OVER THE YEARS, THE JOURNAL 'SAÚDE EM DEBATE' has been an important vehicle for the dissemination of scientific papers, essays and documents of political positioning on the courses of the Brazilian Sanitary Reform (RSB) process and the tortuous construction of the Unified Health System (SUS) in our country. From its beginnings, the commitment that animates the publication of the journal is based on the understanding that scientific production is not neutral and that it is necessary to construct and defend bravely the spaces in which a 'militant knowledge' is elaborated and diffused. That is, a knowledge that subsidizes the critical analysis of the problems of health in Brazil and the elaboration of policy proposals consistent with the purposes that inspired the creation of the Brazilian Center for Health Studies (Cebes), in other words, the democratization of health and of the Brazilian society.
As a result, thousands of pages of journals published over these four decades reflected the history of the RSB struggles, beginning with the articles that analyzed the determinants of the 'health sector crisis' in the mid-1970s, pointed to the limits and boundaries of Governmental programs, and indicated ways for popular mobilization around the proposals for changing health policy in the context of the struggle for democracy.
Following the course of history, the issues published in the 1980s made explicit the debates between the militants about the action strategies, in the context of the so-called 'democratic transition', a process which implied the exercise of 'political analysis in health' and the creative incorporation of concepts and methods of health planning and management, especially in its strategic aspect. It is worth recalling that it was during that period that the reflection on the different theoretical-methodological currents of health planning was disseminated in the academic sphere, constituting the embryo of the field of Policy, Planning, and Management, one of the articulating axes of collective health. That debate subsidized the development of innovative experiences, still in the period of implementation of the Unified and Decentralized Health System (Suds) in the states and, in the following decades, in the process of implementation of the SUS.
Despite the many difficulties faced over the last 28 years, the SUS has been the greatest public health system in the world, an example of the will and determination with which its defenders have used the most diverse tactics to broaden the alliances, principally at the political-institutional level, that is, 'inside' the institutions that manage the system, at federal, state and municipal level, taking advantage of the opportunities created by the inclusion of militants in the public administration.
While on the one hand this process may have contributed to a certain narrowing of RSB's political support bases, on the other hand, it has enabled the development of hundreds and perhaps thousands of innovative practices, not only in the reorganization of health care, particularly in Primary Care, but also in the management, planning, programming and evaluation of health systems, programs and services.
The close connection between the practice - political, managerial, and organizational - and the theoretical-methodological reflection that feeds on experience and transforms into scientific knowledge has generated a multiplicity of articles, among which, the ones that now make up this thematic issue of the journal 'Saúde em Debate'. Dedicated primarily to the theme of Health Evaluation, this issue contemplates a variety of works that reflect the maturity that this field has been acquiring, since it began to be emphasized by several researchers of many institutions. More than that, however, these works express the concern about the quality and rigor of the scientific research, contributing to the improvement of the debate around governmental policies, programs and actions.
At the current conjuncture, in which we watch and repudiate the 'dismantling' of the social policies harshly conquered in the last decades and worry, about everything, about the regression that has been taking place in health policy, it is fundamental to count on evaluative studies that record the advances and the limits of the SUS and that can subsidize the political struggle in all possible spaces. After all, overcoming the activism and systematic denunciation of the perverse effects that are already being felt over the SUS, due to the decisions adopted by the current government, requires the incorporation into the debate, of evidence pointed out by scientific research, giving strength to the political discussion, in a way to win the hearts and minds of all who care about the future of the SUS and the defense of the right to health in our country.
Vice President of the Brazilian Center for Health Studies (Cebes)
- Publication in this collection