'Enterprise-Mode' and Sparks of Resistance on the SUS Shop Floor in Brazil

The Brazilian Health Reform Movement succeeded in enshrining health as a constitutional social right, resulting in the creation of the Unified Health System (Sistema Único de Saúde, or SUS), based on the principles of universality, comprehensive care, equity, and democratized participation of users and workers in system management. However, the SUS faces a process of privatization by private Social Health Organizations (Organizações Sociais de Saúde, or OSS). This article reports part of a study involving researchers, including public mental health service workers. The methodological strategy explored narratives related to episodes of care in workplaces. The results revealed what we termed the 'enterprise-mode,' impacting both workers and the care provided in services managed by OSS. SUS health care workers on the shop floor face the challenge of commercial privatizing forces acting against the foundational principles of democratic management inscribed in the Brazilian Psychiatric Reform law enacted in 2001. A relationship is imposed that corrodes interactions within the team and between the team and service users, attempting to silence those who defend the SUS. However, the narratives also reveal sparks of resistance and insubordination emerging in the daily lives of SUS shop floor workers that can strengthen resistance movements for social health rights.