O papel dos atores na formulação e implementação de políticas públicas: dinâmicas, conflitos e interesses no Programa Mais Médicos

Abstract

Many different actors take part in the process of formulating public policies, which includes individuals, groups and organizations that exert a direct or indirect influence at different times. Thus, the specific purpose of this article has been to map the actors involved in the formulation and implementation of the ‘Mais Médicos’ Program and to understand the dynamics and contributions of these actors. In order to analyze this particular public policy, a theoretical and empirical study has been adopted with a qualitative approach and case study method. Among the key players in this process were the federal government, social movements, the mass media, and social networks, as well as the Councils of Medicine. With regard to the analysis of the program cycle, it was found that its processes were not continuous, but rather asymmetrical and permeated by conflicting relations. This same analysis showed that the June 2013 protests provided a window of opportunity for the ‘Mais Médicos’ Program, but that nevertheless, there was still considerable opposition to the program. The opposition movements involved were bound by a series of different dynamics, conflicts and coalitions that applied to both government actors as well as those from civil society. One should highlight, for example, the relationship between those parties for and those against the ‘Mais Médicos’ Program, in which there were conflicts and setbacks on both sides. The conclusion is, therefore, that the different actors involved in the process were motivated by a variety of different interests, ideologies and goals. Thus, conflict permeated the entire process, from the program’s initial proposal, its announcement, the enactment of the Law governing it and the arrival of the different doctors to the start of their activities in hospitals throughout the country.