Judicial governance and intersectoral deliberation in the SUS: A normative evaluation of the Pernambuco State Health Committee

Abstract

The judicialization of healthcare is a challenge for Brazil’s Unified Health System (SUS) and the Judiciary, which led the National Council of Justice to create the Comitês Estaduais de Saúde (CES) (State Health Committees). This study aimed to evaluate the normative compliance of the CES of Pernambuco (CES/PE), analyzing its potential as a governance body. The study used a qualitative-quantitative approach, analyzing 23 meeting minutes, as well as questionnaires from 18 committee members. The quantitative analysis used a 60% compliance criterion, while the qualitative analysis employed content analysis. COREQ criteria were adapted to ensure methodological rigor. The CES/PE achieved an overall compliance rate of 68.2%. Performance was mixed across the following dimensions: structure (77.8%), process (53.8%), and outcome (73.1%). The main advances were inter-institutional coordination and the production of technical notes by the Judiciary’s Technical Support Units. Identified weaknesses include the lack of a work program, limited regulatory proposals, and limited proactive action. It is concluded that the CES/PE is a relevant body of judicial governance in health, but its effectiveness depends on strengthening the ‘process’ dimension and the institutionalization of regulatory mechanisms. This experience can provide insights to improve national guidelines to combat the judicialization of health.