OBJECTIVE: To analyze the impact of implementing the Contrato Organizativo de Ação Pública (COAP – Public Action Organizational Contract) on the expansion of access to primary care in the states of Ceará and Mato Grosso do Sul. METHODS: We used the interrupted time series method to analyze the effect of COAP on primary care coverage (PCCov) and on avoidable hospitalization rates. To analyze the effects of increased PCCov on avoidable hospitalizations, we used non-segmented time series models. RESULTS: The results showed that implementing COAP had a positive impact on increased coverage in both cases, with did not happen in the control states. However, this impact was not reflected in the decrease in hospitalizations due to primary care sensitive conditions (HPCSC) or for acute preventable causes. When we analyzed the effects of the increase in PCCov on avoidable hospitalizations between 2009 and 2016, we observed that coverage had a positive impact on the decrease in the rate of HPCSC only in Ceará, although hospitalizations have a significant trend to decrease in time both in this state and in Mato Grosso do Sul, except for acute respiratory infections. CONCLUSIONS: The COAP continues to be the regulatory instrument of regionalization force, however, the results obtained by adhering to it in the expansion of primary care in Ceará and Mato Grosso do Sul makes us question whether the contractual model, as predicted, is the best instrument for advancing regionalization in the Brazilian Unified Health System.

At the end of the XXth century, a simple declaration of rights does not satisfy. It is necessary to establish its content meaning, and its limits with precision, so that the best structure to guarantee the right declared shall be created. Thus has tre conception of and the right to health been analysed with a view to descovering in the organization of Brazil - a federal and capitalistic State - the best tools effectively to guarantee the right to health. The municipalization of the Health Services, toghether with the need for the legislative approval of the Health Plan and the organization of the local judiciary, were considered important instruments in the quest to make the right to health effective.

An attempt at a reorganization of the Epidemiological Surveillance Service at regional level in the Central Health Region of Governador Valadares, MG, Brasil, undertaken during 1985 is reported on. This study discusses simple measures that may be taken with a view to increasing interest in Epidemiological Surveillance actions at the local level and emphasizes the fact that the of data to the local level is essential to this interest.

Este artigo teve como objetivo analisar, através da perspectiva dos gestores estaduais, como ocorreu a implementação do processo da regionalização da saúde no Rio Grande do Sul, a partir dos anos 2000. Trata-se de um estudo qualitativo descritivo, desenvolvido na Secretaria da Saúde do Estado do Rio Grande do Sul. As informações foram obtidas através de dez entrevistas semiestruturadas. Para a interpretação dos dados levantados, utilizou-se análise de conteúdo, modalidade temática. Como resultados, destacaram-se a melhoria na qualidade da atenção à saúde, o progresso na organização do sistema de saúde do estado, a mudança na função da gestão estadual, o desenvolvimento da tecnologia e o reconhecimento das instâncias de pactuação para a tomada de decisão. Identificou-se que a governança regional foi dificultada pela fragmentação do sistema e a histórica insuficiência de planejamento. Concluiu-se que se faz necessário implementar uma cultura de gestão estratégica, amparada pela alocação adequada de recursos e qualificação da governança nas regiões de saúde.