A Judicialização do Direito à saúde e o diálogo entre instituições jurídicas e políticas: um estudo de caso sobre a Defensoria Pública do Estado do Rio de Janeiro

Abstract

Considering the importance of arrangements capable of enabling institutional dialogue that makes it possible to mitigate negative impacts of the phenomenon of judicialization of health in the management of the Unified Health System (SUS), the main objective of the present study is to analyze the Project “Building the SUS with the Public Defender's Office of the State of Rio de Janeiro” (DPERJ), aiming to understand if the proposed institutional arrangement has the potential to strengthen the management and health care networks in metropolitan municipalities. We opted for the single integrated explanatory case study method. Data collection took place between August and December 2021, thus encompassing the period of the COVID-19 pandemic. It was carried out through field research by way of semi-structured interviews with health and law professionals, bibliographic research and documental research. The project under analysis was born with the objective of internalizing the actions of the Health Litigation Resolution Chamber (CRLS), in partnership with Municipal Health Departments (SMSs). Its activities are in force in 15 municipalities in the state of Rio de Janeiro. The research scenario consisted of 6 of the municipalities in the metropolitan region. The technique used to identify the subjects was the nonprobabilistic chain in Snowball. In terms of the Public Defender's Office, two significant results obtained through the experience can be highlighted: the expansion of the possibility of action by the DPERJ in the implementation of public policies and the promotion of the idea of being all (executive, judiciary and DPERJ) on the same “team”. In terms of municipal management of the SUS, the Project improves communication between DPERJ and SMSs and consolidates institutional dialogue, enhancing the ability to provide transparency to the entire legal-administrative apparatus that governs the operation of the SUS. There is an underused potential in the agreement that could help strengthen health care networks, especially at the municipal level. The challenges presented as being from the experience itself are reflections of structural weaknesses in the consolidation of the SUS as a public policy in the country. It is concluded that judicialization is not the bottleneck itself, but points to the bottlenecks of the system, as it can help to recognize aspects of the operationalization of the right to health, which need to be resolved or improved. Therefore, a change in focus is necessary for judicialization; from understand it as “something that needs to be fought” to “something that need to be managed properly”, and which can be an ally in signaling bottlenecks of the network, concentrating efforts to guarantee the right to health.