Public prosecutor’s office and social control in the National Unified Health System: a systematic review

Pereira, Ilma de Paiva; Chai, Cássius Guimarães; Loyola, Cristina Maria Douat; Felipe, Ilana Miriam Almeida; Pacheco, Marco Antonio Barbosa; Dias, Rosane da Silva

doi:10.1590/1413-81232018245.16552017

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REVIEW • Ciênc. saúde colet. 24 (5) • May 2019 • https://doi.org/10.1590/1413-81232018245.16552017 copy

Public prosecutor’s office and social control in the National Unified Health System: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The 1988 Constitution increased the Public Prosecutor’s Office attributions and facilitated social participation through management councils in the construction of public policies and in the implementation of social control. In this context, it is necessary to reflect critically on the Public Prosecutor’s Office work and its interaction with Health Councils to strengthen social control in the National Unified Health System. We conducted a systematic literature review to identify the national panorama of the relationship between the Public Prosecutor’s Office and Health Councils with a view to providing answers on this institution’s contributions toward effective social control in the National Unified Health System (SUS). The following databases were consulted: PubMed, BVS, CAPES Journals and BDTD. We included 17 studies, papers and dissertations, which were selected in the period 2006-2015. Results summarize that the Public Prosecutor’s Office should focus its activities on health, especially on the operative and extrajudicial matrix, in order to boost popular participation and overcome Health Councils’ shortcomings. An essential dialogue between the Public Prosecutor’s Office and Health Councils is in place and mutually benefits the strengthening and effectiveness of social control in the SUS.

