Bureaucracy and social integration: a study on the Ministry of Health in the management of the National Health System (SUS)

Abstract

Although the National Health System (SUS) is implemented in a decentralized manner, with strong emphasis on the municipal level, the role of formulating and coordinating national health policy remains the responsibility of the Ministry of Health, which shows the importance of federal level in inducting and conducting that policy. This study has as its objective the analysis of the state apparatus' structure responsible for the formulation and coordination of healthcare politics after 1990, starting with the configuration of the bureaucracy of the Ministry of Health and its connections with the societal forces involved in this topic. This analysis is supported by the model of "embedded autonomy" theorized by Peter Evans (1995), based in the comparative institutionalist approach, to treat the State not as isolated from the environment, but as sensitive to the surrounding social relations coupled with the concept of isomorphism by Powell and DiMaggio (1983).The study reveals that the federal management of SUS was developed by an extremely vulnerable administrative frame, through analysis of both the recruitment model of the servants of the Ministry of Health headquarters as well as the processes of internal promotion in the sector. Nonetheless, healthcare policy is still recognized nationally, after the consolidation of SUS, as one of the most successful social policies. Advances in health policy can partially be explained by the spread of a strong hygienist culture that led to compensation for the absence of typical elements of traditional bureaucracies in the conduction of health policy.