A governança das Organizações Sociais de Saúde sob o olhar do Tribunal de Contas e Conselho Estadual de Saúde em Pernambuco

Abstract

The Unified Health System faces structural obstacles that hinder the universalization of healthcare, including underfunding, fragmentation of the healthcare network, and tensions between the public and private sectors. In this context, Social Health Organizations have begun to manage public facilities through management contracts, justified by the premise of greater administrative efficiency. Given this, the present study aims to analyze the contractual agreements and the oversight and regulatory mechanisms of these organizations in Pernambuco, considering the role of the Court of Auditors and the State Health Council. This is a qualitative study based on a documentary analysis of contracts, addenda, and management reports covering the period from 2009 to 2025, obtained from public databases. The results indicated the recurring presence of contractual irregularities, affecting approximately one-quarter of the units analyzed, as well as a high incidence of addenda, which suggest constant renegotiations and weaknesses in contractual planning, with limitations also observed in the effectiveness of external and social oversight. Furthermore, the findings demonstrated that the model of Social Health Organizations, without adequate strengthening of oversight and regulatory mechanisms, tends to increase the risks of opacity, contractual instability, and the misappropriation of public funds; thus, greater rigor in regulation and transparency are vital to ensuring a universal and public health policy.