The process of implementation of emergency care units in Brazil

Abstract

OBJECTIVE: To analyze the process of implementation of emergency care units in Brazil.METHODS: We have carried out a documentary analysis, with interviews with twenty-four stateurgency coordinators and a panel of experts. We have analyzed issues related to policy backgroundand trajectory, players involved in the implementation, expansion process, advances, limits,and implementation difficulties, and state coordination capacity. We have used the theoreticalframework of the analysis of the strategic conduct of the Giddens theory of structuration.RESULTS: Emergency care units have been implemented after 2007, initially in the Southeastregion, and 446 emergency care units were present in all Brazilian regions in 2016. Currently, 620emergency care units are under construction, which indicates expectation of expansion. Federalfunding was a strong driver for the implementation. The states have planned their emergencycare units, but the existence of direct negotiation between municipalities and the Union hascontributed with the significant number of emergency care units that have been built but thatdo not work. In relation to the urgency network, there is tension with the hospital because ofthe lack of beds in the country, which generates hospitalizations in the emergency care unit. Themanagement of emergency care units is predominantly municipal, and most of the emergencycare units are located outside the capitals and classified as Size III. The main challenges identifiedwere: under-funding and difficulty in recruiting physicians.CONCLUSIONS: The emergency care unit has the merit of having technological resources andbeing architecturally differentiated, but it will only succeed within an urgency network. Federalinduction has generated contradictory responses, since not all states consider the emergencycare unit a priority. The strengthening of the state management has been identified as a challengefor the implementation of the urgency network.