Challenges for healthcare coordination: strategies for integrating levels of care in large cities

This article analyzes the development of instruments for coordination between the Family Health Strategy and other levels in the health system, with a focus on measures to promote coordination linked to the "integration among levels of care". The results of case studies in four large cities indicate the presence of mechanism for integration among levels of care, suggesting concern with guaranteeing comprehensive care. The principal strategies identified here were: creation and strengthening of regulatory structures in the Municipal Health Secretariats and family health units with decentralization of roles to the local level, organization of flows, electronic patient charts, and expansion in the supply of specialized services at the municipal level. However, lack of integration among different providers, insufficient formal flows for hospital care, and absence of policies for medium complexity care were detected as barriers to the guarantee of comprehensive care, making the network's integration incomplete.