Advocated in the Federal Constitution of 1988, the decentralization is a relatively recent process that yet not established in full form. The result of this process can be felt directly in the public policies, which have a diversity of results, for several reasons: regional inequalities, absence of management capacity of many counties, excessive dependence on federal transfers, etc. In this context, the implementation of National Political of Urgency Attention (PNAU) in Belém and Ananindeua was the object of this study, the general goal investigate the autonomy and participation of Pará state and Belém and Ananindeua cities in the implementation and decision taking in PNAU. The research is qualitative based in figures answer the question: “which the extend of implementation barriers identified in PNAU are caused by the centralization by the federal government that persist before the counties become “full management” in health services?” The central hypothesis is that the PNAU results in Belém and Ananindeua are reflection overlapping of responsibilities from federal entities and deficiencies of coordination between them, even with relative autonomy assigned to states and counties the centralization of more important decisions it remains under the control of the federal government. To answer and attend this goal the methodological procedures used were survey and document analysis and semi structured interview. Were used some elements of content analysis, considering mainly thematic analysis to identify information on the perception of the actors on the confrontation in the study object with the information gathered in the literature review phase and documentary. Allying the theory of neo-institutionalism and institutional change and empirical data was possible concluded in this study that the Union still concentrates the major decisions related to emergency politics, because through regulatory instruments, also known as formal and informal laws intend to mold the actors involved behavior and limited their decision power and the counties protect by the Union, whether the financial dependence to implementation their public policy and/or being limited by regulations shipped by the Union, support the results of this relationship federalism that do not considered the peculiarities of each region and limit the city manager and to adapt to the city reality.
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