O gerencialismo na saúde pública: uma análise sobre o programa de melhoria do acesso e da qualidade na atenção básica à saúde.

Abstract

The Brazilian Unified Health System is considered an important achievement of the working class, considering that the right to health in its universal form is logical. Among its main actions, we can find Primary Health Care through the Family Health Strategy. However, since the 1990s, in the midst of the advance of Neoliberalism, this principle of universality is limited by a series of elements based on the counter-reform of the Brazilian State, which, among other aspects, institutes the managerialist perspective in the state apparatus. In the field of public health, these elements emerge in order to hide the contradictions imposed by the capitalist accumulation model, especially with regard to the incompatibility between promoting a concept of health management that adopts managerial elements in search of efficiency, efficacy and effectiveness, without addressing structural problems such as underfunding and resource de-financing, subject to a fiscal regime that strangles the full effectiveness of SUS. In Primary Health Care we see the Access and Quality Improvement Program (PMAQ-AB) as an inducer of managerial practices in the work of health professionals and teams, created in 2011 by the Dilma Roussef government, the program seeks to enable the induction of managerialism to improve health indicators through the insertion of goals, objective indexes. In this sense, the present master's thesis aims to analyze how the Brazilian State through the PMAQ-AB reproduces managerialism in the Family Health Strategy. To achieve this goal, we carried out a bibliographic survey in books and academic journals, in addition to documentary analysis based on the materials available at the Ministry of Health about the Program that were collected taking into account the period from 2011 to 2018. In this way, we show that PMAQ-AB, although apparently seeking to systematize administrative conduct based on modernizing elements, finds its own limit on its structural issues associated with the concept of health as a resource to be managed, remitting the responsibility for health indicators and indexes to the work of the health teams, disregarding the governmental political sphere with regard to the maintenance of fiscal austerity policies and health de-financing, in addition to influencing the bureaucratization of the dynamics between the Health Team and the community.