The existing literature about the causes of welfare state change, including health care reform, emphasizes stability, yet there is evidence of remarkable changes taking place in welfare systems in much of the developing world. This study analyzes health care reform in Ghana, a country which has experienced significant path-departing changes in just four decades (1957-2003). These changes – the establishment of a National Health Service system with deep (first-dollar) coverage, the introduction of a user-fee system, and the transition to a social health insurance scheme – have been pursued despite key countervailing factors, especially the high political costs associated with them. The study argues that to adequately account for these changes, the policy process should be given special consideration, particularly through the examination of how new policy proposals moved onto the agenda; how they were formulated, adopted, implemented and sustained; and how the reformers managed the entire reform process over time. Based on this analysis, I identified three main interconnected contextual and agential explanatory factors: (a) conjunctural factors, which created windows of opportunity for the changes to occur; (b) policy entrepreneurs, whose leadership, commitment and strategies helped in taking advantage of these opportunities to propel, sponsor, design, adopt, implement and sustain the policy changes; and (c) the concentrated institutional configuration of Ghana, which limited the number and scope of the veto points available to interest groups opposed to the proposed changes. While these three factors contributed to why and how the changes occurred, I identified policy entrepreneurs’ commitment, leadership and strategies, including the feedback effects of those strategies, as the most crucial factors. The study contributes to existing health policy literature by showing how perspectives such as the window of opportunity thesis, the dynamic political process model, the historical institutionalist approach to radical policy change and, finally, the ideational scholarship on framing processes can be combined to enrich our understanding of radical policy change. The study also introduces additional mechanisms of policy change that involve the use of repressive strategies before suggesting some modifications to a number of widely-shared assumptions within the welfare state literature focusing on path dependency, globalization, partisan ideology and vested interests.

O Sistema Único de Saúde (SUS), modelo universalista que existe atualmente no Brasil, encontra-se em posição de destaque dentre as políticas sociais vigentes. Num contexto de aumento de recursos e crescimento da demanda, o SUS constantemente sofre alterações que visam aumentar a qualidade, o acesso e a efetividade do serviço prestado; dessa forma, são necessários instrumentos para acompanhar seu desempenho. Não obstante, este trabalho versa em seu marco teórico sobre a trajetória do Sistema Único de Saúde e as avaliações de políticas públicas em saúde, visto que a incorporação de novas ferramentas é incontestavelmente importante para a produtividade do recurso destinado à saúde pública no Brasil - cada vez mais, a utilização de novas tecnologias e processos contribuirá para a adequada tomada de decisão dos gestores, melhores políticas públicas de saúde e um sistema verdadeiramente universal e funcional. Uma das novas ferramentas utilizadas pelo SUS é o IDSUS, que se propõe a medir o desempenho de cada município e região em relação ao acesso e à efetividade do sistema. O índice é composto por 24 indicadores, em que 14 medem o acesso à saúde e 10 se referem à efetividade do sistema. Oportunamente, para este trabalho utilizou-se como universo amostral o Grupo Homogêneo 2, divisão estabelecida pelo IDSUS para classificar os municípios de acordo com características similares de estrutura e condições de saúde. O grupo formado por 94 municípios do país foi analisado por meio de dados provenientes das bases do IDSUS e Siops, para o ano de 2011, e dados complementares do IBGE e PNUD. Após a estruturação dessas informações, procedeu-se à análise estatística descritiva e à análise de clusters, com o intuito de reagrupar os municípios semelhantes de acordo com as variáveis estabelecidas: nota do IDSUS, população e receita total em saúde per capita. Diante disso, o objetivo deste trabalho foi propor um modelo de análise de custo-efetividade para comparar as notas alcançadas no IDSUS do Grupo Homogêneo 2, diante da nova configuração de agrupamento, com as respectivas receitas totais per capita destinadas à saúde pública, além