Abstract
ABSTRACT This article analyzes the impact of decentralization on the recruiting standards for the position of municipal health secretary, aiming to understand the extent to which local power has been democratized, as a consequence of the Unified Health System (SUS) implementation. Municipal health secretaries all over the country answered a questionnaire at two different times in the decentralization process - 1996 and 2006 - achieving representative results. The goal was to collect data about their socioeconomic, professional profile, political trajectory and public life. Results show that there are more women, brown (‘pardos’) and low-income people holding the position, and that the qualification of municipal health secretary improved in the period between the two surveys. However, this does not apply to the larger cities and more developed regions, where competition for this position has led to a recruiting standard that combines high levels of professionalism with restricted access for disadvantaged groups. We also found that municipal health secretary are now more politically engaged in manager’s associations than in their previous insertion in civil society networks.
Highlights
The relationship between democracy and local government is a recurring theme in social sciences, stressing the positive correlation between elected local government, free association, and effective services’ provision[1,2]
As shown in chart 2, access to the position of municipal health secretary has been more permeable to managers from outside the city where they perform their tasks, but who have been residing there for over 10 years
We found large differences in recruiting standards based on city size, with women making up 53.7% of the municipal health secretary in cities with 5,000 to 20,000 inhabitants, to 25.2% in cities with over 200,000 inhabitants
Summary
The relationship between democracy and local government is a recurring theme in social sciences, stressing the positive correlation between elected local government, free association, and effective services’ provision[1,2]. According to John Stuart Mill, elected local government is more likely to tackle local affairs base on suitable knowledge, skills and expertise[3]. Since democracy implies the impersonal, competent and non-discriminatory exercise of power as a requirement for expanding citizenship, the predominance of the rational-legal bureaucratic administration, in the development of the modern state, has propelled trends to centralization. This results in inflexible state structures, giving way to contradictory moves of strengthening local self-government. Expressed as a conflict between public administration and policy, or efficiency versus responsibility
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