Impact of Co-Management on the Quality of Healthcare Services: A Case Study Based on the Perception of Professionals in a Municipality in Paraná-Brazil

This study analyzes governance in Brazil’s Unified Health System (SUS), focusing on care coordination between primary and specialized care based on the perceptions of professionals in a municipality in Paraná. Out of 69 professionals invited, 27 voluntarily participated in the study, including PHC physicians, cardiologists, managers, and regulators. Using a mixed-methods approach with online and printed questionnaires, the study identified critical gaps in access to cardiology, such as a shortage of specialists, diagnostic limitations in PHC, and infrequent interdisciplinary case discussions. Most referrals were due to clinical complexity or unavailable diagnostic tests at the primary care level. Although the number of PHC physicians meets national standards, challenges remain in the integration with specialized care. The findings suggest that improving care coordination requires investment in infrastructure, expansion of specialized staff, clear clinical protocols, and workforce retention strategies. Strengthening democratic governance in SUS depends on intersectoral articulation and participatory, effective decision-making.