title: Interdependence between government levels in Brazilian health policy: the implementation of Emergency Care Units in the State of Rio de Janeiro, Brazil.
abstract: This article addresses policymaking related to Emergency Care Units (ECU) in the State of Rio de Janeiro between 2007 and 2013, duly identifying the relationships between the various levels of government in this process. It prioritized the context of policy formulation, the factors that motivated the inclusion and maintenance of ECUs on the state agenda and the process of how the policy was implemented in the state. The study was based on the literature that defines the agenda and implementation of public policies and on contributions from historic institutionalism. The research involved analysis of documents, secondary data, and 51 interviews with people in positions of authority in state and municipal governments. The priority given to ECUs in the government agenda was the result of a confluence of historical, structural, political and institutional factors, as well as the current context. The results of this study indicate the existence of interdependence between levels of government, however federal coordination problems have prejudiced the integration of the various components of emergency health care in the state.
authors.affiliation: Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil, luciana@ensp.fiocruz.br.
authors.forename: Luciana Dias
authors.initials: LD
authors.lastname: de Lima
authors.affiliation: Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil, luciana@ensp.fiocruz.br.
authors.forename: Cristiani Veira
authors.initials: CV
authors.lastname: Machado
authors.affiliation: Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil, luciana@ensp.fiocruz.br.
authors.forename: Gisele
authors.initials: G
authors.lastname: O'Dwyer
authors.affiliation: Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil, luciana@ensp.fiocruz.br.
authors.forename: Tatiana Wargas de Faria
authors.initials: TW
authors.lastname: Baptista
authors.affiliation: Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil, luciana@ensp.fiocruz.br.
authors.forename: Carla Lourenço Tavares
authors.initials: CL
authors.lastname: de Andrade
authors.affiliation: Programa de Pós-Graduação em Saúde Pública, ENSP, Fiocruz.
authors.forename: Mariana Teixeira
authors.initials: MT
authors.lastname: Konder
mesh_terms: D001938:Brazil; D004636:Emergency Service, Hospital / Q000458:organization & administration; D006076:Government; D006291:Health Policy; D006801:Humans