This research deals with the potential and limitations of the strengthening of subjects in health management, based on the experience in Fortaleza in the period from 2005 to 2008. The subject is approached from a historical-cultural standpoint, which considers the dialectical interaction between the individual and the collective in deepening human consciousness on the self and the world. Focus groups were conducted with managers linked to Primary Healthcare and secondary data were utilized. An attempt was made to understand the meaning of the narratives constructed using a hermeneutic dialectic approach. Empirical categories were identified and analyzed as well as co-intentionality of change, political and conceptual drives, human management, reduction of hierarchy, fragmentation of work processes and concentration of decision-making power. Reflections arose on three main strategic policies: co-management, humanization, and continuous health education. It was concluded that, despite the persistence of obstacles, in order to improve the quality of healthcare services it is essential to establish a democratic management system through organizational arrangements and participatory methods that enhance integration and commitment of the Unified Health System players (SUS).