Human resources for health and decentralization policy in the Brazilian health system

The Brazilian health reform process, following the establishment of the Unified Health System (SUS), has had a strong emphasis on decentralisation, with a special focus on financing, management and inter-managerial agreements.

This paper assesses whether the process of decentralising human resources for health (HRH) management and organisation to the level of the state and municipal health departments has involved investments in technical, political and financial resources at the national level.

Using a combination of survey and focus group data, as well as through triangulation with the results of previous research, the authors find that:

• the evolution policy, previously restricted to the field of 'personnel administration', has now expanded to a conceptual model for health labour management and education.
• 76.3% of the health departments have an HRH unit.
• 63.2% of health departments have an HRH information system.
• in most health departments, the HRH unit uses only the payroll and administrative records as data sources.
• concerning education in health, 67.6% of the HRH managers mentioned existing cooperation with educational and teaching institutions for training and/or specialization of health workers. Among them, specialization courses account for 61.4% and short courses for 56.1%.

Due to decentralisation, the authors conclude that the HRH area has been restructured and policies beyond traditional administrative activities have been developed.

Finally, twenty years on from the establishment of the SUS, the authors conclude that there remains a low level of institutionalisation in the HRH area, despite recent efforts of the Ministry of Health.