Descentralização e cooperação federativa no Sistema Único de Saúde: o caso do consórcio público de saúde da microrregião de Juazeiro do Norte – CE

Abstract

This dissertation analyzes the role of the Public Health Consortium of the Juazeiro do Norte Microregion as an instrument of decentralization and intergovernmental cooperation in public health policies in the state of Ceará, Brazil. It is an applied research with a qualitative approach and an exploratory-descriptive design, conducted through a case study. The units of analysis included state-level managers, consortium administrators, and municipal health secretaries from the participating municipalities, as well as institutional and regulatory documents related to health consortium policies. The data collection was carried out through bibliographic research, document analysis, and semi-structured interviews. The textual corpus was processed using the software Iramuteq, while the analysis followed a hybrid deductive-inductive strategy combined with triangulation across different sources of evidence. The results indicate that the consortium has consolidated itself as a relevant mechanism of intergovernmental cooperation, contributing to the regional organization of service provision and to the expansion of population access to specialized procedures. However, the study also highlights challenges related to the governance of the consortium arrangement, asymmetries in administrative capacity among municipalities, and the dependence on state coordination for the sustainability of the model. It is concluded that public consortia represent important institutional instruments for strengthening the regionalization of the Brazilian Unified Health System, although their effectiveness depends on coordination among federative entities and on the improvement of intergovernmental management and coordination mechanisms.