The Pact establishes the responsibilities of each entity, so as to reduce the competing powers and to set clear responsibilities, therefore contributing to the strengthening of solidarity and shared management of the SUS. Support received from CAPES and the work presented for participation in the event

7. The situation found at the border of the twin-cities region reveals a gap between the propositions of the Pact and the reality of health services available to the population, which allows to launch the hypothesis examined in this research, that decentralization and regionalization proposed by the Pact, did not ensured greater freedom to local governments, and thus no effective transfer of decision-making power in the management process occurred. Support received from CAPES and the work presented for participation in the event

8. Under four theoretical categories- territory, borders, health and management, the study rescues the history of management principles, contemporary and traditional management paradigms to analyze the theoretical categories of management and health management. Support received from CAPES and the work presented for participation in the event

9. Discusses social policy and health management in Brazil, from the Federal Constitution perspective, while conflicting processes, establishes guidelines, plans, and health programs and includes issues of creating and using resources to implement the principles of organization of this policy. Support received from CAPES and the work presented for participation in the event

10. Finally, discusses the process of health agreement in RS, with the twin-cities, analyzing it from the survey respondents’ perspective and responding to the issues and objectives of the research. Support received from CAPES and the work presented for participation in the event

11. The research findings suggest that regionalization and decentralization strategy envisaged in the Pact for Health can be an important tool for improving the provision of services and guarantee of rights to health, but the implementation has been a failure, contributing to the growing inequalities in the twin-cities at the border between the State of RS with Argentina and Uruguay. Support received from CAPES and the work presented for participation in the event