Public prosecutor’s office; Social control; Health councils

Thematic Lines	Author/Year	Main objective	Main outcome
The Public Prosecutor’s Office , the right to health and social control in the SUS	Oliveira et al., (2015)¹³13. Oliveira LM, Andrade EIG, Milagres MO. Ministério Público e políticas de saúde: implicações de sua atuação resolutiva e demandista. Rev Direito Sanit 2015; 5(3):142-161.	To analyze the possible contribution of the Public Prosecutor’s Office (MP) for effective right to health.	The extrajudicial performance of the Public Prosecutor’s Office is more adequate to address the complexity of the right to health and health policies in Brazil.
	Machado, (2013)⁴4. Machado EP. Ministério Público, gestão social e os conselhos gestores de políticas públicas. Lavras: UFLA; 2013.	Analyze how the MP can contribute to effective management councils.	Interface between a resolute MP, social management and management councils is important.
	Lehmann, (2013)⁸8. Lehmann LHM. Participação popular em saúde e Ministério Público: contribuições para a efetivação do Sistema Único de Saúde. Florianópolis: UFSC; 2013.	To analyze how the MP should act in the field of population participation in health.	The MP should focus on strengthening population participation.
	Oliveira, (2013)¹⁴14. Oliveira FF. O Ministério Público resolutivo: a tensão entre a atuação preventiva e a autonomia institucional. Rev Direito Const 2013; 12(1):317-339.	To evaluate the tension between the preventive action and the institutional autonomy of the Brazilian MP.	The MP must find solutions through resolution, which provides mechanisms for expanded democratic citizen participation.
	Santana, (2011)¹¹11. Santana P. Implementação do direito à saúde no município do Rio de Janeiro: Conselho Municipal de Saúde e Promotoria de Justiça de Tutela Coletiva da Saúde [dissertação]. Rio de Janeiro: Pontifícia Universidade Católica do Rio de Janeiro; 2011.	To examine the actions of the Attorney-General Office at the Municipal Health Council of Rio de Janeiro.	The extrajudicial action of the MP provides a valuable space for interaction with health councils, strengthening their performance.
	Batista e Melo, (2011)¹⁵15. Batista EC, Melo EM. A participação popular em Ipatinga (MG, Brasil): conquistas e desafios do setor saúde. Cien Saude Colet 2011; 16(1):337-347.	To understand how social stakeholders ensure the right to participate in political decision-making in Health.	There is a setback in participatory practice in the health sector.
	Asensi, (2010)¹²12. Asensi FD. Indo Além da Judicialização: o Ministério Público e a saúde no Brasil. Rio de Janeiro: Escola de Direito do Rio de Janeiro da Fundação Getúlio Vargas, Centro de Justiça e Sociedade; 2010.	To study how the institutional scheme between MP, society and members of municipal management develops.	The institutional scheme established between the MP, health councils and management has facilitated actions focused on the public sphere.
	Ribeiro, (2008)⁶6. Ribeiro CFB. O Ministério Público e o Controle Social: possibilidades de interação na construção da defesa e garantia do direito à saúde. Londrina: Almedina; 2008.	To identify the possible interaction between MP and health councils in the right to health advocacy.	Interaction among stakeholders marked by subordination. Offense against the principles of the SUS finds resistance in MP’s actions.
	Machado et al., (2006)¹⁶16. Machado FRS, Pinheiro R, Guizardi FL, De Laai T, Asensi FD, Silva TBSV. Novos espaços e estratégias na gestão em saúde pública: notas sobre parcerias entre Conselho de Saúde e Ministério Público. In: Pinheiro, Roseni; Ferla, Alcindo Antonio; Mattos, Ruben Araújo de, organizadores. Gestão em redes: tecendo os fios da integralidade em saúde. Rio de Janeiro: EdUCS, IMS/UERJ, CEPESQ; 2006. p. 25-36.	To analyze the new participation model, mainly from institutional stakeholders MP and CS.	Association between CS and MP has been recurrent and has reciprocal advantages for these two social stakeholders.
	Machado, (2006)³3. Machado FRS. Direito à saúde, integralidade e participação: um estudo sobre as relações entre sociedade e Ministério Público na experiência de Porto Alegre [dissertação]. Rio de Janeiro: Universidade do Estado do Rio de Janeiro; 2006.	To analyze the current relationships between the MP and the Health Council.	The MP has fostered greater interaction between the management of services and health councils, establishing a space for dialogue. The joint action of the MP and Health Councils has led to the establishment of new ways and mechanisms of negotiation and agreement.
Participatory Democracy, population’s participationandhealth Councils	Zambom e Ogata, (2013)¹⁷17. Zambon VD, Ogata MN. Controle Social do Sistema Único de Saúde: o que pensam os conselheiros municipais de saúde. Rev Bras Enferm 2013; 66(6):921-927.	To analyze social control from the perspective of health counselors.	Health counselors do not recognize social participation as SUS guideline; centralization of decisions in the management and recognition of technical expertise.
	Farias Filho et al., (2014)¹⁸18. Farias Filho MC, Silva NA, Mathis A. Os limites da ação coletiva dos conselheiros municipais de saúde. Cien Saude Colet 2014; 19(6):1911-1919.	To verify the actions of the health counselors regarding their collective participation actions.	Actions marked by the co-optation of health counselors and the definition of deliberative agendas by the manager.
	Bispo Junior e Gerschman, (2013)⁵5. Bispo Júnior JP, Gerschman S. Potencial participativo e função deliberativa: um debate sobre a ampliação da democracia por meio dos conselhos de saúde. Cien Saude Colet 2013; 18(1):7-16.	To analyze Health Councils as expanded democracy spaces.	Health Councils are mechanisms for expanded democracy, understood as the assurance of social rights.
	Oliveira et al., (2013)¹⁹19. Oliveira AMC, Ianni AMZ, Dallari SG. Controle Social no SUS: discurso, ação e reação. Cien Saude Colet 2013; 18(8):2329-2338.	To describe and analyze the dynamics of social participation in the CMS of Belo Horizonte (MG) and verify possible signs of institutional reaction to the difficulties reported.	The Health Council operates several mechanisms to improve its modes of action, organization and commitment of the stakeholders to this forum.
	Moreira e Escorel, (2009)⁹9. Moreira MR, Escorel S. Conselhos Municipais de Saúde do Brasil: um debate sobre a democratização da política de saúde nos vinte anos do SUS. Cien Saude Colet 2009; 14(3):795-805.	To understand reactions and rules of the Health Councils institutionalization process.	Health Councils have an autonomy and organization issue.
	Van Stralen et al., (2006)²⁰20. Van Stralen CJ, Lima AMD, Sobrinho DF, Saraiva LES, Van Stralen TBS, Belisário SA. Conselhos de Saúde: efetividade do controle social em municípios de Goiás e Mato Grosso do Sul. Cien Saude Colet 2006; 11(3):621-632. [acessado 2016 set.8] Disponível em http://www.scielosp.org/pdf/csc/v11n3/30978.pdf http://www.scielosp.org/pdf/csc/v11n3/30...	To investigate the effective participation of Municipal Health Councils in the management of health policies.	Councils have little impact on the restructuring of health services.
	Oliveira e Pinheiro, (2010)²¹21. Oliveira LC, Pinheiro R. A participação nos conselheiros de saúde e sua interface com a cultura política. Cien Saude Colet 2010; 15(5):2455-2464.	To analyze the participation practices in the Municipal Health Council of a capital of the Brazilian Northeast and its relationship with the local political culture.	Authoritarianism and cooptation in relationships between municipal managers and representatives of civil society. Counselors recognize the fragile deliberative and oversight power of health councils.

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[1] Collaborations

IP Pereira worked on the design, outline, data analysis and interpretation and writing of the paper; CG Chai worked on data analysis and interpretation, writing of the paper and in the final version to be published; CMD Loyola worked on the final version to be published; IMA Felipe e MAB Pacheco worked on the design and outline, its critical review and the approval of the version to be published; RS Dias participated in the data analysis and interpretation, critical review and approval of the version to be published.