Coap and SUS regionalization: The various implementation patterns in the Brazilian states

Abstract

This paper analyzes the implementation process of the Public Action Organizational Contract (Coap) and its impacts on state agendas of SUS regionalization, comparing the different institutional reactions of the states to the strategy proposed by Decree 7.508/11. The comparison of developing dynamics of state agendas took as reference a normative baseline structured in eight strategic political-institutional moments in the implementation of the Coap in accordance with the logic defined in Decree 7.508/11. We collected data through a questionnaire containing 35 questions (1 open, 25 closed and 9 mixed) and extensive documentary research in 2013 and 2014 in all states, except for the Federal District. Results showed that state agendas were distributed around three differentiated developing patterns: six states maintained greater distance from the national agenda established by Decree 7.508/11, engaging in a very fragmented way; 12 states engaged in the Coap agenda, selectively focusing on specific moments or stages, strengthening the process they have been developing; and 10 states maintained greater performance regularity during the eight moments of the Coap implementation cycle.