Implications of implementing a PROADI project for the SUS management: Weakening of public management?

Abstract

The objective of this article is to discuss the participation of political and in-stitutional actors in the implementation process of the project Planifica-SUS, under the Uni-fied Health System Institutional Development Support Program (PROADISUS), and its im-plications for SUS management. It is a thematic section of a multiple-case study that ana-lyzed this process. The sources of evidence used were unstructured interviews conducted with eight institutional actors within the SUS related to the project, including the hospital of excellence responsible for it. Significant differences were revealed in the involvement of these actors, who comprise SUS management from the three spheres of government in this process. The fragility of municipal management participation was highlighted, despite the project directly impacting the (re)organization of Primary Health Care. The adoption of a top-down implementation model may have led to resistance and compromised its continuity. It is important to highlight the importance of discussing the Ministry of Health’s option to use PROADI as a strategy to implement priority SUS programs and policies, which may im-ply the weakening of public management and the strengthening of the participation of the private health sector in the management of the system.