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
鉴于当前财政紧缩、社会权利倒退以及民主公共管理式微的整体时局，本文旨在剖析卫生领域公众参与的当前发展趋势。为此，本研究分析了世界卫生组织（WHO）、泛美卫生组织（PAHO）、巴西官方机构及世界银行发布的相关文件，同时纳入由公共管理者（Conass）发起的全民健康系统未来国际研讨会的会议记录。本研究的文献调研范围涵盖：刊载于与巴西卫生改革运动政治与组织基础相关的学术科研机构旗下卫生期刊的研究成果，以及为纪念巴西统一卫生系统（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所依托的政治协调民主基础，国际文件中提及的公众参与模式为国家-社会-市场伙伴关系框架下的工具化、去政治化参与。上述国际文件的核心关注点为基于州际协作框架的卫生服务管理与参与机制，此时国家仅为卫生服务供给主体之一。然而，在Conass主办的本次研讨会中，对参与式制度建设的探讨仅寥寥数语；而在卫生领域专业期刊以及巴西统一卫生系统（SUS）成立30周年纪念出版物中，则完全未涉及该议题。