Revista Panamericana de Salud Pública
Print version ISSN 1020-4989
ARAUJO, Maria Arlete Duarte. Results-oriented management and accountability in the Brazilian Unified Health System. Rev Panam Salud Publica [online]. 2010, vol.27, n.3, pp. 230-236. ISSN 1020-4989. http://dx.doi.org/10.1590/S1020-49892010000300011.
By examining normative instruments, the present article evaluates if the discourse of results-oriented management and accountability has become a reality within the Brazilian health care system following the reform started in the 1990s with the establishment of the Unified Health System (SUS). The analysis shows that there is, in fact, an effort aimed at the construction of results-oriented management, with the incorporation of many management tools (plans, reports, agendas, indicators, joint goals-setting). Also, the health care system has strived to adopt performance indicators and views evaluation as an essential management tool. However, difficulties are also evident, such as the absence of citizens in the construction of the system, due to an institutional design that only provides space for official bodies (Health Councils); accountability mechanisms that are limited to bureaucratic aspects typical of public administration, following the traditional accountability path of audit and controllership; no engagement of health care system users in the decision-making about health care policies and operating arrangements; and no evaluation of the efficacy and effectiveness of contracts, placing the current management systems far from results-oriented management. It is possible to state that the conditions for accountability are slowly being created; however, it is still not possible to foresee the consolidation of results-oriented management and accountability within the SUS.
Keywords : Management indicators; health management; Unified Health System; outcome assessment (health care); Brazil.