La influencia de las instituciones en los consejos locales de salud

OBJECTIVE: To analyze the influences of the institutions in the operation of the Local Health councils. DESIGN: qualitative, descriptive and exploratory study. STUDY SETTING: 02 Primary Health Care services of a municipality in the inland of the state of São Paulo, Brazil. PARTICIPANTS: twenty-four members of the Local Health Councils and 4 key informants. METHODS: Supported by the theoretical methodological framework of Institutional Analysis. Data were produced through 28 semi-structured interviews, observation and participation in the activities of the councils and recording in the research diary. Data were organized and analyzed by the process of transcription, transposition and reconstitution. RESULTS: The institutions act in the territories represented by social actors who occupy positions and functions within the Primary Health Care services, evidencing the perpetuation of hierarchization with valorization of the speeches of professionals and managers to the detriment of patients and predominance of bureaucratized meetings. The social actors reproduce the ideals of the collective to which they belong in these spaces. CONCLUSIONS: The health management teams do not recognize the different forces that act in the health territory, however, these forces interfere in the activities performed and in health care. The groups act both in formal spaces through official representatives who meet and discuss issues in collegiate meetings and in informal spaces, and constitute forces in dispute in the health territory.