Controle social no Sistema Único de Saúde sob a ótica da governança pública: um estudo multicasos

Abstract

Public management currently requires overcoming traditional and anti-democratic models, with the incorporation of public governance principles. This study aims to analyze and describe the model of organization of municipal health councils from the perspective of public governance in the exercise of social control in the SUS. To this end, a descriptive, qualitative research was carried out, through a multicase study, in three health councils in small municipalities in the territory of the 15th Regional Health Coordination of Rio Grande do Sul. The data collection procedure included a semi-structured interview with directors, non-participant observation in ordinary meetings, in addition to documentary research. The theme choice is due to the many practical and theoretical challenges for the implementation of the SUS, a public policy that is born anchored in democratic, but incipient, fragile practices and that demand collective efforts for their effectiveness. Also, given the need for studies that enable greater understanding of public governance tools in existing spaces of participation and social control. This research has an innovative character, as it is carried out in an unexplored scenario, small municipalities, instrumentalizing social actors and scholars with tools built in a contextualized way and based on evidence. The present study revealed significant limitations regarding public governance in municipal health councils in small municipalities. The councilors' knowledge about their functions and responsibilities is, for the most part, restricted, which compromises their engagement, autonomy and protagonism, with hierarchy and verticality prevailing in decision-making and definition of public policies, with the sovereignty of the agent public. The challenge is the qualification of these collectives in structure and processes. It is essential the accountability of the State to comply with the existing legal framework, and thus ensure the effectiveness of the councils, which requires quality indicators, monitoring and evaluation, support and permanent education for all involved.