de serem detalhadas as análises por bloco de financiamento, no total de cinco, de acordo com especificações do Ministério da Saúde. A análise de custo-efetividade foi escolhida pelo fato de, dentre as ferramentas de análise econômica, permitir mensurar tanto benefícios monetários quanto benefícios sociais. Mesmo com a divisão dos municípios por grupos homogêneos e após a utilização de variáveis como população e receita para reagrupá-los, os resultados evidenciaram que existem municípios que apresentam características heterogêneas. Outro achado encontra-se na utilização e no cruzamento de duas bases distintas (IDSUS e Siops), o que proporcionou a visualização sobre o impacto dos recursos em saúde no desempenho dos municípios; isso parece complementar a avaliação de desempenho já realizada. Além disso, a análise de custo-efetividade culminou na verificação de que não só o montante de recurso financeiro impacta no melhor desempenho, como também outras variáveis, a exemplo de população e formas de alocação do recurso nos blocos de financiamento. Espera-se que este trabalho sirva como uma ferramenta de consolidação de informações e tomadas de decisão para os gestores, posto que são observados não só os dados clínicos, mas também a efetividade na alocação dos recursos no sistema de saúde. Vislumbra-se a possibilidade de contribuição para a melhoria de instrumentos de avaliação já utilizados pelo SUS. / The Public Health System (SUS), universalist model that currently exists in Brazil, is in a prominent position compared to the existing social politics. In a context of increased resources and demand, SUS is constantly changed toward to increase quality, access and effectiveness of the services; this way, tools are needed to monitor its performance. Nevertheless, the theoretical framework of this dissertation focus on SUS trajectory and the reviews of public health politics, as the incorporation of new tools is undeniably important to the funds productivity for public health in Brazil - the use of new technologies and processes will increasingly contribute to adequate decision making of managers, better public health politics and a truly universal and functional system. One of the new tools used by SUS is IDSUS, which purposes to measure the performance of each municipality and region in relation to access and effectiveness of the system. The index consists of 24 indicators: 14 measure access to health and 10 refer to the effectiveness of the system. The Homogeneous Group 2 was used as a sampling universe, division established by IDSUS to classify municipalities according to similar characteristics of structure and health conditions. The group formed by 94 municipalities in the country was analyzed using data from IDSUS and SIOPS bases, for the year 2011, and additional data from IBGE and PNUD. After structuring this information, it was carried to a descriptive statistical analysis and a cluster analysis in order to regroup similar municipalities in accordance with the established variables: IDSUS performance, population and total revenue in health per capita. Therefore, the aim of this study was to propose a model of cost-effectiveness to compare IDSUS performance achieved in Homogeneous Group 2, according to the new group setting, with its per capita total revenues for public health, besides the details of analyzes for finance package, totaling five, according to specifications of Ministry of Health. The cost-effectiveness was chosen because, among the economic analysis tools, it allows to measure both monetary and social benefits. Even with the division of municipalities by homogeneous groups and after the usage of variables such as population and income to regroup them, the results have shown there are municipalities with heterogeneous characteristics. Another finding is in use and intersection of two distinct bases (IDSUS and SIOPS), which provided visualizing the impact of health care resources in the performance of municipalities; it seems to complement the performance evaluation that was already made. Moreover, the cost-effectiveness culminated in the verification that not only the amount of financial resource impacts in better performance, but also other variables (population and ways of resource allocation in finance packages, for example). It is hoped that this work will serve as a tool to consolidate information and decision-making for managers, as not only the clinical data are observed, but also effectiveness in the resources allocation in the health system. It is seen the possibility of contributing to improve the assessment tools already used by SUS.

