Silva Bueno, Wanderlei. Betim: construindo um gestor pleno. [Building t otal management.] In: Merhy, Emerson E., Onocko, Rosana. Agirem saúde: um desafio para o público. [Performance in health care: a publicchallenge.] São Paulo: Editora Hucitec / Buenos Aires: Lugar Editorial, 1997. p. 169 – 196.

Objectives: To present the work carried out by the Health Administration and Planning Laboratory of the University of Campinas, at the request of the health authorities of the municipality of Betim. The overall objective was to transform the health care model from one focused on hospitals to one based on units of primary care. A further concern of the health authorities was to prevent the privatization of services.

Methodology: Analytic and descriptive

Results: The authors describe the initial activities carried out by health authorities to define accurately the assistance and managerial models, projects and goals, and stages of implementation. This chapter explains work dynamics, problems encountered, and proposed solutions. The plan adopted to evaluate services is also described, as are the results of the two assessments made with the plan. The first assessment was carried out at the beginning of the reorganization of the municipal health care system and the second, one year after its implementation.

The reorganization process was based on the concept of the Unified Health System (Sistema Único de Salud), as grounded in the 1988 Brazilian Constitution, which focused on taking care of users’ needs by giving them broad access to services.

Conclusions: The project’s accomplishments showed that the government was able to meet the challenge of reform, and to address the health problems of a major portion of the population, in an efficient manner. The author poses a series of questions that open new challenges to the task of continuing municipal reform are also posed.

The chapter concludes with a critique of the Basic Operational Norm (Norma Operacional Básica) of 1996, approved by the Brazilian government. Although the 1996 Norm proposed that municipalities manage health care systems, it also created obstacles to the realization of this goal.

Copyright 2007 University of New Mexico