OBJECTIVETo analyze the role of a Municipal Health Ombudsman and its contribution to the public health management from the perspective of the public health system users and the municipal health counselors.METHODSQualitative research approach using the case study, descriptive and transversal methods. The unit of analysis was a Municipal Health Ombudsman, in the state of Minas Gerais, Southeastern Brazil, between May and August 2010. The study was observational in nature and data were collected through interviews with two groups of stakeholders: users and municipal health counselors. We interviewed 44 Brazilian Unified Health System users who had made direct use of the Municipal Health Ombudsman and all 20 municipal health counselors. The data obtained were analyzed based on three issues: (1) nature of the data obtained; (2) discussion of subsidies to qualify the ombudsman’s functioning as a management tool; (3) proposals for actions to improve democratic management in the area of public health.RESULTSThe complaints to the ombudsman denoted difficulties in access to health care services running the risk of their being perceived as shortcuts to gaining accessibility, disregarding the principle of social justice. The role of the ombudsman has the citizens’ approval. Users reported the following main functions of the ombudsman: to support the resolution of health problems, to listen and to clarify issues regarding Brazilian Unified Health System operations and procedures. Information was emphasized by health counselors as an instrument of power and access to the rights of Brazilian Unified Health System users. They highlighted that the ombudsman has the role of ensuring justice to foster an effective health policy, besides playing an important mediating role between the board of the municipal health system, its managers and citizens. Furthermore, the ombudsman was shown to have an execution role that transcends its regular functions.CONCLUSIONSThe study found that the ombudsman is a key management tool in monitoring the health care system. Therefore, the establishment of the ombudsman is an advance in the field of democratic management. Nevertheless, there are challenges to be overcome in order to improve ombudsman contribution to the execution of health policies and representing citizens in ensuring their rights to health care.

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Introduction Social participation is one of the guidelines of the Brazilian health system. Health councils are collegiate instances of participation established by Law 8.142/90. The most recent legal regulation for council organization and functioning was established through Resolution 453/2021. The institution of health councils has a permanent and deliberative nature to act in the formulation, deliberation and control of health policy implementation, including in economic and financial aspects. Objective To evaluate the compliance of health councils with the directives for the establishment, restructuring and operation of the councils from Brazil, based on Resolution 453/2012. Methods An exploratory, descriptive study that used the Health Council Monitoring System as a data source. Qualitative variables were selected to identify the characteristics related to the councils’ establishment (legal instruments for establishment), the strategies adopted for restructuring (budget allocation, existence of an executive secretariat, provision of a dedicated office) and the characteristics of the health councils’ operation (frequency of regular meetings, existence of a board of directors, the election of the board of directors). Results The study analyzed three groups of characteristics related to the constitution, strategies adopted for restructuring and the functioning of the councils. Regarding the constitution of the councils, the findings revealed that the vast majority was constituted in accordance with the legislation and, therefore, is in compliance with Resolution 453/2021. In the second group of characteristics that describe the restructuring of councils, the study found that less than half of registered councils are in compliance with the standard. And, finally, in the third group of characteristics, it was found that the boards have adopted different frequencies for regular meetings and approximately 50% of the boards studied have a board of directors. Conclusions The councils still do not meet the minimum conditions necessary to fulfil their role in the Unified Health System (SUS), as stipulated in Resolution 453/2021. This situation requires monitoring by public oversight agencies. Despite the increase in popular participation with the creation of the health councils, this study demonstrated that most councils still do not meet the minimum conditions for monitoring public health policy. The improvement of the Health Councils Monitoring System (SIACS) to become an instrument for monitoring the councils, with the definition of goals and results, may contribute to the organization of the councils and, therefore, to the realization of social participation in Brazil.

The text addresses the representativeness in health councils in Brazil, based on guidelines proposed by the National Health Council. This study aimed to verify the adequacy of the councils to the criteria described in Resolution 453/2012, which demonstrate the representativeness of the segments that make up the collective. A descriptive cross-sectional study was conducted during May and June 2017. The study population was composed of health councils registered in the Health Councils Monitoring System, with public access and available on the Internet. The results obtained were organized considering the geographical distribution of the councils. The regions with the highest rates of non-compliance with the parity criterion were identified. It has been demonstrated that the guidelines for reformulating the councils are aligned with the notion of representativeness, but they are not a guarantee for the effectiveness of the representation. Future studies may deepen the analyses on representativeness in health councils in Brazil, and identify which mechanisms are adopted by entities to ensure the effectiveness of representation, as well as whether representation is renewed. It is recommended that the rules ordering the functioning of councils be permanently updated to promote social participation in health.

RESUMOO presente artigo se propôs a estudar as demandas do Ministério Público em um município de pequeno porte, a partir do olhar da ouvidoria da saúde. Foi realizada pesquisa de natureza exploratória e qualitativa que utilizou como método o estudo de caso. As unidades de análise foram as demandas apresentadas pelo Ministério Público à secretaria municipal de saúde no período de janeiro a dezembro de 2010. A pesquisa documental consistiu na análise de 77 ofícios. As variáreis estudadas foram: assunto, natureza e teor das demandas. Os dados foram agrupados conforme as categorias analisadas e apresentaram seis tipos de assunto: comunicação, intimação, recomendação, requisição de atendimento, requisição de informação e solicitação de providências. Quanto à natureza das demandas encontramos: execução de pena, curadoria do idoso, cível, procedimento ordinário, contravenção penal, cível (curatela/interdição), medida de proteção e pedido de providência. A análise do teor das demandas demonstrou que a intervenção do Ministério Público tem características bastante peculiares no município estudado, pois, das 77 demandas, apenas três referemse a serviços indisponíveis no sistema público de saúde. Portanto, apesar de ser objeto de demandas oriundas do Ministério Público, 96,11% das solicitações foram de serviços ou insumos disponíveis no município. O estudo concluiu