Abstract The article analyzes the insertion of mid-level administrative professionals in health services aiming at discussing the roles they play in the power structures and relations that make up such institutions. Data are presented concerning the workers' understanding of their roles and the relations they envision between their work processes and the management of the Unified Health System. The study was carried out in a health region of the city of Rio de Janeiro, and involved mapping the middle-level administrative work processes at the different public health institutions in this territory. In total, 44 semi-structured interviews were conducted, covering the different processes that were identified. The results show that decision-making prioritization is associated with the devaluation of these professionals, who see themselves as mere implementers of definitions set out by higher hierarchical levels. We conclude that instrumental administrative rationality remains hegemonic in the territory. These aspects lead to reflection on whether or not it is possible to further consolidate SUS without the active participation of the social actors involved in building it, among whom we highlight the administrative agents due to the strategic role they play in the management processes.
health work; health management; institutional democracy; autonomy