Made available in DSpace on 2017-07-21T14:42:40Z (GMT). No. of bitstreams: 1 Aparecida Garcia dos Santos.pdf: 2778641 bytes, checksum: 3f546ca886d40061c014cd904b8a5766 (MD5) Previous issue date: 2016-07-21 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Leprosy is a sickness that has been around for thousands of years, and since the biblical times has always been a focus of various discussions. For a long time, a person infected with leprosy was isolated from society, excluded, as well as called leper, unclean, dirty, and a sinner. In this sense, Leprosy became a sickness marked with stigma and discrimination, and those inflicted suffered from such. The objective study is to comprehend the structure of the Support Group of Patients with Leprosy (GAPHAN) while group action gives support to the public politics of health for lepers in the process of being attended. Developed in the City of Ponta Grossa – PR, in the Specialized Assistance Service (SAE), with professionals and participants of GAPHAN. This research is a descriptive and explorative work. Quality study was utilized, accomplished through semi-structured interviews with oral testimonies and non-participant observation, together with the participants of the research. The research was founded in bibliographical and documental study. The results of this research give evidence that the action of the support group strengthen the attendance and treatment of those with leprosy, in the city of study. This study made possible the understanding of the universe of meanings understood by the word leper, and gave evidence of the stigma, as explained by Goffman. The activities and happenings of GAPHAN aid in the attendance and precocious detection of leprous cases of relatives. Group co-living aids in the elevation of self-confidence, cognitive development, self-care and contributes to the reintegration of lepers into society, giving support to the public politics of health for lepers. In this sense, the group becomes a support for the control program and elimination of leprosy in the city of Ponta Grossa – PR. / A hanseníase é uma doença milenar, que desde os tempos bíblicos vem sendo foco de várias discussões. Por muito tempo, a pessoa doente era isolada da sociedade, excluída, bem como, nomeadas de termos como: leproso, imundo, sujo, pecador. Nesse sentido, a hanseníase tornou-se uma doença marcada por estigma e discriminação, os quais são vivenciados por aqueles que por ela são alcançados. A pesquisa objetiva compreender a estrutura do Grupo de Apoio a Pacientes com Hanseníase (GAPHAN) enquanto ação de grupo para dar suporte às políticas públicas de saúde voltadas aos hansenianos no processo de atendimento.Desenvolvida no Município de Ponta Grossa – PR, no Serviço de Assistência Especializada (SAE), com profissionais e participantes do GAPHAN. Trata-se de pesquisa descritiva e exploratória. Utilizou-se a pesquisa qualitativa, realizada por meio de entrevistas semiestruturadas, com depoimentos orais e observação não participante, junto aos participantes da pesquisa. Fundamentou-se em pesquisa bibliográfica e documental. Os resultados evidenciam que o grupo de apoio enquanto ação no SAE fortalece o atendimento e tratamento voltado à hanseníase,no Município de estudo. Esse estudo possibilitou compreender o universo de significados dos cometidos pela hanseníase, o qual ficou evidenciado o estigma, que é explicado por Goffman. As atividades e encontros ocorridos no GAPHAN auxiliam no atendimento e na detecção precoce dos casos de hanseníase dos familiares. A convivência grupal auxilia na elevação da autoestima, no desenvolvimento cognitivo, no autocuidado e contribui para a reintegração do hanseniano a sociedade, e dá suporte à política pública de saúde voltada à hanseníase. Nesse sentido, o grupo torna-se um apoio para o programa de controle e eliminação da hanseníase no município de Ponta Grossa – PR.

This thesis examines the politics of Zimbabwe's catastrophic cholera outbreak in 2008/09, which caused an unprecedented 98,000 cases and over 4,000 deaths. Epidemiologically, the outbreak can be explained by the breakdown of the country's water and sanitation systems. Such a reading, however, belies the byzantine political, economic and historical processes that precipitated the dysfunction of the water systems, that delineate the socio-spatial pattern of the outbreak and that account for the fragmented and inadequate response of the national health system. The complex causal factors and the far-reaching consequences of the outbreak indicate that cholera is a unique prism through which to view different political phenomena including the dilemmas and contradictions of political change, bureaucratic order, humanitarianism, crisis and citizenship in Zimbabwe. Drawing on extensive field research, I make three inter-locking arguments in this thesis. First, I argue that Zimbabwe's cholera outbreak was a 'man-made' disaster. It was the final stage of both path-dependent and contingent processes rooted in questions of political economy such as the collapse of public health infrastructure, failing livelihood strategies and violent repression. Second, I argue that cholera reproduced and exacerbated a multiplicity of socio-political crises pertaining to the legitimacy of the Zimbabwean state, the nature of structural inequalities in Zimbabwean society and fundamental flaws in the global humanitarian response to epidemics. Third, I look at the myriad meanings, memories and narratives the epidemic has left in its wake across public institutions and in civic life. I argue that cholera has been committed to historical memory as a health crisis, a political-economic crisis, and a social crisis as well as a crisis of expectations, history and social identity.

