Auditoria do Sistema Único de Saúde, componente do Estado da Bahia, como instrumento de accountability horizontal.

Abstract

The promulgation of the Constitution of the Federative Republic of Brazil, in 1988, revealed devices linked to the public administration, urging it to comply with principles and to create control bodies, a fact that, at least in theory, contributed to the accountability process in its sense horizontal. The public administration has sought to improve mechanisms and instruments that can meet the needs and expectations of citizens, while protecting constitutional rights. Public health services should also look for ways to be accountable, that is, transparent to the point of holding those responsible for causing damage to the citizen or the purse. It is in this context that the Audit/SUS/BA, with its assignment as a supervisory body, can contribute to the rendering of accounts, the transparency of governmental acts and the accountability of public management. This work has the general objective of proposing suggestions for improvement in the work process of the Audit of the Unified Health System (Auditoria/SUS/BA), a state component of the National Audit System (SNA), an internal control body, that contribute to its acting as an instrument of horizontal accountability, identifying its limits and potential, specifically regarding its dimensions of answerability and enforcement. In order to achieve their desideratum, a discussion was made about the translation into Portuguese of the term accountability and the interrelation of its dimensions with the SUS/BA Audit, and then, through a qualitative approach, we analyzed the audit reports, available at Sisaud (Audit Information System), scheduled and closed between the years 2016 until December 2019 and which resulted in referrals to the State Prosecutor's Office. Semi-structured interviews were also applied to the auditors and managers of the SUS /BA Audit and for the analysis of the data, thematic categorical analysis was used. The results show that the Audit/SUS/BA reports are not published; there is also no standardization of referrals to Sesab's internal bodies; auditees and providers do not make full use of the appeal phase; for the most part, there is no response from the Public Ministry of the State of Bahia (MPBA) to the audits carried out; most of the time, it is not possible to determine clearly and explicitly the authorship and materiality of the irregular and illegal facts for effective accountability and there is a patent delay in completing the administrative audit processes, culminating with this, often in filing processes and non-punishment of those responsible. To improve the work process, it is suggested to publish the reports on the Sesab website; periodic meetings with the actors of the Audit; implement the Accountability Matrix in the preparation of reports and create a nucleus for monitoring deadlines and monitoring audit processes. Finally, it is suggested that studies be carried out on the other components of the National Audit System.