Práticas de governo na gestão do SUS: poderes, dilemas e pragmatismos

Abstract

This Ph.D. thesis has the Brazilian Unified Health System (the SUS ) and the defense of life, as ethical-polítical project and public policy, its general horizon of meaning, taking from there, the SUS management in government structures as strategic areas for its construction and at the same time as object of interrogations. Based on management practices (or practices of government) in the SUS as an object, memories-affections of the author, which were collected from a sensitive attentiveness effort, supported by records, driven by study issues and the meeting with managerial experience in the Health Ministry between the years 2011 and 2013. Selected memories played dual roles: they were the basis for the (re)construction of scenes, and have provided clues and analyzers that allowed enter and walk through different lines of thought regarding management practices. Using Foucauldian notions of power as an exercise, as government and of government strategic action on current and possible actions, considered accurate in some areas in the SUS (such as organizational arrays and dynamics, the national and local realities, cooperation strategies and networking, among others), it posed problems some games and power technologies. From a pragmatic perspective guided more by effects than the aims and collated with strategic relationships, we tried to work on policy analysis on polítical times in the SUS management, on discursive practices and, transversely, on the issue of functioning, results and effects. Management practices in the SUS, in particular the polítical actors and collective militants in left field that share common ethical-polítical perspectives, can be invested in terms of some challenges, among which are: the modes and exercises of power placed in the tension between democracy and strategies; tension between idealization and different pragmatists; polítical-subjective construction of managers based on dilemmas that analyze different ethic and implications present in management practices in the SUS.