Protected social control? Confrontations and democratic dynamics in the implementation of social organizations in the health capital of northeastern Brazil
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.25761/anaisihmt.371 |
Resumo: | Brazil’s Unified Health System (SUS), based on guidelines for decentralization, integrality and community participation, consists of a set of health actions and services, organized at increasing levels of complexity. Within the scope of social control of public health, the Law nº 8.142/90 (3) which establishes the principles of participation and social control envisages two collegiate bodies: the Health Conference - held every four years; and the Health Council, of a permanent and deliberative nature, being regulated by the resolution CNS nº 333/1992 (retained in the review of the resolution CNS n.º 453/2012) (4) which regulated the global guidelines of health councils and conferences at the three levels of SUS. This study seeks to detail some of the explanatory mechanisms and democratic dynamics in the implementation of social organizations in the health of Fortaleza, from the theoretical thread of historical institutionalism, which was the analytical option of this study, namely through the Pierson model (neo-institutionalism) [12, 13] and from North [14, 15] as to path dependence. In this regard, the historical-legal path of OSs in Brazil was presented and to characterize the evolution of laws implementing OSS management in the health of Brazil, Ceará and Fortaleza. Thereupon, the expense graphs showed the growth of this managerial option. In the advances of the model, there was an intensification of disputes within the Municipal Health Council of Fortaleza, which intensified the debates on the requirements of control and monitoring and of studies that generate scientific evidence of the advantages of outsourcing the units, according to TCU judgments (judgments nº 3.239/2013, nº 352/2016, nº 1.215/2016 e nº 2.444/2016). Finally, we highlight the difficulties of relations in the labor sphere, which need an expansion in the debate regarding the qualification and valuation of the teams for the legal exercise of the professionals responsible for health care, the need to deepen the legal support for the activities of the OSs, as well as fiscal control procedures validated by the respective court of auditors, in order to be part of the planning of local health policies, and to enable inspection activities at the instance of social control. |
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Protected social control? Confrontations and democratic dynamics in the implementation of social organizations in the health capital of northeastern BrazilControle social tutelado? Enfrentamentos e dinâmicas democráticas na implantação de organizações sociais na saúde de capital do Nordeste do BrasilBrazil’s Unified Health System (SUS), based on guidelines for decentralization, integrality and community participation, consists of a set of health actions and services, organized at increasing levels of complexity. Within the scope of social control of public health, the Law nº 8.142/90 (3) which establishes the principles of participation and social control envisages two collegiate bodies: the Health Conference - held every four years; and the Health Council, of a permanent and deliberative nature, being regulated by the resolution CNS nº 333/1992 (retained in the review of the resolution CNS n.º 453/2012) (4) which regulated the global guidelines of health councils and conferences at the three levels of SUS. This study seeks to detail some of the explanatory mechanisms and democratic dynamics in the implementation of social organizations in the health of Fortaleza, from the theoretical thread of historical institutionalism, which was the analytical option of this study, namely through the Pierson model (neo-institutionalism) [12, 13] and from North [14, 15] as to path dependence. In this regard, the historical-legal path of OSs in Brazil was presented and to characterize the evolution of laws implementing OSS management in the health of Brazil, Ceará and Fortaleza. Thereupon, the expense graphs showed the growth of this managerial option. In the advances of the model, there was an intensification of disputes within the Municipal Health Council of Fortaleza, which intensified the debates on the requirements of control and monitoring and of studies that generate scientific evidence of the advantages of outsourcing the units, according to TCU judgments (judgments nº 3.239/2013, nº 352/2016, nº 1.215/2016 e nº 2.444/2016). Finally, we highlight the difficulties of relations in the labor sphere, which need an expansion in the debate regarding