Práticas da gestão do SUS na atenção básica e o protagonismo dos gestores, trabalhadores de saúde e usuários: uma responsabilidade pública e exercício de cidadania?

Abstract

Research on the practices of SUS management in Primary Care in the city of Alagoinhas-BA, whose aims were understand the sense and/or the meaning on the care management in Primary Heath Care, considering the participation of managers, health workers and users in Primary Care in the city of Alagoinhas –BA; analyze the practice of the SUS management in Primary Care and discuss the competence and attribution of the municipal government (managers, health workers and householders), policies and 'new' models of health in Primary Care. Qualitative research, with family health units as investigation field. The participant subjects in the study were divided into four groups: Group I, managers; Group II, health workers; Group III, users; Group IV, key informants, in total 26 participants. We used systematic observation, semi-structured interviews and document analysis as data collection techniques. The method of data analysis was an approximation with Hermeneutics-dialectical, from which were drawn three categories of analysis: categorical-Practice of management in Primary Health Care: sense and meaning; category 2-A orchestra-'ideal' of rationality, hegemonic order and productive and category 3-social Control: in search of democracy. According to the survey results, the SUS management practices in Primary Care of Alagoinhas-BA municipality occur disjointed among user subjects, health workers and managers, characterized by the centralization of decision-making power of managers to the detriment of the interests of users and workers, reflecting the fragility of the citizenship exercise. Thus, social control, permanent education and health planning as a tool for sharing of power among subjects has only been theorized, reproducing one centralized management, since the senses and meanings for the management sometimes approach, sometimes depart from the practices of the involved participants. In the subject understanding, the management practices should be established in the user-centered model of health to provide the best service to users. However, these manager practices are still rooted in the hegemonic model, focused in normative planning. Regarding to the workers, there is a double understanding: the planning owns features of normative focus and a small part in the situational-local strategic focus. However, the workers practices have been developed in care model of Programmatic Actions, welcome and user participation in the work process. The social participation occurs in the county through the Municipal Health Council and community neighborhood Association. Faced with such reality, the practices of health management in the county of Alagoinhas are stuck to the model of a Taylorist management, although of starting hearing the echo of co-management in family health Units.