Construindo o "pacto de gestão" no SUS: da descentralização tutelada à gestão em rede

Résumé 0

"Over time, the implementation of Brazil´sNational Health System (SUS) has encounteredmanagement problems. Initially, steadilyrising pressures calling for State reform and trimmercosts affect the universal healthcare that isthe purpose of this system. Conflicts then flare upbetween the decentralization principle and thenetwork concept, viewed here as not merely linksamong different spheres of management, but ratherthe model through which access to a right isexercised through a network. Operating decisionson healthcare have been decentralized, while thebudget transfers underwriting these decisions remainunchanged. From the civil service standpoint,the decentralization of healthcare managementwas halted by the issue of the OperationalHealthcare Directive in January 2001.From the management standpoint, the introductionof the network concept − which is the mosteffective weapon against verticalizing decisionstructures − must deal with operating and financialbottlenecks that prevent players in differentorganizations from speaking the same "language",which is the most effective way of building upinter-organizational links. Effective interactionamong these languages will be attained onlythrough constructing management pacts."