Controle social na atenção básica do sistema único de saúde brasileiro

Abstract

The study analyses the concept of social control in public health primary care expressed in official documents, and its implications in the process of implementing Local Health Councils, which aim to consolidate social control and broaden human rights. Investigation is based on documents, and the research follows the quantiqualitative method and aims at analyzing the phenomenon from all its multiple dimensions and interrelations. This approach is used so the researcher can get an ample perspective, so the study used the qualitative method to get to know the Local Health Councils. Initially democracy and human rights in contemporary society are discussed. A brief retrospective of history is presented and the development of participative social processes is analyzed, pointing the challenges of radicalizing democracy and universalizing human rights. The dialectic of health social control in Brazil and the relationship between State and civil society point to proposals that go beyond institutional mechanisms of social participation in health politics, rethinking the control of society over the actions of the State. The problems of centralized public health primary care are problematized, taking into consideration the guidelines of decentralization and popular participation. The history of health politics in Brazil is briefly presented, and the present conjuncture is analyzed situating social changes that happened during the last two decades of the 20th century and the counter reformation of the State in the context of productive restructuration. The relation between the attention model and the management model is discussed based on history and on how they are expressed in different social projects. The study points to the conjuncture of privatizing public primary care and uses the city of Porto Alegre, located in the state of Rio Grande do Sul, Brazil, as an example. The specificities of social control in primary care that were institutionally materialized with the Local Health Councils are elucidated. Research data shows that there are two antagonistic concepts about social control in primary health care. Analyses point to a humanrights oriented concept and a management-oriented concept through premises that appeared during the study and affect social control in primary care.