In August 2008, a biomedical intervention providing free drugs to school aged children to treat two endemic diseases –schistosomiasis haematobium and soil-transmitted helminths - in Morogoro region, Tanzania, was suspended after violent riots erupted. Parents and guardians rushed to schools to prevent their children taking the drugs when they heard reports of children dying in Morogoro town after receiving treatment. When pupils heard these reports, many of those who had swallowed the pills began to complain of dizziness and fainted. In Morogoro town hundreds of pupils were rushed to the Regional Hospital by their parents and other onlookers. News of these apparent fatalities spread throughout the region, including to Doma village where I was conducting fieldwork. Here, protesting villagers accused me of bringing the medicine into the village with which to “poison” the children and it was necessary for me to leave the village immediately under the protection of the Tanzanian police. This thesis, based on eleven months fieldwork between 2007 and 2010 in Doma village and parts of Morogoro town, asks why was this biomedical intervention so vehemently rejected? By analysing local understandings and responses to the mass distribution of drugs in relation to the specific historical, social, political, and economic context in which it occurred, it shows that there was a considerable disjuncture between biomedical understandings of these diseases, including the epidemiological rationale for the provision of preventive chemotherapy, and local perspectives. Such a disjuncture, fuelled by the reports of fatalities and the pupil’s fainting episodes brought about considerable conjecture both locally and nationally, that the drugs had been faulty, counterfeit, or hitherto untested on humans. Among many of the poorer inhabitants of Morogoro town, there was suspicion that this had been a covert sterilization campaign. From an official perspective, such conjecture was dismissed as mere rumour, proliferated by “ignorant” people. However, from an anthropological perspective, these ‘rumours’ reveal profound local anxieties including a pervasive fear that poor Africans are being targeted for covert eugenics projects by governments in the industrialized world. The thesis also shows that many of the assumptions embedded in global policies seeking to control neglected tropical diseases are mistaken. Indeed, it is suggested that it is unlikely that schistosomiasis haematobium and soil-transmitted helminths will be controlled so long as policy makers persist with the idea that one policy, designed by staff working for the World Health Organisation – with minor modifications added in Dar es Salaam - can be rolled out uniformly, irrespective of the political, social and economic context in which the programme occurs.

Η παρούσα μελέτη φιλοδοξεί να πραγματευτεί το θέμα της προαγωγής της υγείας στο πανεπιστήμιο. Συγκεκριμένα θα γίνει προσπάθεια να αναλυθούν οι έννοιες της υγείας και της προαγωγής της υγείας καθώς και οι πολιτικές για τη δημόσια υγεία και να ολοκληρωθεί με τις πολιτικές για την προαγωγή της υγείας που εφαρμόζονται στα πανεπιστημιακά ιδρύματα. Στο θεωρητικό μέρος γίνεται εκτενής αναφορά σε όλες τις έννοιες μέσα από την ανασκόπηση της υπάρχουσας βιβλιογραφίας, των επίσημων κειμένων των παγκόσμιων οργανισμών και ενώσεων για τα θέματα που αφορούν στην προαγωγή της υγείας και του θεσμικού πλαισίου τόσο της Ευρωπαϊκής Ένωσης όσο και της Ελλάδας. Στη μελέτη περίπτωσης, βασικό ζήτημα αποτελεί η διερεύνηση των πολιτικών για την προαγωγή της υγείας που εφαρμόζονται σε πανεπιστημιακά ιδρύματα σε διεθνές και εθνικό επίπεδο. Η εργασία αυτή αναδεικνύει τη σπουδαιότητα των πολιτικών για την προαγωγή της υγείας και υπογραμμίζει την ανάγκη για περαιτέρω και πιο συστηματική έρευνα που αφορά στον τομέα του Πανεπιστημίου. / In this piece of work we discuss the issue of the health promoting universities. In particular, we analyze the concept of health, health promotion and public health policies in relation to the health promotion politics at the university level. The theoretical part of this dissertation covers the literature review on the issue which is based on the archives and the official documents of the health organizations and unions over the world. Relevant data have also been drawn from the European Union and the Greek state. In this context an investigation is taken place about the health promotion policies in the universities both at international and national level. This work revealed the power of health promotion politics and underlined the need for a further and systematic research on the topic in the university sector.

