[Strategies for the development of local health systems in the State of Rio de Janeiro, Brazil]

The organization of health services has undergone large-scale changes since the beginning of the 1980s, as may be seen in the organization of local health systems, the introduction of integrated health actions, and the establishment of the unified and decentralized health system. These changes are aimed at municipalizing the services. In Rio de Janeiro, particularly in the Baixada Fluminense, the public and private network categories have ceased to exist, having been replaced by a single municipal network. Delay in the transfer of INAMPS services is impeding the formation of a fully unified network. Complete organization of the decentralized system demands the elimination of political and bureaucratic obstacles.