The city manager in the present phase of the SUS implementation: characteristics and challenges

Abstract

Since the creation of the Unified Health System (SUS), by law number 8080/90 and its subsequent regulation systems, all city governments have seen their responsibilities increase in terms of organization and operation of the local health systems. This article presents the result of a qualitative survey carried out with the managers of 20 different municipalities from a Regional Health Board of the State Health Secretariat in São Paulo. An attempt has been made to outline the managers' profiles, their professional careers, whether they develop heath projects for their municipalities, and if so, how, what the composition of their teams are, their strategies to guarantee access to health services which are not available in their municipalities, and how they deal with their state manager and the inter-managerial issues which are present in their region. The study reveals a great heterogeneity among the municipal managers. However, limited abilities for creating, implementing and evaluating city health policies predominate. The article points out the need for permanent training strategies for managers so that they can perform their duties.