the qualification and valuation of the teams for the legal exercise of the professionals responsible for health care, the need to deepen the legal support for the activities of the OSs, as well as fiscal control procedures validated by the respective court of auditors, in order to be part of the planning of local health policies, and to enable inspection activities at the instance of social control. O Sistema Único de Saúde (SUS) do Brasil, embasado em diretrizes de descentralização, integralidade e participação da comunidade, consiste em um conjunto de ações e serviços de saúde, organizados em níveis de complexidade crescentes. No escopo de controlo social da saúde pública surgiu a Lei nº 8.142/90 (3) que estabelece os princípios de participação e controlo social tendo duas instâncias colegiadas: a Conferência de Saúde – realizada a cada quatro anos; e o Conselho de Saúde, de caráter permanente e deliberativo, sendo normatizada pela resolução CNS nº 333/1992 (mantidos na revisão da resolução CNS n.º 453/2012) (4) que regulamentou as diretrizes globais dos conselhos de saúde e das conferências dos três níveis do SUS. Este estudo busca explicitar alguns dos mecanismos explicativos e dinâmicas democráticas na implantação de organizações sociais na saúde de Fortaleza, a partir da linha teórica do institucionalismo histórico, que foi a opção analítica deste estudo, nomeadamente por meio do modelo de Pierson (neo-institucionalismo) [12, 13] e de North [14, 15] quanto a dependência de trajetória (path dependence). Nesse propósito apresentou-se o percurso histórico-legal das OSs no Brasil e caracterizar a evolução das leis de implementação da gestão por OSS na saúde do Brasil, do Ceará e de Fortaleza. De seguida, os gráficos de gastos mostraram o crescimento dessa opção gerencial. Nos avanços do modelo, houve um acirramento das disputas dentro do Conselho Municipal de Saúde de Fortaleza que acirrou os debates nas exigências de controlo e acompanhamento e dos estudos que gerem evidências científicas das vantagens da terceirização das unidades, conforme acórdãos do TCU (acórdãos nº 3.239/2013, nº 352/2016, nº 1.215/2016 e nº 2.444/2016). Por fim, destacam-se as dificuldades das relações na esfera trabalhista, que necessitam de uma ampliação no debate no que diz respeito a qualificação e valoração das equipas para o exercício legal dos profissionais responsáveis pela atenção à saúde, a necessidade de aprofundamento no amparo legal para as atividades das OSs, assim como procedimentos de controlo fiscal validados pelo respectivo tribunal de contas, a fim de compor ao planejamento das políticas de saúde locais, e possibilitar atuação fiscalizatória à instância de controlo social. Universidade Nova de Lisboa2021-03-15T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.25761/anaisihmt.371oai:ojs.anaisihmt.com:article/371Anais do Instituto de Higiene e Medicina Tropical; Vol 20 (2021): Saúde digital e desenvolvimento internacional: avanços e desafios; 34-45Anais do Instituto de Higiene e Medicina Tropical; v. 20 (2021): Saúde digital e desenvolvimento internacional: avanços e desafios; 34-452184-23100303-7762reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttp://anaisihmt.com/index.php/ihmt/article/view/371https://doi.org/10.25761/anaisihmt.371http://anaisihmt.com/index.php/ihmt/article/view/371/308http://creativecommons.org/licenses/by/4.0info:eu-repo/semantics/openAccessMoita, Galba FreireHartz, Zulmira M. A.Melanda, Viviane SerraColares, Jorge MouraKaminski, Ana Paula Romeiro2022-09-23T15:30:29Zoai:ojs.anaisihmt.com:article/371Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:04:03.494250Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Protected social control? Confrontations and democratic dynamics in the implementation of social organizations in the health capital of northeastern Brazil Controle social tutelado? Enfrentamentos e dinâmicas democráticas na implantação de organizações sociais na saúde de capital do Nordeste do Brasil |
title |
Protected social control? Confrontations and democratic dynamics in the implementation of social organizations in the health capital of northeastern Brazil |
spellingShingle |
Protected social control? Confrontations and democratic dynamics in the implementation of social organizations in the health capital of northeastern Brazil Moita, Galba Freire |
title_short |
Protected social control? Confrontations and democratic dynamics in the implementation of social organizations in the health capital of northeastern Brazil |
title_full |
Protected social control? Confrontations and democratic dynamics in the implementation of social organizations in the health capital of northeastern Brazil |
title_fullStr |
