A historical overview of regional health planning and primary care services in the state of São Paulo

Abstract

In recent years, public health debate in Brazil has settled the idea that regional planning of primary health care is an obligatory initial step towards the achievement of the principles of universality, equity and integrality of the Sistema Único de Saúde (SUS - National Health System). That view opposes the historical weight of decentralization as the essence of service organization in the States, but also marks the failure of the bureaucratic model of administration and of the classic roles of governmental levels, with particular consequences to the capability of the State Health Departments. Thus, this paper seeks to contribute with an overview of the ideas, management changes and the role of the State level in the conformation of the regional and primary care services organization in the state of São Paulo. Within the framework of discourse history, the text is structured on the identification of four dynamic periods, marked by health reforms that alter the regional issue and the question of primary care services organization in the State of São Paulo. The model of district health centers, introduced in the 1920s, is seen as the most remote origin of the contemporary discourse of primary health care.