Maria Eliana Labra

Associativismo, participação e cultura cívica: O potencial dos conselhos de saúde

No Brasil, a democratizacao e a descentralizacao abriram espaco para inumeras experiencias de participacao popular em arenas de decisao de politicas publicas. O setor saude se destaca no pais e na America Latina pelo funcionamento de mais de 5.500 conselhos de saude, nos quais a representacao da sociedade civil organizada e compartilhada de forma paritaria com autoridades setoriais, prestadores profissionais e institucionais e trabalhadores do setor. Este trabalho apresenta resultados de pesquisa que buscou tracar um perfil sociopolitico dos representantes dos usuarios nos conselhos de saude do Estado do Rio de Janeiro. A exposicao aborda elementos teoricos relativos a temas como democracia, associativismo e cultura civica, examina a democratizacao brasileira, a reforma do sistema de saude e os conselhos de saude, e analisa os dados da investigacao. Entre as consideracoes finais, postula-se que a participacao nos conselhos de saude fomenta um circulo virtuoso caracterizado pelo envolvimento dos cidadaos em questoes de interesse geral, pela acumulacao de capital social e pelo despertar de uma cultura civica, contribuindo, em ultima instância, para o fortalecimento da democracia.

A produção pública de medicamentos no Brasil: uma visão geral

Este artigo analisa o papel da producao publica de medicamentos no Brasil, a partir de analise bibliografica e documental. Examina as principais caracteristicas da industria farmaceutica e do mercado de medicamentos em suas dimensoes internacional e nacional. Enfatiza, particularmente, a producao de medicamentos do setor publico, bem como aspectos da visao governamental sobre o tema. O estudo se fundamenta na analise de documentos oficiais do Ministerio da Saude. A exposicao conclui com um diagnostico da situacao atual do parque de laboratorios publicos, que mostra a existencia de problemas de ordem politica, administrativa e de funcionamento, aliados a baixa capacitacao tecnologica e a escassez de recursos humanos qualificados em geral.This paper analyzes the role of government production of medicines in Brazil, based on a review of the literature and public documents. It begins by examining the main characteristics of the national and international pharmaceutical industry and market dimensions, mainly in the public sector. The government view was examined through Ministry of Health documents. The article concludes with a diagnosis of the state-owned pharmaceutical industry in Brazil, showing a variety of difficulties faced by the laboratories due to political and institutional constraints, management deficiencies, shortage of qualified human resources, and low technological capability.This paper analyzes the role of government production of medicines in Brazil, based on a review of the literature and public documents. It begins by examining the main characteristics of the national and international pharmaceutical industry and market dimensions, mainly in the public sector. The government view was examined through Ministry of Health documents. The article concludes with a diagnosis of the state-owned pharmaceutical industry in Brazil, showing a variety of difficulties faced by the laboratories due to political and institutional constraints, management deficiencies, shortage of qualified human resources, and low technological capability.

La reinvención neoliberal de la inequidad en Chile: el caso de la salud

This paper examines the main changes in the Chilean health system from the 1920s to the present, identifying contradictions, limits, and successes in terms of policy outcomes. Taking equity as the central theme, the analysis focuses on decisions made from the mid-1920s until 1973 in moving toward socialized medicine, with the sudden interruption of this process by the military coup in 1973. The author then discusses the set of regressive measures taken by authoritarian neoliberalism, with the help of Pinochet, to insert health into the market economy. Finally, the article analyzes efforts made by democratic administrations since 1990 to redress the legacy of socioeconomic inequalities, focusing on the commitment to rebuild the health care system with a new basis in equity, solidarity, and peoples participation.

Six Countries, Six Health Reform Models? Health Care Reform in Chile, Israel, Singapore, Switzerland, Taiwan and The Netherlands

Abstract This research contribution presents a diagnosis of the health reform experience of six small and mid-sized industrial democracies: Chile, Israel, Singapore, Switzerland, Taiwan and The Netherlands during the last decades of the twentieth century. It addresses the following questions: why have these six countries, facing similar pressures to reform their health care systems, with similar options for government action, chosen very different pathways to restructure their health care? What did they do? And what happened after the implementation of those reforms? The article describes the current arrangements for funding, contracting and payment, ownership and administration (or “governance”) of health care at the beginning of the twenty-first century, the origins of the health care reforms, the discussion and choice of policy options, processes of implementation and “after reform adjustments”. The article looks at factors that help explain the variety in reform paths, such as national politics, dominant cultural orientations and the positions of major stakeholders.

