THE DECISION-MAKING PROCESS IN THE MUNICIPAL HEALTH COUNCIL OF ITAJAÍ/SC / O PROCESSO DECISÓRIO NO CONSELHO MUNICIPAL DE SAÚDE DE ITAJAÍ/SC

AUTOR(ES)
DATA DE PUBLICAÇÃO

2006

RESUMO

The last two decades have been marked by transformations in the Brazilian health system, related to changes in the political and institutional spheres. The New Constitution of Brazil, in 1988, incorporated the main proposals of the 8th National Health Conference in 1986, creating the Sistema Único de Saúde (SUS) the Brazilian national health system which was regulated at the end of 1990, through Laws 8.080 and 8.142. This latter legislates on institutionalized social participation through health conferences and councils, which became the pillars of the SUS. The Health Councils have the function of deliberating and making decisions, formulating strategies, and controlling and supervising the implementation of health policies. However, this has not been happening correctly, and various authors have detected problems in the quality of participation in the councils, including problems affecting the decision-making process. The objective of this study was to describe and analyze the decision making process in the Municipal Health Council of Itajaí (SC). The methodological approach used was the qualitative one, of the case study type. The data was collected through the analysis of minutes, observations during the period 2004-2005, and semi-structured interviews with councilors. Three categories emerged from the analysis: The role of the health council/councilor, the definition of the agenda and the dynamic of the decision-making process. In relation to the role of the council/councilor, the attribute most commonly cited by the councilors was supervising, followed by searching for/divulging information, and on a smaller scale, formulating public policies. However, for supervision to occur, it is necessary to first formulate policies. For this, it is essential to have access to information/knowledge, in order to build arguments that will enable participation in a discussion, and then make a decision. It was also observed that the councilors do not use the Municipal Health Plan as a tool in the process of supervision and policy formation or as a means of gaining power and knowledge to further the analysis and take part in the decision-making process. In relation to the definition of the agenda, it was observed that in the majority of cases, it is the Municipal Health Secretary/Secretariat that proposes the subjects for discussion. The subjects present at all the meetings in the years investigated were accreditations of agreements and contracts with health services. In relation to the period leading up to the meeting, it was observed that some matters are not scheduled until the meeting itself, and no material is made available for prior analysis: these are the so-called crucial matters, which offer little opportunity for analysis on the part of the councilors. With regard to the dynamic of the decision-making, it was observed that the tone that permeated the meetings in 2004 was one of almost automatic approval of the matters raised, practically without any discussion. In that same year, a third of the meetings did not take place due to insufficient quorum. In 2005, however, there was a change in the tone, which became more questioning. There were a higher number of meetings, more than one a month, all with sufficient quorum. There was also more discussion on the matters raised. Another observation relating to the decision-making process was that the analysis of the subjects was, in the majority of cases, based on problems that had already occurred and that should have been addressed for evaluation by the council, often detected after raised by the media. This exposes a reactive nature in the way the council acts, whereas a more proactive participation would be preferable. Although some problems were detected, we understand the decision-making process as one which offers councilors power to participate in the process of policy formation. What they need to understand and consider is that there is a relationship between knowledge and power, and that the true exercise of power can only occur within a wider symmetry between the actors, becoming more concrete as they learn the facts and are able to debate on them.

ASSUNTO(S)

saude coletiva decision-making process processo decisório conselhos de saúde, saúde pública família - saúde e higiene public health health councils

ACESSO AO ARTIGO

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