Travessias do controle social no Amazonas: nas trilhas do conselho estadual e municipal de saúde em Manaus

Abstract

The public health policy proposal defended by the Federal Constitution of 1988 presents important and innovative democratic principles for the Brazilian scenario in its context of redemocratization. It is in a process of democratic struggle and revitalization that health starts to be recognized as a universal social right, non-contributory and component of the tripod of social security. As a democratic innovative principle, the Federal Constitution institutes participation and social control as ways to effect a democratic management of health policy. This research aims to analyze how the effectiveness of social control in Amazonas has been consolidated within the scope of the State and Municipal Health Council of Manaus, highlighting the dynamics of social participation for the viability of the right to health, as well as verifying the discussions undertaken on social control in the spaces of the state and municipal conferences of Manaus in the period from 2010 to 2019, to characterize the organization and functioning of health councils at the municipal and state level, focusing on the challenges for the effectiveness of social control in health and to examine the view of the social subjects involved - health counselors - about the development of social control in health, its limits and its possibilities of action through shared management. For this, bibliographic, documentary and field research was carried out. In documentary research, we analyzed the various documents referring to the regulation of social control in health, such as regulations, statutes, laws, decrees, reports of conferences carried out by health councils, among others. For data collection, a form with open and closed questions was applied to municipal and state health counselors. In this work, we seek to understand the paths taken by the municipal and state health councils in Amazonas for the realization of a shared management of health policy, as well as the possibilities of action in these spaces for the realization of democratic social control and organization of civil society. The results obtained show that, in Amazonas, social control has been developing with many weaknesses, requiring the intervention of the State Prosecutor's Office to promote democracy in the process of formation and composition of these councils. At health conferences, although social control is a mandatory theme and has been present in all the reports analyzed, we have observed that, in almost 30 years of its implementation, the discussions held in these spaces have contributed more to maintaining the democratic discussion of the that the expansion of democracy itself. Shared health management, although present in the councils, still ends up representing the interests of the government more than those of the community due mainly to the little influence of the users' segment in these institutions.