0005/2023 - Difusão da Estratégia Saúde da Família: fatores explicativos da adesão dos municípios de São Paulo no contexto coercitivo de indução pela esfera federal Diffusion of the Family Health Strategy: explanatory factors of the accession of municipalities in São Paulo in the coercive context of induction by the federal government
Este artigo tem como objeto de análise a adesão de municípios paulistas à Estratégia Saúde da Família (ESF). Os dados de adesão em SP demonstram que ela não ocorreu de forma unânime, imediata e nem uniforme. Utilizou-se do referencial teórico de difusão de políticas públicas, tendo como objetivo conhecer de maneira específica o processo de adoção e implementação de programas e políticas públicas por entes subnacionais, em contextos em que haja coerção pela esfera federal. A partir das discussões teóricas relacionadas ao mecanismo de difusão chamado de coerção, respondeu-se a seguinte pergunta: o que explica a difusão da ESF nos municípios paulistas, no contexto coercitivo de influência vertical? A técnica análise de sobrevivência foi aplicada para a identificação de fatores explicativos da difusão da ESF, considerando variáveis de desenho institucional, políticas e partidárias, efeito vizinhança, necessidade da política e fatores estruturais. Os resultados demonstram que as interações horizontais entre governos subnacionais, tanto ideológicas quanto regionais, e mais as questões sociais, econômicas e políticas locais foram importantes. Esse achado permite refletir sobre os limites da influência vertical na promoção de iniciativas para governos subnacionais.
Palavras-chave:
Difusão de inovações. Estratégia Saúde da Família. Coerção. Governo local. Análise de sobrevivência.
Abstract:
This paper aims to analyze the accession of municipalities in São Paulo to Family Health Strategy (FHS). The accession data in SP showed that it did not occur unanimously, immediately or uniformly. The theory of policy diffusion was used, with the objective of studying the process of adoption and implementation of public policies by subnational entities, in contexts coercion happens. From the discussions related to the diffusion mechanism called coercion, the following question was answered: what explains the diffusion of the FHS in the municipalities of SP, in coercitive context of vertical influence? A survival analysis was applied to identify explanatory factors for the diffusion of the FHS, considering covered institutional design, political and partidary aspects, neighborhood effect, internal needs, and structural factors. The results demonstrate that horizontal interactions between subnational governments, both ideological and regional, plus the local social, economic and political issues are relevant to answer the research questions. This finding allows us to reflect on the limits of vertical influence in the promotion of initiatives for subnational governments.
Keywords:
Diffusion of Innovation. Family Health Strategy. Coercion. Local government. Survival analysis.
Diffusion of the Family Health Strategy: explanatory factors of the accession of municipalities in São Paulo in the coercive context of induction by the federal government
Resumo (abstract):
This paper aims to analyze the accession of municipalities in São Paulo to Family Health Strategy (FHS). The accession data in SP showed that it did not occur unanimously, immediately or uniformly. The theory of policy diffusion was used, with the objective of studying the process of adoption and implementation of public policies by subnational entities, in contexts coercion happens. From the discussions related to the diffusion mechanism called coercion, the following question was answered: what explains the diffusion of the FHS in the municipalities of SP, in coercitive context of vertical influence? A survival analysis was applied to identify explanatory factors for the diffusion of the FHS, considering covered institutional design, political and partidary aspects, neighborhood effect, internal needs, and structural factors. The results demonstrate that horizontal interactions between subnational governments, both ideological and regional, plus the local social, economic and political issues are relevant to answer the research questions. This finding allows us to reflect on the limits of vertical influence in the promotion of initiatives for subnational governments.
Palavras-chave (keywords):
Diffusion of Innovation. Family Health Strategy. Coercion. Local government. Survival analysis.
Carvalho, G.P, Coêlho, D.B. Difusão da Estratégia Saúde da Família: fatores explicativos da adesão dos municípios de São Paulo no contexto coercitivo de indução pela esfera federal. Cien Saude Colet [periódico na internet] (2023/Jan). [Citado em 28/09/2024].
Está disponível em: http://cienciaesaudecoletiva.com.br/artigos/difusao-da-estrategia-saude-da-familia-fatores-explicativos-da-adesao-dos-municipios-de-sao-paulo-no-contexto-coercitivo-de-inducao-pela-esfera-federal/18631
