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The Brazilian health system has as principles the integrality of assistance and the regional health planning of services, organized through attention networks. In the constitution of this network, specialized care fraction, even though it concentrates a significant importance in citizens right of health guarantee, has represented a problem of great relevance, constituting a challenge for the organization of health care, whether in the field of management or assistance, in Brazil, as well as in other countries. In this perspective, this study aims to identify the challenges and propose strategies to effectuate the provision of specialized care fraction in the Brazilian health system. This is a qualitative and exploratory study, developed in the northern macro-region of the State of Paraná in Brazil. The data collection took place through semi-structured interviews, with the participation of public and private managers and other subjects that compose the assistance and management network of this region, between 2016 and 2017. The data were organized through discourse analysis, supported by policy analysis referential. The results show an expressive demand for this fraction of assistance in the analyzed territory, mostly offered by private institutions. The high demand is linked to the low resoluteness of primary health care and an ineffective communication system between different points of care. Other challenges highlighted in this phenomenon are: the lack of solidarity and the sharing of responsibilities between federal entities; the weakness of the counties; asymmetries of power between public and private managers; the fragile integrated and regionalized planning; the underfunding of the system; the fledgling regulatory system; the conflicts between governance actors; and political interferences. Key messages In order to overcome challenges to provise the specialized care fraction, is necessary to strength the cooperation between entities, making viable health policies coherent to collective needles. With the objective of organize the provision of integrality of health, one of the essential requirements would be qualify the assistance on the different points of care that compose the health network.

Brazilian especialized care: challenges and proposals to provide integrality on health assistance