Improvement of Active Transparency and of the Unique Health System’ Ombudsman Unit (BR0053)

to establish mediation between the government and the citizens – in compliance with Law No. 8,080/1990, regulated by the Decree No. 7,508/2011 – and to increase the access to information, in compliance with Law No. 12,527/2011. To this end, the Ministry of Health’s Portal shall be improved by disclosing the Citizen Information Service’s (SIC) frequently asked questions and the National Ombudsman System shall be expanded, in compliance with the Organizational Contract of Public Action, with the aim of enhancing the mechanisms for citizen participation in the improvement of public health policies.

Commitment 2.16. Improvement of Active Transparency and of the Unique Health System’ Ombudsman Unit

Commitment Text: To establish mediation between the government and the citizens – in compliance with Law No. 8,080/1990, regulated by the Decree No. 7,508/2011 – and to increase the access to information, in compliance with Law No. 12,527/2011. To this end, the Ministry of Health’s Portal shall be improved by disclosing the Citizen Information Service’s (SIC) frequently asked questions and the National Ombudsman System shall be expanded, in compliance with the Organizational Contract of Public Action, with the aim of enhancing the mechanisms for citizen participation in the improvement of public health policies.

Responsible institution: Ministry of Health

Supporting institution: None

Start date: Not specified                          End date: 14 December 2014

Commitment aim

The National Ombudsman System of the Single Health System (SUS) works to integrate a complex network of ombudsmen overseeing health services at the federal, state, and local levels. The commitment aimed to both facilitate user participation in the permanent evaluation of health services through this system, and improve active transparency within the SUS.

Status

Midterm: Completed

The government simplified the ombudsman system during the action plan by adopting guidelines, conducting trainings, and releasing instructions for establishing additional ombudsmen within the SUS. The architecture of the system’s online portal was also simplified, and a new regulation on the standardisation of municipal, state, and federal ombudsman practices was implemented. For additional details, please see the IRM Midterm Progress Report.

Did it open government?

Access to information: Marginal

Civic participation: Marginal

Public accountability: Marginal

In addition to being a transparency and participation mechanism, the ombudsman is the federal government’s main instrument of accountability. It analyses access to information processes; oversees the operations of the SUS Council, which comprises members from government and civil society; and is the most important public accountability institution of the SUS. Thus, by seeking to strengthen this ombudsman system, the commitment had the potential to make improvements in all OGP value areas.

Nevertheless, most of the commitment results revolved around internal regulations that did not greatly affect how SUS ombudsmen operate. For instance, while there are new agreements, guidelines, and manuals that formalise the structure of the SUS ombudsman system, there is no concrete evidence of significant improvements in ombudsman practices (e.g., lower average processing times, or more cases of holding government agencies accountable). Normative Ruling nº 2416, for example, sets core expectations and responsibilities for the SUS ombudsmen.^{[Note 69: Ministry of Health, Ordinance Nº 2.416, 7 November 2014, http://bit.ly/2n4LyLF.]} While local health administrators agree with these new guidelines,^{[Note 70: Raelma Paz Silva et al., “The thought of municipal managers about the ombudsman as a potential tool of participatory management of SUS,” 40, no. 110 (2016), http://bit.ly/2nPuJBi. ]} there is no evidence that the ordinance has resulted in a change in behaviour.

On the other hand, the government collaborated with external partners to carry out trainings across the country for SUS ombudsmen.^{[Note 71: Government of the State of Rio Grande do Sul, 23 June 2016, http://bit.ly/2nQ4aff. ]} The 80-hour-long course trained participants on health policy and legal frameworks, how to operationalise auditing and audit budgets, and best practices in the field.^{[Note 72: “Curso Nacional Qualificação de Auditorias e Ouvidorias do SUS: Detalhamento da Estrutura de Governança e Orientações de Funcionamento do Curso,” http://bit.ly/2oRLqLO.]} In the short term, one of the main contributions of the trainings was the linking of SUS ombudsmen who have created new systems of ombudsmen as well as forums to further discuss SUS health policies.^{[Note 73: Portal da Saúde, “Oficina prepara facilitadores para curso nacional de qualificação de auditorias e ouvidorias do SUS,” 26 February 2016, http://bit.ly/2ouKWin. ]} As for access to information, the Ministry of Health carried out seminars and trainings on the Law of Access to Information, which constitutes a positive — yet marginal — step forward in access to information.

Carried forward?

Part of this commitment was carried forward to Brazil’s third action plan. Specifically, the third plan contains a commitment to launch an active transparency platform with health data. Though the ombudsman element of the commitment was not carried forward, the IRM researcher recommends investing in mechanisms of collaboration between users and government to promote improvements in the system. It is also important to document the impact of the SUS ombudsman system in the country. This is a well-established network that organises national conferences regularly, has a strong regulatory framework, and aims to be more accessible to citizens (e.g., by adopting a dial-in number, 136). The lessons learned from the SUS ombudsman system can help improve the broader culture of ombudsmen in the country.