O contracontrole no Sistema Único de Saúde: análise do controle social exercido pelos Conselhos de Saúde

Abstract

This thesis is formed by two studies. Study 1 aimed to analyze the concept of countercontrol in Behavior Analysis, for this purpose a systematic review of articles was carried out in the databases: Medline, BVSpsi, Embase, Psycinfo, Scopos e Web of Science, with the terms “contracontrol*” or “countercontrol*”. And a Search was made in publications with social themes by experts and recognized authors of Behavior Analysis (Skinner, Sá, Sidman e Holland). It was included 19 articles found in the systematic review and 51 papers including books, thesis and articles in newspapers and periodicals by the cited authors. The paragraphs that contained the word “countercontrol” were selected and analyzed considering: the presence of a definition of the concept, the topography of the response, its responsible agents, and agents over which the countercontrol is exercised, the possible antecedents and consequences. 474 paragraphs were identified. Countercontrol was utilized for describing responses preceded by aversive and/or exploitative control and succeeded by prevention, elimination or attenuation of this control, or the punishment of controller’s behavior and changes in control techniques. Study 2 aimed to analyze the formal proposition of Health Councils in the light of the concept of countercontrol. Responses described in two manuals of the Councils were selected, categorized into different sections of action and the possibilities of countercontrol were analyzed, their responsible agents and agents over which the countercontrol, their responsible agents and agents over which the countercontrol is exercised, the possible antecedents and consequences and sought to identify strategic factors for the effectiveness of countercontrol, through the analysis of Study 1. Thus, the Health Councils have the potential to be instruments of countercontrol over the management of the Sistema Único de Saúde since they can exercise control over the stages of the policy formulation and implementation process and can exercise most of the characteristics of effective countercontrol described in the literature. However, the absence of a description of contingencies that would help to formulate more effective countercontrol strategies is highlighted, based on the behavior of the counselors and the variables involved. Thus, it proposes new dialogues between behavior analysis and the political sciences and advances in the production of knowledge about countercontrol, especially basic and applied research