Made available in DSpace on 2014-06-11T19:35:37Z (GMT). No. of bitstreams: 0 Previous issue date: 1998-08-18Bitstream added on 2014-06-13T20:07:05Z : No. of bitstreams: 1 molina_vli_dr_arafcl.pdf: 906451 bytes, checksum: edf3999baf12d2a26f8d2a6fc014d82f (MD5) Bitstreams deleted on 2014-12-12T11:34:12Z: molina_vli_dr_arafcl.pdf,Bitstream added on 2014-12-12T11:34:46Z : No. of bitstreams: 1 000139853.pdf: 1613123 bytes, checksum: 36192a232d510f78fb597ecde67aa8ea (MD5) Bitstreams deleted on 2015-08-28T16:08:52Z: 000139853.pdf,. Added 1 bitstream(s) on 2015-08-28T16:09:57Z : No. of bitstreams: 1 000139853.pdf: 10276499 bytes, checksum: 71da75345a228917b0c2885bbe31d4b0 (MD5) / O processo de investigação do presente estudo teve por objetivo discutir a negociação na formulação das políticas de saúde, em São José dos Campos entre 1980 e 1996. A relação entre as idéias expressas pelos relatores dos documentos e pelos entrevistados nos permitiu defender a tese de que as negociações das Políticas de Saúde, prevalente na perspectiva social, são técnico-burocráticas e também limitadas ao Secretário Municipal de Saúde nos meandros do Poder Local, tendo a audiência como processo básico, ao mesmo tempo excluindo-incluindo neste momento aqueles que são os setores populares/usuários do Sistema Municipal de Saúde. Podemos concluir mostrando que as experiências da Negociação Política das Políticas de Saúde, mesmo sendo técnico - burocráticas, tornaram possível um Sistema Municipal de Saúde com qualidade técnica e de reconhecimento nacional. Até agora o que permanece aberto a discussões é a relação entre a qualidade técnica destes serviços de saúde e a demanda social que eles não têm atendido com sucesso desde que as necessidades do comunitário são decodificadas pelos que estão principalmente comprometidos com os interesses da Elite Local de Poder, grupo do qual faz parte e em nome do qual trabalham. A exclusão-inclusão destes setores populares, os usuários do Sistema Municipal de Saúde no mínimo obstacula a participação popular proclamada pela própria Constituição Brasileira de 1988. É o reconhecimento de que o Poder Local ainda considera os setores populares como coadjuvantes e não autores políticos, sensíveis às questões políticas. / The process of investigation of this present study had the aim of discussing the political negotiation in the elaboration of the Health Politics in São José dos Campos, from 1980 up to 1996. The link between the ideas expressed by the documents reporters and by the subjects interviewed allowed us to defend the thesis that the negotiations of the Health Politics, prevalent in the social perspective, are technical bureaucratic and also limited to the Municipal Heath Secretary in the meanders of the Local Power having the audience of the Local Mayor with the Municipal Health Secretary as its basic process, , at the same time excluding from - including in this moment those who are the popular usufructuary sectors of the Local Health System. We may conclude by showing that the experiences of the Health Politics Political Negotiation, even being technical - bureaucratic, made possible a Municipal Health System with technical quality and national acknowledgement. So far what remains open to dicussions is the relation between the technical quality of these Health Services and the social demand it hasn't successfully answered since the needs of the community are decoded by those who are mainly committed to the concerns of the Local Elite of Power, group of which they are part and on whose behalf they work. The exclusion - inclusion of these popular sectors, the usuaries of the Municipal Health System, at least hinders the popular participation proclaimed by the 1988 Brazilian Constitution. This is the recognition that the Local Power still consirders the popular sectors as coadjuvants and not as political authors sensitive to political issues.

