INSTITUTIONAL SUPPORT OF COSEMS - RN IN THE IMPROVEMENT OF MONITORING OF HEALTH MANAGEMENT IN RN MUNICIPALITIES: REFLECTIONS ABOUT SARGSUS
Unified Health System - SUS. Support. Management.
The 1988 constitution established mandatory instruments for public management planning,
such as the Multi-Year Plan (PPA), the Budgetary Guidelines Law (LDO) and the Annual
Budget Law (LOA). The Unified Health System (SUS) Legislation defines the conditions for
the municipalities, states and union to enable the management, the elaboration of health
planning instruments: the Health Plan, the Annual Health Program and the Annual
Management Report RAG). In the administrative scenario of planning, stands the RAG,
according to item IV of art. 4 of Law No. 8,142 / 90, also referenced in Complementary Law
141/2012, 575/2012 and 2,135/2013 of the Ministry of Health, as a pillar for evaluation and
monitoring of health actions. The RAG constitutes the instrument for verifying the
application of resources, with the purpose of guiding the preparation of the annual
programming, as well as possible redirections necessary in the Health Plan, in the three
spheres of direction of the System. In 2005, the Ministry of Health launches the Single
Health System Planning System (PLANAJASUS), together with the National Council of
Municipal Health Secretaries (CONASEMS) and the National Council of State Secretaries
of Health (CONASS). As an integral part of the management cycle, PlanejaSUS would
need strategies to articulate and support SUS decision levels. In this sense, the Institutional
support emerges as a permanent way of making feasible the functional bases of SUS
planning, monitoring and evaluation. In order to support the managers in the elaboration
and sending of the RAG to the Health Councils, SargSUS was created. The present study
is a Research-Action (Barbier, 2002) that will use the emerging fourth-generation Approach
approach (Guba and Lincoln, 2011) to describe and analyze the influence of the COSEMS-
RN institutional support in improving health in the municipalities of the RN. The
methodological steps used consisted of the analysis of the scenario of the health planning
instruments of the 167 municipalities, by health region, through SARGSUS. After identifying
this high rate of default, COSEMS-RN carried out specific awareness workshops with
managers, management teams and institutional supporters, recently implemented by
COSEMS-RN, through the Collaborative Network for Strengthening Project of the Municipal
Management of the SUS (German Hospital-FIOCRUZ / MS and CONASEMS), an approach
was taken regarding individual responsibility in relation to the management instruments,
which occurred from May to June 2017, in the 8 (eight) Health Regions of Application Office
for Construction of Management Instruments. After this process, it was observed that
83,83% of the municipalities fulfilled their responsibilities to elaborate the RAG, among
other instruments, and to feed SARGSUS. It is believed that, with the mobilization of
COSEMS-RN regarding the need to comply with the normative acts of the system,
managers assume their responsibilities to elaborate and feed SARGSUS, specifically the
RAG. In the course of the activities of the workshop, the participants recognized in the final
evaluations the COSEMS-RN and the role of the institutional supporter as fundamental to
qualify municipal management.