Gestão municipal do SUS: desafios, sobrecarga e estratégias de enfrentamento de secretários municipais de saúde da Macrorregião Sudeste de Minas Gerais

Abstract

Municipal health managers play a central role in the operationalization of the Brazilian Unified Health System (Sistema Único de Saúde – SUS), as they are responsible for articulating guidelines, resources, services, and local demands in contexts marked by different levels of institutional capacity. This study aimed to characterize the profile of municipal health secretaries in the Southeast Health Macroregion of Minas Gerais and to understand the challenges experienced in the management of the municipal Unified Health System. A qualitative, descriptive, and exploratory study was conducted in two complementary stages. In the first stage, 36 managers completed an electronic questionnaire addressing their profile, professional trajectory, working conditions, management challenges, and the repercussions of the position on health and well-being. In the second stage, eight semi-structured, individual, dialogical interviews were conducted, either in person or online, with participants intentionally selected to include municipalities of different population sizes. The interviews were subjected to thematic content analysis based on Bardin’s approach, from which empirical categories emerged related to management responsibilities, required competencies, structural limits to governability, the repercussions of work on managers’ lives, and support networks. The qualitative findings revealed municipal managers as professionals exposed to high levels of pressure, responsible for articulating healthcare, administrative, financial, political, and judicial demands, often without having proportional governability over the resources and services required to respond to them. The main findings included multiple roles, dependence on the regional healthcare network, underfunding, regulatory uncertainty, judicialization, the predominance of immediate demands over the managerial agenda, permanent availability, and decisional loneliness. At the same time, positive aspects emerged, including satisfaction with the role, recognition, meaningfulness of work, leadership, technical autonomy, collaborative relationships, and commitment to the SUS. Population size influenced the way managerial complexity was expressed, without eliminating the pressures associated with the position. It is concluded that strengthening municipal health management requires articulation between individual qualification and institutional capacity, including adequate funding, technical support, networks of shared responsibility, and sustainable working conditions. As a TechnicalTechnological Product, a Technical Note was developed for municipal managers, management teams, and COSEMS-MG.