Submitted by Geyciane Santos (geyciane_thamires@hotmail.com) on 2015-07-30T13:37:49Z No. of bitstreams: 1 Dissertação - Luena Matheus de Xerez.pdf: 885562 bytes, checksum: a24ef14d33cd6faecd02e3717b9d1147 (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2015-07-30T20:23:50Z (GMT) No. of bitstreams: 1 Dissertação - Luena Matheus de Xerez.pdf: 885562 bytes, checksum: a24ef14d33cd6faecd02e3717b9d1147 (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2015-07-30T20:27:16Z (GMT) No. of bitstreams: 1 Dissertação - Luena Matheus de Xerez.pdf: 885562 bytes, checksum: a24ef14d33cd6faecd02e3717b9d1147 (MD5) / Made available in DSpace on 2015-07-30T20:27:16Z (GMT). No. of bitstreams: 1 Dissertação - Luena Matheus de Xerez.pdf: 885562 bytes, checksum: a24ef14d33cd6faecd02e3717b9d1147 (MD5) Previous issue date: 2013-08-30 / FAPEAM - Fundação de Amparo à Pesquisa do Estado do Amazonas / This dissertation has as goal to investigate the Leprosy History in the state of Amazonas, between 1930 to 1978, by privileging the memories from people Who experienced the treatment, that was characterized by the isolation on “colonies”, and the institutions built to sustain this disease that caused so much commotion and fear. Methodologically, we adopted two points of perspective: the first one, to collect the personal narratives and, the second one is a research into bibliographic sources and historical documents to approach the history of the institutions and the public health politics and its impacts and social threats. Accordingly, we emphasize that this dissertation privileges the socialanthropological nature of Leprosy, without ignore the biological issues, we remind that there is no disease without subject, and still, in each society and time, the way of comprehension of a disease will always be in the correlation between people and their interpretations and knowledge. / Esta dissertação teve como foco investigar a história da hanseníase no Amazonas, no período de 1930 a 1978 privilegiando, como recorte, as memórias das pessoas que experimentaram o período do tratamento que se caracterizava pelo isolamento em colônias, e as instituições que foram sendo construídas para dar conta desta doença que tanta comoção e temor causava nas pessoas sadias. Metodologicamente adotamos duas perspectivas, a primeira delas para colher as narrativas pessoais dos depoentes e, a segunda, a pesquisa em fontes e documentos históricos para abordar a história das instituições e das políticas públicas de saúde e seus impactos e contornos locais. Neste sentido ressaltamos que se trata de uma dissertação que privilegia a natureza socioantropologica da hanseníase, sem descartar as questões de natureza biológica, lembramos apenas que não há doença sem sujeito e, ainda, que em cada sociedade e tempo a forma de compreender e modelar uma doença estará sempre na correlação com as pessoas suas interpretações e saberes.

O Sistema Único de Saúde (SUS), modelo universalista que existe atualmente no Brasil, encontra-se em posição de destaque dentre as políticas sociais vigentes. Num contexto de aumento de recursos e crescimento da demanda, o SUS constantemente sofre alterações que visam aumentar a qualidade, o acesso e a efetividade do serviço prestado; dessa forma, são necessários instrumentos para acompanhar seu desempenho. Não obstante, este trabalho versa em seu marco teórico sobre a trajetória do Sistema Único de Saúde e as avaliações de políticas públicas em saúde, visto que a incorporação de novas ferramentas é incontestavelmente importante para a produtividade do recurso destinado à saúde pública no Brasil - cada vez mais, a utilização de novas tecnologias e processos contribuirá para a adequada tomada de decisão dos gestores, melhores políticas públicas de saúde e um sistema verdadeiramente universal e funcional. Uma das novas ferramentas utilizadas pelo SUS é o IDSUS, que se propõe a medir o desempenho de cada município e região em relação ao acesso e à efetividade do sistema. O índice é composto por 24 indicadores, em que 14 medem o acesso à saúde e 10 se referem à efetividade do sistema. Oportunamente, para este trabalho utilizou-se como universo amostral o Grupo Homogêneo 2, divisão estabelecida pelo IDSUS para classificar os municípios de acordo com características similares de estrutura e condições de saúde. O grupo formado por 94 municípios do país foi analisado por meio de dados provenientes das bases do IDSUS e Siops, para o ano de 2011, e dados complementares do IBGE e PNUD. Após a estruturação dessas informações, procedeu-se à análise estatística descritiva e à análise de clusters, com o intuito de reagrupar os municípios semelhantes de acordo com as variáveis estabelecidas: nota do IDSUS, população e receita total em saúde per capita. Diante disso, o objetivo deste trabalho foi propor um modelo de análise de custo-efetividade