Dezentralisierung des Gesundheitssystems in Brasilien: Grenzen und Möglichkeiten einer Strategie des Empowerments.

The present work defends the participation of society in the construction of the health care service as a process of empowerment, and, consequently, as a factor of strengthening the individual and collective health. The empirical study has as its focus the participation of the Health Pastoral ( an organization of the Brazilian Catholic Church that offers assistance and advice to the communities) in the process of construction of the health care service in the West of Santa Catarina., situated in the south of Brazil. Active observation in encounters and courses, semi-structured interviews and reading of documents, were used as instruments of data collection, as well as others. The obtained data were interpreted through the analysis of content, and the principles of SUS were elected as uniting categories: universality, integration, decentralization and social participation. In this sense, limits and possibilities of the social participation in the sphere of the political-administrative decisions of the towns of the region coherent with such principles, were identified. The results indicate that the construction of the health care service in Brazil: 1) opens spaces and invites the citizens to be co-responsible for the social construction of health; 2) makes conflicts of interest emerge, demanding and promoting the availability of different groups to overcome selfish interests and to make decisions in favor of the collective; 3) broadens the understanding of the limits and possibilities in conformity with a system that promotes health. The transformations in which the involved actors experience, personal and collectively, reveal a process of empowerment, whose limits impose and redo themselves daily in the power game exercised in the relations and social institutions; and whose possibilities initiate in the indignation and will to change the order of things and become stronger in the recognizance.