Challenges for the implementation of the Network of Care for Persons with Disabilities in a health region: a look from the dimensions policy, organization, and structure

Abstract

People with Disabilities (PWD) experience profound inequalities both social and in the access to health. The Network of Care for Persons with Disabilities (RCPD) was instituted in 2012, with the goal of improving this access in an equitable and equal manner. This article aims to analyze the implementation and constraints of the implementation and the conditionings of the RCPD in the health region of São José do Rio Preto. This is an exploratory case study, of qualitative and quantitative approach, anchored in the instrumental of public policy analysis. The dimensions of policy, organization, and structure guided the analysis of results. Interviews were conducted with 37 key players from management, providers, and society. The Ministry of Health is considered the protagonist in defining policy and transferring financial resources. The state is the service provider and conciliator of municipal demands by the RCPD direction group. The lack of an assistance regulation system is an obstacle to the organization of the network. Contracted services decide who will have access to care, not respecting agreed flows. The structure of rehabilitation services, with the exception of the Specialized Rehabilitation Center, was not guided by health needs but by the existence of services in the territory. Barriers to guaranteeing the right to health are evident, perpetuating the inequalities experienced by PWD.