Estado, burocracia e gerência: uma análise sobre o agir gerencial no cotidiano dos serviços de saúde.

Abstract

This thesis aimed at understanding the managerial action in the everyday life of organizations of health services in the context of bureaucratic Brazilian state. The phenomenological approach was chosen to theoretically sustain their basic assumptions. The field research focused the daily practice of health services designed not as a space of ideas assessment, but of knowledge production, and the scenario was the units of basic care of Piraí, in Rio de Janeiro and their managers, the subjects. It was from the reading of the work "Responsibility and judgment", by Hannah Arendt, (2004), and her colocation on the "cogwheel" that the issues raised have gained a better direction. The theoretical and analytical central categories of the study were: State; bureaucracy; and management. In order to understand the operation of the "cog" - the managerial action - it was necessary to understand the bureaucracy as the "engine" that runs the State. The most important concepts guiding this paper were taken from Hegel (1997). This author stressed the role of the State and of its bureaucracy as the organizer of the common welfare and the public official as a "universal class", as a neutral power, addressed to ensure "the integration of individual and private interests. In the specific case of public Brazilian bureaucracy, we have seen that since colonial times it has been more subject to the private logic than to public logic. It has been argued that the construction of SUS should obey a political 'grammar' of Hegelian cutting, or universal, addressed to the common interests, in opposition to patrimonialism and clientelism, present in Brazilian bureaucracy. As regards the management, the nature of this kind of work, the knowledge necessary for its exercise, as well as the specificities needed to it in health organizations. It has been argued that, in view of the historical circumstances, the deployment of a public health system with the characteristics of SUS would require from the State some consistent effort to build the public machine, form a meritocratic state civil service and, mainly, capacitate managers of health services. Given the fragility of the bureaucratic Brazilian machine in general, the difficulties in the process of construction of the management of SUS and the fact of having never been pointed out the need for a clear strategy to build its bureaucracy in Hegelian molds, managers of health services tend to be mere "cogwheels", sentenced to develop their work without appropriate conditions and in an alienated way.