Análise de políticas, modos de policy-making e intermediação de interesses: uma revisão

O artigo aborda o tema da analise de politicas a partir de contribuicoes de diversos autores. Os marcos referenciais enfatizam: (1) a ordem social e a regulacao do conflito, em particular a dimensao associativa enquanto base institucional adicional a comunidade, ao mercado politico/economico e ao Estado/burocracia; (2) as correntes neo-institucionalistas da escolha racional e do institucionalismo historico; (3) os enfoques sociologico, regime politico, coalizao de atores e sistema internacional; (4) componentes analiticos, como agenda, atores, arenas, processos e produtos; (5) relacoes entre modos de policy-making e tipos de intermediacao de interesses organizados nas teorizacoes pluralista, neocorporativa e neopluralista.

As instâncias colegiadas do SUS no Estado do Rio de Janeiro e o processo decisório

: The literature concerning governmental policy-making generally encompasses the entire policy-making field. This study focused on one particular aspect of this process in the State of Rio de Janeiro, from January 1998 to July 1999: the formal decision-making tiers represented by State Health Council (CES) and the Bipartite Inter-Managerial Commission (CIB), as well as the relationships between these councils and the State Health Secretariat (SES), which holds political responsibility for approving or rejecting decisions and is thus a key player in the implementation of the Unified Health System (SUS) at the State level. Despite the political confrontation among the SES, CIB, and CES, we have observed that the new design in health policy vis-a-vis the decision-making process has fostered increasing influence by social actors involved in decisions and that the negotiated arrangements, although the result of a given correlation of forces, have favored the democratization of policy-making in the health sector.Abstract The literature concerning governmental policy-making generally encompasses the en-tire policy-making field. This study focused on one particular aspect of this process in the Stateof Rio de Janeiro, from January 1998 to July 1999: the formal decision-making tiers representedby State Health Council (CES) and the Bipartite Inter-Managerial Commission (CIB), as well asthe relationships between these councils and the State Health Secretariat (SES), which holds po-litical responsibility for approving or rejecting decisions and is thus a key player in the imple-mentation of the Unified Health System (SUS) at the State level. Despite the political confronta-tion among the SES, CIB, and CES, we have observed that the new design in health policy vis-a-vis the decision-making process has fostered increasing influence by social actors involved in de-cisions and that the negotiated arrangements, although the result of a given correlation of forces,have favored the democratization of policy-making in the health sector.Em geral, a literatura sobre o policy-making governamental refere-se a todo o processo de formulacao das politicas. Neste estudo, examinamos, no periodo de janeiro de 1998 a julho de 1999, um aspecto desse processo no Estado do Rio de Janeiro, qual seja, as arenas decisorias representadas pelo Conselho Estadual de Saude (CES) e a Comissao Intergestores Bipartite (CIB), na qualidade de espacos formais de decisao das politicas de saude, bem como a relacao desses colegiados com a Secretaria Estadual de Saude (SES) como instância de aprovacao e veto e, portanto, fundamental na implementacao do SUS no estado. Apesar de confrontos politicos observados entre a SES, a CIB e o CES, percebe-se que o desenho dessa politica vem possibilitando a maior influencia de atores sociais envolvidos nas decisoes, e que os arranjos de pactuacao, embora frutos da correlacao de forcas em cada conjuntura, propiciam a democratizacao do policy-making setorial.

Institutional change and political decision-making in the creation of the Brazilian National Health Surveillance Agency

This article examines the decision-making process that led to the creation of the Brazilian National Health Surveillance Agency (ANVISA) in 1999. The authors begin by discussing the history of the Agencys predecessor, the Health Surveillance Secretariat, and the need for its modernization to adjust the quality of the products under its control to domestic and international demands. From the theoretical perspective of neo-institutionalism, the article goes on to analyze the social and political context surrounding the debate on the proposed alternatives to adjust Health Surveillance to new rules in line with such requirements, focusing especially on the formulation of the new policy, the decision-making arena, and the actors with specific interests in the sector. The research drew on extensive documentary and media material, plus interviews with key actors. The article concludes that a determinant factor for the creation of ANVISA was the favorable domestic political context, fostering a positive correlation of forces that (in an extremely short timeframe, 1998-1999) allowed the creation of the first regulatory agency in the social policies area in Brazil.

