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Advisor(s)
Abstract(s)
Nos últimos 50 anos, em Portugal, diversos governos ao transformarem o modelo de funcionamento do
Estado enveredaram pela descentralização. Seguindo uma senda reformadora, o XXI Governo
Constitucional, estabeleceu como base da reforma do Estado a concretização dos princípios da
subsidiariedade, da autonomia das autarquias locais e da descentralização da administração pública.
Das diversas áreas descentralizadas e tendo em conta o melhor interesse dos cidadãos, foram
transferidas para a alçada das autarquias locais um conjunto de competências no domínio da saúde.
Este estudo visou analisar se a descentralização da saúde vai ao encontro dos interesses dos
cidadãos e do Município do Fundão. A pesquisa envolveu a análise documental do processo de
transferência e entrevistas semiestruturadas com representantes do Município, da Administração
Regional de Saúde do Centro e do Agrupamento de Centros de Saúde da Cova da Beira e presidentes de
junta. A técnica de análise de conteúdo foi usada para avaliar a
perceção dos entrevistados sobre a implementação das competências transferidas.
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Os resultados indicaram que há potencial para maior proximidade entre a comunidade e a autarquia,
permitindo um atendimento mais focado nas necessidades locais. No entanto, embora a
descentralização atenda ao interesse dos cidadãos a curto prazo, existem preocupações quanto ao
acesso aos cuidados de saúde no longo prazo, especialmente pela falta de profissionais de saúde.
Além disso, constatou-se uma desproporção entre as competências transferidas e o financiamento,
que é insuficiente para atender às
necessidades.
Apesar de uma visão positiva sobre a descentralização, o mesmo não se observa em relação às da
saúde, sobretudo pelo financiamento para fazer face às necessidades pré-existentes e ao próprio
papel da Autarquia. Além disso, não é garantido o maior acesso a cuidados de saúde pela escassez de
profissionais, colocando-se desafios de gestão de expectativas,
priorização de necessidades e gestão de recursos.
Over the past 50 years, several governments in Portugal, by transforming the state’s operational model, have embraced decentralization. Following a reformist path, the XXI Constitutional Government established the realization of the principles of subsidiarity, local government autonomy, and public administration decentralization as the basis for state reform. Among the various decentralized areas, and considering the best interests of citizens, a set of responsibilities in the health sector was transferred to local authorities. This study aimed to analyze whether the decentralization of health aligns with the interests of citizens and the Municipality of Fundão. The research involved a documentary analysis of the transfer process and semi-structured interviews with representatives from the Municipality, the Regional Health Administration of the Centre, the Cova da Beira Health Centers Group, and local council presidents. Content analysis techniques were used to assess the interviewees' perceptions on the implementation of the transferred responsibilities. The results indicated that there is potential for greater proximity between the community and the municipality, allowing for a more focused approach to local needs. However, although decentralization serves the citizens’ interests in the short term, there are concerns about access to healthcare in the long term, particularly due to the lack of healthcare professionals. Additionally, there was a disproportion between the transferred responsibilities and the funding, which is insufficient to meet the needs. Despite a generally positive view on decentralization, this is not the case with health, mainly due to the funding required to address pre-existing needs and the role of the municipality itself. Furthermore, greater access to healthcare is not guaranteed due to the shortage of professionals, posing challenges in managing expectations, prioritizing needs, and resource management.
Over the past 50 years, several governments in Portugal, by transforming the state’s operational model, have embraced decentralization. Following a reformist path, the XXI Constitutional Government established the realization of the principles of subsidiarity, local government autonomy, and public administration decentralization as the basis for state reform. Among the various decentralized areas, and considering the best interests of citizens, a set of responsibilities in the health sector was transferred to local authorities. This study aimed to analyze whether the decentralization of health aligns with the interests of citizens and the Municipality of Fundão. The research involved a documentary analysis of the transfer process and semi-structured interviews with representatives from the Municipality, the Regional Health Administration of the Centre, the Cova da Beira Health Centers Group, and local council presidents. Content analysis techniques were used to assess the interviewees' perceptions on the implementation of the transferred responsibilities. The results indicated that there is potential for greater proximity between the community and the municipality, allowing for a more focused approach to local needs. However, although decentralization serves the citizens’ interests in the short term, there are concerns about access to healthcare in the long term, particularly due to the lack of healthcare professionals. Additionally, there was a disproportion between the transferred responsibilities and the funding, which is insufficient to meet the needs. Despite a generally positive view on decentralization, this is not the case with health, mainly due to the funding required to address pre-existing needs and the role of the municipality itself. Furthermore, greater access to healthcare is not guaranteed due to the shortage of professionals, posing challenges in managing expectations, prioritizing needs, and resource management.
Description
Dissertação para a obtenção do grau de Mestre em Administração Pública
Keywords
Descentralização Saúde Proximidade Município do Fundão Decentralization Health Proximity Municipality of Fundão