Governança pública nos contratos de gestão: possíveis contribuições da auditoria do SUS

Abstract

The institution of the State Program of Social Organizations in Bahia demands the improvement of the mechanisms of inspection and regulation of private action to increase efficiency, as well as to restrain behaviors that do not converge with good administrative practices. Thus, this research aimed to analyze the limits and possibilities of the Audit of the Unified Health System of Bahia to contribute to the implementation of public governance of management contracts signed by the Health Department of the State of Bahia (Sesab) with Social Organizations for the management of hospital units. To this end, institutional documents and audit reports were analyzed. The thematic categorical analysis technique was used, considering the definition of the categories, the conceptions presented by different authors and the propositions made by the Federal Audit Court, regarding the implementation of governance mechanisms and the evaluation of the maturity level of public policies. The results point out that the Audit of SUS/BA contributes to the implementation of governance of Sesab, through independent assessment, acting in the third line of defense; recommending to senior management and auditees the measures that need to be taken to remedy the irregularities; and making referrals to the competent bodies for the adoption of the necessary measures for accountability. However, there are limitations related to promoting transparency and ensuring accountability that interfere with the full effectiveness of its actions. It was pointed out the need for the publication of audit reports, promoting greater transparency to the citizen of the actions developed; the adoption of a standardized procedure for accountability; the use of the developments from the measures adopted by internal and external bodies in the preparation of its planning; and the scheduling of follow-up audits of the audited contracts, allowing the evaluation of the implementation of recommendations and the correction of non conformities. As for the qualification of the audits, we suggest adjustments in the methodology, incorporating concepts related to Public Governance. The dissertation has as limitations the infeasibility of comparing the evolution of the OS in the management of different health units, as well as the in-depth analysis of the audits' risk approach. These limitations can be overcome with future studies that build on the results presented here, including new dimensions of analysis. Research can also be conducted to evaluate the systematic follow-up and implementation of the recommendations of the internal audit activities, as a way to ensure the effectiveness of the actions of this control mechanism. Likewise, it is opportune the development of studies that analyze the impacts caused by the pandemic of the new Corona virus on the governance of public institutions. With this, it is considered to be possible to deepen the knowledge about the theme in public organizations.