Associativismo no setor saúde brasileiro e organizações de interesse do empresariado médico

O objetivo deste artigo e o de introduzir a reflexao a respeito das possibilidades de construcao de um pacto social ou formas de concertacao entre os atores organizados do setor saude, tendo em vista a implantacao do Sistema Unico de Saude e seus impasses, A exposicao aborda aspectos teoricos colocados pelo enfoque neocorporativo quanto as relacoes Estado-sociedade civil, a dimensao associativa da ordem social, o intercâmbio politico entre as esferas publica e privada e a intermediacao de interesses organizados no policy-making nas democracias contemporâneas. Passa-se em revista o padrao de organizacao de interesses estruturado historicamente no Brasil, salientando o formato hibrido ou dual da representacao. Com base em um quadro sinoptico que ilustra a evolucao do associativismo setorial vis-a-vis as politicas de saude, sao examinadas particularidades tais como formatos de representacao (dual, tricotomica) e densidade da constelacao de associacoes representativas dos interesses das profissoes, dos produtores de tecnologia em saude e, em particular, do empresariado medico assistencia). Finalmente, em face da maturidade e complexidade do universo analisado, indaga-se a respeito das condicoes de eficacia politica do Conselho de Saude enquanto instrumento criado para operar transformacoes estruturais e culturais no sistema de saude e locus adequado para a concertacao coletiva entre os interesses organizados ali representados.

Redes de política no combate à fome e à pobreza: a estratégia Comunidade Solidária no Brasil

This paper analyzes a strategy deployed by the Brazilian Government for combating hunger and poverty: the Solidarity Community (1995-2003), particularly institutional mechanisms used to fine-tune targeting processes and allocate resources to the Food Stocks Distribution Program (PRODEA) and the Undernourished Child and High-Risk Pregnancy Program (PCDMI). Primary data were obtained through interviews with policy network players, including segments of government and society: nine Federal; six State and 82 from eight Municipalities in Rio de Janeiro state. Moving towards its goal of converging programs for the poorest municipalities, the Solidarity Community made them more visible to executive civil servants. The introduction of different sectors into the Solidarity Community network varied, according to the political clout and institutional capacity of each sector. The Solidarity Community strategy was: to negotiate criteria with Ministries for setting priorities and provide technical support and information for local governments, improving their skills for obtaining federal funding. The role of the Solidarity Community was thus limited at the local level, due to poor intersectoral networking and difficulties in monitoring program implementation and beneficiary selection processes, blunting its advantages for more vulnerable groups.

Public production of medicines in Brazil: an overview

Este artigo analisa o papel da producao publica de medicamentos no Brasil, a partir de analise bibliografica e documental. Examina as principais caracteristicas da industria farmaceutica e do mercado de medicamentos em suas dimensoes internacional e nacional. Enfatiza, particularmente, a producao de medicamentos do setor publico, bem como aspectos da visao governamental sobre o tema. O estudo se fundamenta na analise de documentos oficiais do Ministerio da Saude. A exposicao conclui com um diagnostico da situacao atual do parque de laboratorios publicos, que mostra a existencia de problemas de ordem politica, administrativa e de funcionamento, aliados a baixa capacitacao tecnologica e a escassez de recursos humanos qualificados em geral.This paper analyzes the role of government production of medicines in Brazil, based on a review of the literature and public documents. It begins by examining the main characteristics of the national and international pharmaceutical industry and market dimensions, mainly in the public sector. The government view was examined through Ministry of Health documents. The article concludes with a diagnosis of the state-owned pharmaceutical industry in Brazil, showing a variety of difficulties faced by the laboratories due to political and institutional constraints, management deficiencies, shortage of qualified human resources, and low technological capability.This paper analyzes the role of government production of medicines in Brazil, based on a review of the literature and public documents. It begins by examining the main characteristics of the national and international pharmaceutical industry and market dimensions, mainly in the public sector. The government view was examined through Ministry of Health documents. The article concludes with a diagnosis of the state-owned pharmaceutical industry in Brazil, showing a variety of difficulties faced by the laboratories due to political and institutional constraints, management deficiencies, shortage of qualified human resources, and low technological capability.