Diálogos interinstitucionais nos cuidados à saúde da pessoa com deficiência: uma análise dos diálogos entre o Conselho Municipal de Saúde de Juiz de Fora (CMS/JF), o Poder Judiciário e o Ministério Público

Abstract

The present study analyzes interinstitutional dialogue practices between the Municipal Health Council of Juiz de Fora (CMS/JF), the Public Prosecutor's Office, and the Judiciary in the context of implementing the Care Network for Persons with Disabilities (RCPD), established by Ordinance No. 793/2012. Considering the increase in healthrelated judicialization and the need for integration among various institutional actors within the Unified Health System (SUS), the research aims to investigate the interactions between these institutions in the oversight and implementation of public policies focused on the health of persons with disabilities. The study adopts an empirical approach based on qualitative methodology, using content analysis as the primary investigative technique. Minutes and resolutions from the CMS/JF between 2012 and 2024 were examined to identify patterns, trends, and gaps in discussions and decisions related to the health of persons with disabilities. An inductive-deductive reasoning process was employed, starting with an inductive approach to uncover emerging themes from the analyzed records, followed by a deductive analysis grounded in Friedman's and Hiebert's theories on interinstitutional dialogue. The results revealed that judicial decisions are frequent topics in CMS/JF debates, driving both the search for public health solutions and the process of justifying executive decisions and ensuring accountability. Key dialogue mechanisms were discussed, such as the creation of the Municipal List of Essential Medicines (REMUME) and the establishment of multidisciplinary committees to support judicial decisions. The Public Prosecutor's Office was identified as a key actor in problem-solving and policy implementation, whereas the lack of active participation from the Judiciary was highlighted as a barrier to effective interinstitutional dialogue. Additionally, the CMS/JF faces organizational limitations, particularly regarding the predominance of Health Department representatives, documentation issues, and meeting records. Although issues related to the health of persons with disabilities are prioritized in national policies, they were often addressed superficially in local discussions. The study concludes that the CMS/JF plays a central role as a coordinating body in planning and implementing public policies for persons with disabilities. However, it faces significant challenges, especially in effectively implementing dialogue mechanisms with the Judiciary and the Public Prosecutor's Office, as well as in fully realizing national guidelines. Overcoming these barriers requires strengthening documentation practices, institutionalizing dialogue with the Judiciary, and promoting greater adherence to inclusive health policies.