Attempts to decentralize in recent Brazilian health policy: Issues and problems, 1988-1994

Decentralization became an official policy in the Brazilian health sector after the fall of the military regime of 1964-1985. In this article the author reviews the concept and types of decentralization, with particular attention to the process of decentralization itself. There is a gap between the type of decentralization (devolution) called for in the national constitution and the deconcentration of activities actually implemented. This gap is explained by Brazil's centralist tradition and its supporters, staff resistance at the national level, and the weaknesses of local governments. Several methods could be used to redirect the reforms toward their original purpose, such as improving community participation, establishing a clear agenda for the decentralization process, and setting up some mechanisms to enhance this policy.