configuração institucional e gestão do sistema Único de saúde: problemas e desafios institutional configuration and administration of brazil's national health system (sus): problems and challenges

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ID: 219643
2007
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Abstract
O trabalho analisa a problemática da "institucionalidade" do SUS, destacando alguns nós críticos a serem enfrentados para a retomada do projeto da Reforma Sanitária Brasileira. A reflexão diz respeito à configuração institucional do SUS, abarcando também aspectos relativos ao processo de condução político-gerencial do sistema, parte da cultura organizacional do Estado brasileiro, patrimonialista, autoritário, burocrático e colonizado por interesses privados. Descreve um conjunto de problemas, como o "engessamento" da gestão, por conta das limitações legais estabelecidas em função da política econômica, a exemplo da Lei de Responsabilidade Fiscal, a inadequação das "alternativas" subsidiárias das reformas gerencialistas, que geram a fragmentação do processo de gestão, e o marcado amadorismo conseqüente à insuficiência de quadros profissionalizados, reprodução de práticas clientelistas e corporativas na indicação de ocupantes dos cargos de direção em todos os níveis. São apresentados argumentos favoráveis à introdução e consolidação de inovações institucionais, a exemplo das fundações estatais de direito privado e discute-se estratégias de fortalecimento da capacidade de governo das instituições gestoras do SUS, em particular a profissionalização da gestão e a formação profissional nesta área.
This paper analyzes the 'institutionality' of Brazil's National Health System, stressing crucial aspects to be dealt with, due to a return to the Public Health Reform Project. The reflection focus on the System´s institutional configuration, covering issues related to the process for its political and management conduct, rooted in the authoritarian/patrimonialistic organizational culture of the Brazilian State, entangled in red tape and colonized by private interests. It describes matters such as strategic resources/services management, hobbled by legal constraints imposed through economic policies, e.g. the Fiscal Liability Act; the inadequacy of subsidiary 'alternatives' suggested by managerialistic reforms cutting the System management processes; and the markedly amateur approach to administration due to the shortage of trained professionals and the ongoing clout of the old-boy network and pork-barrel politics when appointing civil servants to all level management positions. It presents arguments urging the introduction and consolidation of institutional innovations, similar to State Foundations created under private law, and discusses strategies to strengthen the governing capacities of the System´s managing institutions, mainly the introduction of professional management with specific training and qualifications.
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Authors Jairnilson Silva Paim, Carmen Fontes Teixeira
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Journal journal of physical activity & health
Year 2007
DOI
10.1590/S1413-81232007000700005
URL
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232007000700005
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