Changes in Primary Health Care Policy: consensus and disputes in deliberative spaces of the SUS

Abstract

The National Primary Care Policy (PNAB), when established in 2006, corroborated the direction of the  care model in accordance with the universalization of  the Brazilian health system. However, recent changes  in its organization and funding demonstrate  inflections. The aim of the study is to analyze decision-making processes related to the PNAB, in  different deliberation spaces of the SUS, which  influenced changes in such policy, in the period  between 2016 and 2020. This is an exploratory and  retrospective case study, which adopted process  tracing. Meeting minutes of the National Health  Council (CNS) and Tripartite Inter-managers  Commission (CIT) from 2016 to 2020 were analyzed.  Recordings of Ordinary CIT Meetings, between 2019  and 2020, were also sources of information. Changes  in the policy took place under the low dialogue and  disapproval of the national instance of participation  and social control of the SUS. The CNS acted as a  space for denunciation and resistance to changes, but with a low capacity to influence political decisions. In  turn, the intergovernmental space of the SUS revealed cooperation between representatives of subnational  managers, with few tensions, with regard to the  change agenda proposed by the Union.