Entre estratégias, dinâmicas e capacidades: uma análise dos arranjos de governança das políticas de saúde do GoveRNo Cidadão/RN

Abstract

This master’s dissertation talks about the governance’s arrangements of the health policy funded by de World Bank, in particular, the Urgency and Emergency of the GoveRNo Cidadão regionalization’s Project, in Rio Grande do Norte state. It was opted to comprehend this phenomenum from the concept of governance. Under the aegis of the Health Unic System fundamentals, the institutional desing of the GoveRNo Cidadão program and the concept of governance, the question that rises this research is wich is the governance’s arrangement in the health policy in the GoveRNo Cidadão? The main objective is to comprehend the process of governance in the health policies funded by the World Bank in the state of Rio Grande do Norte, by the time of 2013 to 2020, in particular the regionalization’s Project of the Urgency and Emergency Network. The theoretical-methodological basis that supports this analysis was anchored in the Capano, Howlett and Ramesh’s (2015) perspective, that suggests that the studies about governance comprehend three analytical dimensions that is a important way of explanation for the autors: 1) Dynamics; 2) Strategics; and 3) Capacity of Governance. To them, the dimension of Dynamics opposes to the idea that governance arrangements are static, reinforcing that they modify with time. The dimension Strategics, in turn, refers to the multiple actors envolved in the decision-making arena, it’s motivations and strategics. The dimension Capacity is about how effective these arrangements are. In a way to operationalize the research, it was opted to adopt a qualitative approach, mobilizing: bibliographic research, document analysis and semi-structured interviews. Content analysis and use of the IRAMUTEQ software were the techniques adopted. The results shown that the history of the World Bank in the Rio Grande do Norte, the exchange fee, the Federal Government program, Brasil sem Miséria, favored the signing of the GoveRNo Cidadão agreement. With regard to health policy, the Ministry of Health, from the definition of Health Care Networks, and the media had a fundamental role in choosing the projects financed in the state. In addition, actors that were not foreseen in the institutional design were identified, but have an influence on the governance arrangement. The data also indicated aspects such as the strength of the judicialization of SUS, the high turnover of health secretaries, institutional activism (RECH and SILVA, 2016) as a strategy and motivation on the part of the actors. With regard to the performance of the policy financed by the GoveRNo Cidadão, there was an increase in regionalized urgency and emergency services, the training of professionals specifically in the area of adult and pediatric cardiology, seven regional hospitals received equipment and were renovated, in addition to the consultancy that restructured the State Health Department. We conclude that the theoretical model adopted allows a holistic view of governance. Furthermore, considering the democratic and participatory constitutional precepts of Brazil, it was possible to infer that the governance arrangements analyzed pointed to a governance model based on a “regulatory” institutional arrangement, specific to projects financed by the World Bank. Therefore, the analysis of the health policy of the GoveRNo Cidadão project highlights the model adopted by the World Bank, which assumes the role of financial actor.