O controle social e o direito fundamental à saúde em tempos de covid-19 no Maranhão.

Abstract

Social control in the Unified Health System (SUS) is a fundamental pillar of participatory democracy, ensuring the participation of society in the formulation, monitoring, and implementation of health policies. During the COVID-19 pandemic, social control proved to be even more essential to ensure the transparency and effectiveness of government actions, in the management of the health crisis, and in equity in access to health services. This dissertation aimed to analyze the performance of CESMA from 2019 to 2023, investigating its effectiveness in guaranteeing the fundamental right to health during the COVID-19 pandemic. Based on the Federal Constitution of 1988 and Laws No. 8,080/90 and No. 8,142/90, the study started from the hypothesis that popular participation needed to be strengthened to ensure transparency, equity, and efficiency in the management of SUS, especially in times of health crisis. The research adopted a qualitative approach, with a legal descriptive and legal-diagnostic method, based on the documentary analysis of legal norms, CESMA minutes and management reports. The methodology included a systematic review using the PRISMA protocol, using official databases, such as the National Health Fund and the Maranhão State Health Department. The results showed that, although CESMA played an important role in the deliberation and monitoring of health policies, its performance was limited by factors such as the lack of institutional autonomy, political interference and restrictions on the monitoring of health units. These challenges compromised the effectiveness of social control and highlighted weaknesses in the participatory governance of the SUS in Maranhão. The COVID-19 pandemic accentuated these difficulties, making even more evident the need to improve social control mechanisms to ensure efficient and equitable management of public resources. The discussion of the findings was based on Jürgen Habermas' theory of deliberative democracy, which emphasizes the importance of public participation in decision-making. It was argued that more robust social control, with greater financial and structural autonomy, could contribute to the realization of the right to health. The pandemic revealed not only the vulnerability of health systems, but also the need to improve mechanisms for popular participation, ensuring greater transparency in the application of resources and effectiveness in the implementation of public policies. It was concluded that strengthening CESMA was essential to consolidate democratic governance in health, promoting greater inclusion and effective monitoring of public policies. It was recommended that access to information be expanded, more effective monitoring mechanisms be created, and strategies be implemented to guarantee the independence of health councils from the executive branch. The research contributed to the debate on participatory governance in the SUS, highlighting challenges and proposing ways to improve social control and the realization of the right to health, especially in times of health crisis.