O papel dos Conselhos de Secretarias Municipais de Saúde na gestão do SUS: o caso do Rio de Janeiro

Abstract

This doctoral thesis analyzes the role of the Council of Municipal Health Secretaries of the State of Rio de Janeiro (Cosems/RJ) in the management of Brazil’s Unified Health System (SUS), in light of the historical processes of federal arrangement and decentralization of public health policies in the country. Employing a qualitative approach, the study is grounded in theoretical review, document analysis, and interviews with 21 strategic actors. It traces the institutional trajectory of Cosems/RJ from its inception to its consolidation as a relevant technical and political actor. The research highlights the council’s institutional strengthening, its active participation in the Bipartite Inter-Manager Commission (CIB/RJ), and its capacity to coordinate among the 92 municipalities of the state. During the COVID-19 pandemic, Cosems/RJ took on a leading role in guiding local actions amid the institutional weaknesses of the State Health Secretariat (SES/RJ) and the Ministry of Health (MS). Key initiatives include the publication of the Manual for Municipal SUS Managers and the implementation of the Regional Supporters Strategy, as well as partnerships with academic institutions such as UERJ and Fiocruz. The findings indicate that Cosems/RJ goes beyond its formal representative function, becoming a space for knowledge production, political mobilization, and advocacy for SUS, thereby contributing to the strengthening of sanitary federalism. The study also helps address gaps in the academic literature on SUS management in the state of Rio de Janeiro.