Dilemmas of Social Control in the Construction of Sistema Único de Saúde (SUS) in the state of Rio de Janeiro: The Case Study of Conselho Estadual de Saúde (CES/RJ)
Author: Flores Durán, Paulo Ren, paulofduran@gmail.com
Department: Department of Health Administration and Planning
University: FIOCRUZ, Brazil
Supervisor: Silvia Gerschman
Year of completion: 2013
Language of dissertation: Portuguese
Keywords:
participation
, social control
, public policy
, health councils
Areas of Research:
Health
, Political Sociology
, Participation, Organizational Democracy and Self-Management
Abstract
The aim of this work is to discuss some of the dilemmas concerning the social control of Sistema Único de Saúde (SUS) in the Health Council of Rio de Janeiro (CES/RJ). The research focused on the role of civil society representatives and health professionals regarding state actors (managers of the State Secretariat of Health of Rio de Janeiro), during the administration of Governor Sergio Cabral (2007-2012). Since 1990, the Health Councils have been institutionalized as deliberative arenas for health policymaking at three levels of the federation (national, state, and municipal). Although the Health Councils marks a new milestone in the decision making process in health policies, there are many deadlocks in the formation and deepening of the political culture of participatory institutions in Brazil. In the case of the Health Councils, the lack of clear definition for the role of various counseling representatives, the high degree of political indoctrination among managers, and the bureaucratization of social control, are some of the challenges faced in the legitimacy of the participatory forums. Furthermore, the formation of core groups in the political decision-making process – both at the Health Councils and other boards (such as the Inter-managers Commissions) – leads to the weakening of the arenas of social participation. In the case of the CES/RJ, the civil society representative counselors and health professionals face dilemmas inherent to the autonomy of the political man, which operates in a political deliberative arena strongly institutionalized and politically driven by the managers of the State Secretariat of Health of Rio de Janeiro. The analysis of the main spaces and outcomes of the deliberative process (the Plenary Meetings, the Minutes of Meetings, the Resolutions and the Health Conference of Rio de Janeiro) all revealed the weakening of the political role of the directors. The research was conducted using a variety of methodologies. As a case study, I conducted direct ethnographic observation (in the meeting space of council), content analysis (identifying core of meetings in the formal documents produced by the CES/RJ) and semi-structured interviews. Thus, I triangulated methods in order to avoid methodological reductionism. At the same time, the state counselors mobilize the political space of the CES/RJ in favor of (or with the intention of) discussing the dilemmas faced by the SUS. However, advances in health policies are distorted by the hegemony SES/RJ representatives. The political project of the state government is carried forward with the participation of civil society. This process creates dilemmas of social control. This dissertation provides a case study of a counter-hegemonic process of political decision-making in the area of health. Moreover, the dissertation research reveals the challenges that mark the relationship between state and society, and which must be overcome in order to create the forums and participatory institutions of Brazilian democracy.
