Controlo social tutelado? Enfrentamentos e dinâmicas democráticas na implantação de organizações sociais na saúde de capital do nordeste do Brasil

Abstract

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, Ceara 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.