A Importância do componente municipal de auditoria para o controle institucional do SUS: um estudo na região de saúde de Salvador

Abstract

The Federal Constitution of Brazil estimates that its public health system Sistema Único de Saúde – SUS must be regulated, supervised, and monitored regularly. Because of its systemic concept SUS needs to be continuously evaluated and the results obtained from these evaluations need to be converted in a feedback for its improvement. The purview to audit and control SUS is given to Sistema Nacional de Auditoria – SNA/SUS that was instituted by the Law Number 8689/93 and regulated by the Decree number 1651/95, as a subsystem of Sistema Único de Saúde acting in a decentralized manner in the three management areas of SUS, through its components (federal, state and municipal). The Componente Municipal de Auditoria do SUS – CMA/SUS (Municipal Audit Component) which is part of the SNA, works as an institutional control instrument and must be implanted and working regularly as legal obligation to the cities that are part of the Gestão Plena do Sistema de Saúde – Comando Único (Full Management of the Health System – Single Command), although the surveys that were conducted show a negligible number of this implanted component. Therefore, it is necessary to have a support through the technical cooperation of the federated parts, in order to strengthen the control mechanisms, through CMA/SUS. Thus, the general objective of this work is: to propose actions that, in the light of the systemic approach, subsidize the Secretaria de Saúde do Estado da Bahia (SESAB) (Health Secretariat of the State of Bahia) to contribute to the reinforcement of the control of the institutional dimension of Sistema Nacional de Auditoria no Estado da Bahia, through the Componente Municipal de Auditoria. For this purpose, we made a qualitative, exploratory, descriptive, bibliographic, documental, and field study. We identified immediately, with the results, important gaps in control in SUS and, because of the existence of this mechanism exercised by CMA, they can contribute to the fragility of the structural actions of SUS. These findings solidify the understanding that the audit, through SNA with its components, need to be invigorated and constitute an instrument that is able of subsidizing the decision-making process of the health manager, adding to the ongoing building and strengthening of SUS.