title: [Decision-making process and administrative practice: managing the State Health Secretariat in Bahia, Brazil].
abstract: This case study is based on research performed by the Bahia State Health Secretariat (SESAB), aimed at analyzing management practices during the implementation of a State government administrative reform. The institutional agenda shows evidence of limited participation by civil society and technical and operational staff in problem selection and prioritization, resulting from a work process pressured by high-level executive government staff. Decisions regarding "output" (projects, services, and activities) were made under the responsibility of subordinate operational levels and did not appear as issues in the institutional routine. Concerns related to "input" (financial and human resources) consumed most of the high-level efforts, with internal and external negotiations and compromises to assure access to them. Meanwhile the possible "outcome", namely public health status, represents the "occult subject" of the institutional discourse. Information emerges in institutional disputes as a technical "power resource" in its medical, epidemiological, health, and administrative dimensions. The issue of government "representation" and allied interests is based on ideological dispositions and authoritarian practices, thus contradicting the need for management transparency and modernization.
authors.affiliation: Departamento de Saúde, Universidade Estadual de Feira de Santana, Feira de Santana, Bahia. tchris@ufba.br
authors.forename: Thereza Christina Bahia
authors.initials: TC
authors.lastname: Coelho
authors.forename: Jairnilson Silva
authors.initials: JS
authors.lastname: Paim
mesh_terms: D001938:Brazil; D003657:Decision Making; D006295:Health Resources; D006801:Humans; D019982:Organizational Case Studies; D016134:Organizational Policy; D011635:Public Health Administration