Protected social control? Confrontations and democratic dynamics in the implementation of social organizations in the health capital of northeastern Brazil |
title_full_unstemmed |
Protected social control? Confrontations and democratic dynamics in the implementation of social organizations in the health capital of northeastern Brazil |
title_sort |
Protected social control? Confrontations and democratic dynamics in the implementation of social organizations in the health capital of northeastern Brazil |
author |
Moita, Galba Freire |
author_facet |
Moita, Galba Freire Hartz, Zulmira M. A. Melanda, Viviane Serra Colares, Jorge Moura Kaminski, Ana Paula Romeiro |
author_role |
author |
author2 |
Hartz, Zulmira M. A. Melanda, Viviane Serra Colares, Jorge Moura Kaminski, Ana Paula Romeiro |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Moita, Galba Freire Hartz, Zulmira M. A. Melanda, Viviane Serra Colares, Jorge Moura Kaminski, Ana Paula Romeiro |
description |
Brazil’s Unified Health System (SUS), based on guidelines for decentralization, integrality and community participation, consists of a set of health actions and services, organized at increasing levels of complexity. Within the scope of social control of public health, the Law nº 8.142/90 (3) which establishes the principles of participation and social control envisages two collegiate bodies: the Health Conference - held every four years; and the Health Council, of a permanent and deliberative nature, being regulated by the resolution CNS nº 333/1992 (retained in the review of the resolution CNS n.º 453/2012) (4) which regulated the global guidelines of health councils and conferences at the three levels of SUS. This study seeks to detail some of the explanatory mechanisms and democratic dynamics in the implementation of social organizations in the health of Fortaleza, from the theoretical thread of historical institutionalism, which was the analytical option of this study, namely through the Pierson model (neo-institutionalism) [12, 13] and from North [14, 15] as to path dependence. In this regard, the historical-legal path of OSs in Brazil was presented and to characterize the evolution of laws implementing OSS management in the health of Brazil, Ceará and Fortaleza. Thereupon, the expense graphs showed the growth of this managerial option. In the advances of the model, there was an intensification of disputes within the Municipal Health Council of Fortaleza, which intensified the debates on the requirements of control and monitoring and of studies that generate scientific evidence of the advantages of outsourcing the units, according to TCU judgments (judgments nº 3.239/2013, nº 352/2016, nº 1.215/2016 e nº 2.444/2016). Finally, we highlight the difficulties of relations in the labor sphere, which need an expansion in the debate regarding the qualification and valuation of the teams for the legal exercise of the professionals responsible for health care, the need to deepen the legal support for the activities of the OSs, as well as fiscal control procedures validated by the respective court of auditors, in order to be part of the planning of local health policies, and to enable inspection activities at the instance of social control. |
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2021 |
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2021-03-15T00:00:00Z |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
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article |
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publishedVersion |
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https://doi.org/10.25761/anaisihmt.371 oai:ojs.anaisihmt.com:article/371 |
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https://doi.org/10.25761/anaisihmt.371 |
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http://anaisihmt.com/index.php/ihmt/article/view/371 https://doi.org/10.25761/anaisihmt.371 http://anaisihmt.com/index.php/ihmt/article/view/371/308 |
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http://creativecommons.org/licenses/by/4.0 info:eu-repo/semantics/openAccess |
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Universidade Nova de Lisboa |
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Universidade Nova de Lisboa |
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Anais do Instituto de Higiene e Medicina Tropical; Vol 20 (2021): Saúde digital e desenvolvimento internacional: avanços e desafios; 34-45 Anais do Instituto de Higiene e Medicina Tropical; v. 20 (2021): Saúde digital e desenvolvimento internacional: avanços e desafios; 34-45 2184-2310 0303-7762 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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