The non-governamental public sector: the social organizations as possibilities and limites in the public management of health. / O setor público não-estatal: as organizações sociais como possibilidades e limites na gestão pública da saúde.
AUTOR(ES)
Nivaldo Carneiro Junior
DATA DE PUBLICAÇÃO
2002
RESUMO
At the end of the 20th century we had seen the come out of a new geopolitical and economical world configuration of neoliberal traces, as an alternative to overcome the capitalism crisis. The Welfare State is criticized by such conception, being assigned to it the responsibility for the crisis and the inefficiency to answer the social demands of a world that is constantly changing. In response to these critiques comes out the State reform movement that has assumed several propositions in the past two decades. The conception of minimum State that prevailed in the 80s, leaving to the market the responsibility for the economical growing and caring of the society needs. In the next decade this model was questioned. Then comes the ideology of the strong State that must regulate and coordinate the social politics, leaving to the market and the non-governmental organizations the productions of goods and services. Influenced by the new public management, this State is conceived as a manager of social development, using mechanisms of the private sector to optimize results, as the retention of expenses and cost control. We observe this orientation in the director plan of reform of the governmental machine, presented by the Brazilian Govern since 1995. One of the main strategies was the creation of the Social Organizations ¾ legal statute that allows the non profit institutions to develop social functions delegated by the State. Since 1998, the Secretaria de Estado da Saúde de São Paulo has repassed hospitals to Social Organizations of Health, through performance agreements, establishing goals to be reached in the production of hospitalar services. Two of these experiences were analysed ¾ the General Hospitals from Itapecerica da Serra and from Itaim Paulista ¾ with the intention to evaluate the ability of the State in promoting such delegation, under the public control and the guarantee of equity in the access to he health services. We used qualitative methodology, through the technique of study of case. There were thirty interviews done, involving members from the technical staff, from the administration and from the owners of these organizations, users of the services, and representatives of the Legislative and Executive of the State. We did read the documents and technical reports. The results indicated that there is no incorporation at the local level in the management of the services done, and that the central level of the Secretaria Estadual is the main coordinator and controller of the goals established. As to the equity in the access, is fundamental the presence of the local Public Power to its effectiveness, in the articulation of the health system, as we have seen in the Itapecerica da Serra experience. The public control is made by inspection actions, through financial procedures of the Tribunal de Contas do Estado, or the local instances of social control of the Sistema Único de Saúde or of the popular counsils of health. There is no participation of the population in the formulation of health actions. In this kind of management the Public Power of the state of the São Paulo has a fundamental role, through the global financing and administrative control of these Organizations, characterizing a desconcentration of function for non governmental public institutions, that is responsible for a private logic of managing, through the contract of human resources and financial administration, limiting aspects of the action of the State.
ASSUNTO(S)
equidade no acesso administração em saúde publica/ tendencias equity in access social organization formulação de políticas organizações sem fins lucrativos/ tendencias organização e politicas governamentais governments policies and organization/trends policy making organização social health sector reform organizations nonprofit/trends reforma do setor saude
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