Federalismo por cooperação e o direito à saúde na Amazônia: o caso da comunidade de Santa Maria de Vila Amazônia no município de Parintins, Amazonas

Abstract

This dissertation aims to analyze, in light of the constitutional model of cooperative federalism, the extent to which demands regarding primary health care from the Santa Maria de Vila Amazônia community in the municipality of Parintins (Amazonas state) are identified and incorporated into the deliberations of Health Conferences. It proceeds from the premise that realizing the fundamental right to health in asymmetrical regional contexts, such as the Amazon, depends on coordination among federal entities, the political - administrative decentralization of the Unified Health System (SUS), and the existence of institutional mechanisms for social participation that are sensitive to cultural and territorial specificities. A qualitative approach is adopted, based on bibliographic and documentary research. Chapter 3 provides an empirical characterization of the community, covering territorial, historical, demographic, and socioeconomic aspects, as well as the history of access to primary health care. Chapter 4 develops a theoretical and normative analysis of cooperative federalism linked to the empirical subject matter, emphasizing the division of health-related competencies, the decentralization of the SUS, and the role of the Amazonas Health Code in the regionalization of public policies. Chapter 5 examines the relationship between federal coordination and health democracy, using participatory proceduralism as an analytical framework, highlighting health conferences and councils, while also debating the limits of proceduralism in contexts of cultural subordination and power asymmetries. Finally, Chapter 6 conducts a critical, discourse-oriented empirical analysis of final reports and official documents from the 16th and 17th National Health Conferences, the 8th and 9th Amazonas State Health Conferences, and the 1st Parintins Municipal Health Conference, with the aim of addressing the proposed research problem. The results indicate that, although Health Conferences represent important democratic spaces for deliberation and social participation, demands regarding primary health care in the Santa Maria de Vila Amazônia community are acknowledged in a predominantly indirect and generic manner, with a low degree of territorialization (lacking direct reference to specific territories). This finding highlights the limitations of cooperative federalism in translating participatory decisions into effective responses to local realities, as well as the need to improve normative and institutional mechanisms to ensure the specific and binding inclusion of Amazonian territories and stakeholders in the formulation of public health policies.