para comparar as notas alcançadas no IDSUS do Grupo Homogêneo 2, diante da nova configuração de agrupamento, com as respectivas receitas totais per capita destinadas à saúde pública, além de serem detalhadas as análises por bloco de financiamento, no total de cinco, de acordo com especificações do Ministério da Saúde. A análise de custo-efetividade foi escolhida pelo fato de, dentre as ferramentas de análise econômica, permitir mensurar tanto benefícios monetários quanto benefícios sociais. Mesmo com a divisão dos municípios por grupos homogêneos e após a utilização de variáveis como população e receita para reagrupá-los, os resultados evidenciaram que existem municípios que apresentam características heterogêneas. Outro achado encontra-se na utilização e no cruzamento de duas bases distintas (IDSUS e Siops), o que proporcionou a visualização sobre o impacto dos recursos em saúde no desempenho dos municípios; isso parece complementar a avaliação de desempenho já realizada. Além disso, a análise de custo-efetividade culminou na verificação de que não só o montante de recurso financeiro impacta no melhor desempenho, como também outras variáveis, a exemplo de população e formas de alocação do recurso nos blocos de financiamento. Espera-se que este trabalho sirva como uma ferramenta de consolidação de informações e tomadas de decisão para os gestores, posto que são observados não só os dados clínicos, mas também a efetividade na alocação dos recursos no sistema de saúde. Vislumbra-se a possibilidade de contribuição para a melhoria de instrumentos de avaliação já utilizados pelo SUS. / The Public Health System (SUS), universalist model that currently exists in Brazil, is in a prominent position compared to the existing social politics. In a context of increased resources and demand, SUS is constantly changed toward to increase quality, access and effectiveness of the services; this way, tools are needed to monitor its performance. Nevertheless, the theoretical framework of this dissertation focus on SUS trajectory and the reviews of public health politics, as the incorporation of new tools is undeniably important to the funds productivity for public health in Brazil - the use of new technologies and processes will increasingly contribute to adequate decision making of managers, better public health politics and a truly universal and functional system. One of the new tools used by SUS is IDSUS, which purposes to measure the performance of each municipality and region in relation to access and effectiveness of the system. The index consists of 24 indicators: 14 measure access to health and 10 refer to the effectiveness of the system. The Homogeneous Group 2 was used as a sampling universe, division established by IDSUS to classify municipalities according to similar characteristics of structure and health conditions. The group formed by 94 municipalities in the country was analyzed using data from IDSUS and SIOPS bases, for the year 2011, and additional data from IBGE and PNUD. After structuring this information, it was carried to a descriptive statistical analysis and a cluster analysis in order to regroup similar municipalities in accordance with the established variables: IDSUS performance, population and total revenue in health per capita. Therefore, the aim of this study was to propose a model of cost-effectiveness to compare IDSUS performance achieved in Homogeneous Group 2, according to the new group setting, with its per capita total revenues for public health, besides the details of analyzes for finance package, totaling five, according to specifications of Ministry of Health. The cost-effectiveness was chosen because, among the economic analysis tools, it allows to measure both monetary and social benefits. Even with the division of municipalities by homogeneous groups and after the usage of variables such as population and income to regroup them, the results have shown there are municipalities with heterogeneous characteristics. Another finding is in use and intersection of two distinct bases (IDSUS and SIOPS), which provided visualizing the impact of health care resources in the performance of municipalities; it seems to complement the performance evaluation that was already made. Moreover, the cost-effectiveness culminated in the verification that not only the amount of financial resource impacts in better performance, but also other variables (population and ways of resource allocation in finance packages, for example). It is hoped that this work will serve as a tool to consolidate information and decision-making for managers, as not only the clinical data are observed, but also effectiveness in the resources allocation in the health system. It is seen the possibility of contributing to improve the assessment tools already used by SUS.

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