O apoio institucional no Sistema Único de Saúde (SUS): os dilemas da integração interfederativa e da cogestão

Abstract

Este estudo objetivou compreender a formulação do apoio institucional pelo Ministério da Saúde (MS) e como essa estratégia do método da roda vem sendo incorporada ao discurso oficial da gestão federal do SUS. O estudo se situa na categoria de pesquisa qualitativa. Analisamos documentos oficiais, diretrizes nacionais, cadernos de formação e políticas do MS. Identificamos dilemas, dificuldades e limites que os gestores do SUS vivenciam, cotidianamente, ao buscarem estratégias de mudança da lógica tradicional de governo (racionalidade gerencial hegemônica), seja na gestão democrática e participativa, ou na relação entre entes federados. A partir dos documentos analisados, pode-se supor um desejo de mudança por parte desses gestores, visto a consistência teórico-política adequada a isso. Entretanto, apresentam contradições, mostrando dificuldade de integração entre as áreas do MS e deste com os gestores descentralizados (estados e municípios). This study aimed to understand how institutional support was formulated by the Ministry of Health and how this strategy of a round-table method has been incorporated into the official discourse of the federal management of SUS. This study is categorized as qualitative research. We analyzed official documents, national guidelines, training booklets and policies of the Ministry of Health. We identified dilemmas, difficulties and limits that SUS managers experience daily while seeking strategies to change the traditional logic of government (hegemonic managerial rationality), either through democratic and participative management or in the relationship between federal entities. From the documents analyzed, it may be supposed that these managers have a desire for change, given that the politicaltheoretical consistency is appropriate for this. However, the documents present contradictions and show the difficulty of integration between areas of the Ministry of Health and between this ministry and the decentralized managers (states and municipalities).

Federal management of the More Doctors Program: the role of the Ministry of Education

“…Institutional support is a management tool usually employed by the MS, but not by the MEC, to create, implement and execute projects and public policies and, at the same time, to support the construction of individual and collective subjects. Furthermore, it can be incorporated by organized groups without the need of an external agent 17 .…”

Organization of oral health actions in primary care from the perspective of dental managers and dentists: process of work, planning and social control

“…Institutional support can facilitate dialogues, mediate conflicts, stimulate thinking and introduce new possibilities for the work process.. It also strengthens individuals or groups of people towards autonomy and protagonism and also avoids supporter's dependency 20 . The lack of institutional support in the management of health work can jeopardize the development of the subjects' guiding capacity and governance when intervention is necessary.…”

A interdisciplinaridade e seus reflexos na formação do cirurgião-dentista

“…Neste sentido, o Apoio Matricial, "reordena a lógica relacional entre profissionais generalistas e especialistas, democratizando as relações de poder das equipes de saúde responsáveis pela clínica e pelo cuidado" 25 , de certo modo, organizando a hierarquia do atendimento, mas sem prever que o superior é mais importante ou mais necessário.…”