Trends of participation in SUS: the emphasis on instrumentality and on interstate interface

ABSTRACT Given the conjuncture of fiscal austerity, regression of social rights and democratic public management, this manuscript aims to analyze the current trends of participation in the field of health. To this end, a study was carried out on documents issued by WHO/Paho/Brazil, the World Bank, and records from the international seminar on the future of universal health systems, promoted by public managers (Conass). Literature research included studies published in health journals linked to academic-scientific entities that constituted the political and organizational bases of the brazilian sanitary reform movement, as well as other national journals that dedicated special issue to the 30 years of the Unified Health System (SUS). The study found in the international documents references to an instrumental, depoliticized participation of the State-society-market partnership type, when compared with the democratic bases of political articulation of the sanitary reform movement. The emphasis of the documents lies on management and participation, based on interstate interface, in which the state is just another subject in the delivery of health services. However, there is a timid appreciation of the participatory institutionality in the Conass event, and a silence on the subject in the field's periodicals, in the commemorative publications of the 30 years of the SUS.

摘要 本研究立足于财政紧缩、社会权利倒退与民主公共管理退化的多重局势，旨在剖析卫生领域公众参与的当前发展趋势。为此，研究团队针对世界卫生组织（WHO）、泛美卫生组织（PAHO）、巴西相关机构、世界银行发布的文件，以及由公共管理者（Conass）主办的全民健康体系未来国际研讨会的会议记录展开分析。文献研究涵盖了与构成巴西卫生改革运动政治与组织基础的学术科研机构关联的卫生期刊发表的研究成果，同时纳入其他为纪念统一卫生系统（SUS）成立30周年推出特刊的国内期刊文献。研究发现，相较于卫生改革运动政治协调的民主根基，国际文件中提及的是一种工具化、去政治化的国家-社会-市场伙伴关系模式下的参与形式。上述文件的核心侧重基于州际互动的管理与参与模式，其中国家仅为卫生服务供给的诸多主体之一。然而，在Conass主办的研讨会中，对参与式制度建设的探讨较为薄弱；而在SUS成立30周年纪念刊物及本领域期刊中，该主题则完全未被提及。