This research aims to analyse political and social implications of the combination of public and private efforts in primary health care, trying to show combinations and tensions between a democratizing health project and a neoliberal project that waives the State's responsibility in enforcing rights. We chose to study these conflicts from the situation of Heliopolis, favela of São Paulo. To construct the empirical material, instruments and techniques from Ethnography were used. In Heliopolis, as in the rest of the country, the Health Reform is crossed by distinct political-economic projects, to the extent that there was an expansion of supplementary healthcare and distorted implementation of the Health System, with practice and privilege of privatizing logic of productivity. The macroeconomic policies and State Reform led to the "tortuous implementation" of the health system, in the context of "perverse confluence" between distinct projects. Some of the potential to transform that are in political processes and social relations shaped by modes of life built on social bonds of solidarity, which are embedded in the dynamics of political-economic determinations and assertion of autonomy. This places the movement of the Health Reform the urgent need to regain the instituting dimension, to transform the system.
health care reform; social participation; primary health care