Democracia no SUS e na reforma sanitária é possível? Um debate a partir da experiência da Política Nacional de Educação Permanente em Saúde (janeiro de 2003 a julho de 2005)

Abstract

This thesis is an essay on democracy, whose main interface is built around the theme of health management, or rather, the rule in health. It starts with a formulation that sets up two strands of different modes of action in the context of the struggles of the health sector, whose main difference is founded in their ways to realize the concepts of democracy. The performance of the sanitary movement in government spaces is critically discussed and the concept of health movement is reinterpreted from a multitudinous comprehension. In this sense, the theoretical framework on democracy by Michal Hardt (from Thomas Jefferson and other authors of the left revolutionary tradition) that underlies a differentiation seeks to outline two ways to operate the State management. On the one hand, a strand of modes of administrative action, whose democracy framework focuses on the construction of a technical and institutional device emphasizing a technique politics. On the other, a focus on modes of multitudinous action, whose understanding of democracy recognizes the different subjects (users, workers, managers, social movements, etc.) as builders of the SUS and invites them to produce health actions in a joint manner, focusing on democratic politics. The argumentative work rests on two main elements: first, a research work and theoretical and conceptual study that sought to address the issue of management, democracy and the construction of SUS both in health and in the field of political theory. The second element is around the reflection on the National Politics on Continuing Health Education. This politics proposed a change in the way of producing health education actions from the concept of continuing education, which in politics expressed a shift in educational practices, on the one hand and, secondly, as a device for democratization of management, in that it implied a broadening of political participation of new actors. We carried out an empirical research including interviews, analysis of documents and of actors positions comprising two dimensions: on one hand, we approached the nationwide experience and the other, we studied the construction of a center for permanent education, which was the main proposal for a democratizing device for that policy management. The argument made from the material collected shows that the policy proposal fits the context of a deep desire for democratization of a group that stayed in the He alth Ministry between January 2003 and July 2005, investing, at least discursively, the second strand of modes of action in this health movement. This desire, however, was all the time crossed by the weight of how to build daily practices, political relations historically. This problem does not relate to the proposal, nor to individuals who personally engaged and got involved with that politics, but to the very challenges that are on the agenda in order to produce a more democratic world. Finally, further discussions are proposed from the micropolitics and democracy benchmark as a way of life, to take the ungovernability of life (and thus of health management), placing democracy at the heart of health production and abandoning the strategy and hegemony as essential elements of the struggle for health.