Paulo Capel warns defenders of SUS: Now is the time. Either we open our eyes to occupational issues, district administration, OSS and health plans, or SUS will be swallowed up.

Lula, 2023-26 Guidelines and Health

By Paulo Capel Narvay*

“Predictions Created,” the popular meme on digital social networks, came to my mind when reading Guidelines for the Reconstruction and Transformation Program in Brazil 2023-2026Lula announced during the launch of the interactive platform Together for BrazilCreated online to receive contributions and encourage popular participation in the Lula-Alckmin campaign.

Inside and outside the Labor Party, criticism emerged immediately for the way Health and the SUS were mentioned in the document, which was announced on June 21, 2022.

Many health and SUS-related expectations were not considered in the guidelines.

Former Senator and Minister Aloisio Mercadante, President of the Perso Abramo Foundation (FPA), emphasized that the “Guidelines are a starting point” and called for discussion all those who “want to help rebuild this country. What are included in the Program Guidelines? Basic Principles and Ideas The impetus that allowed this historic agreement of these seven parties.”

The historic agreement Mercadante referred to corresponds to what Louise Wernick called Viana “National Salvation Movement“According to him, it is necessary to defeat Bolsonaro and remove Bolsonaro from the presidency.

The guidelines, organized in four main axes (reconstruction of the country, social development and guarantee of rights, economic development and social, environmental and climate sustainability, defense of democracy and rebuilding of the state and sovereignty) are a summary of consensus proposals formulated by the directorates, institutions and technical teams of the seven parties that make up the front ” Vamos Juntos Belo Brazil”.

So that there was no doubt about the origin and purposes of the Guidelines, the Heads of Parties (PT, PSB, PCdoB, PV, PSol, Rede and Solidariedade) participated in the launch of the interactive platform which was broadcast live. The registration Available online.

Regarding the guidelines, Lola compared it to the foundations of the house. “We will have to build the house over time. Listen to the people and implement the policy.”

Despite these reservations by Lula and Mercadante about the more general meaning of ‘Brazil’s Reconstruction and Transformation Program Guidelines’, the reference to SUS and health fell far short of expectations, lit a yellow light and generated dissatisfaction across the spectrum Wide. . , which ranged from researchers and leaders of social movements working in the sector, to health advisors and trade unionists.

It was considered insufficient, vague, weak, “not wet rain”, generic, “warm”, “more of the same”, “less than the same” and “taste of mold”, as I read on social media.

The trend indicated in the 121 guidelines for the reconstruction and transformation of the country was generally considered positive.

In this group, the term health appeared 14 times, associated with both economic and social development and other axes, and the abbreviation SUS was mentioned in 35 situations.

But, since only two of the guidelines (23 and 24) specifically referred to health and SUS, and did so in general, this was enough to fall short of criticism.

There were also those who questioned this, let’s say, the accounting side of the number of health guidelines (“only two out of 121?”) to express dissatisfaction with the guidelines, and an explanation that this number would give the dimension of “neglect” with health and SUS.

But what do Guidelines 23 and 24 say? Basically, they repeat the diagnosis that

The current government has neglected health, the right to life, and the unified health system. There is a lack of investments, preventative measures, health professionals, consultations, exams, and medicines. It is necessary to give conditions to the SUS to resume fulfilling the demands that were closed during the epidemic, to help people suffering from the consequences of the covid-19 virus and to resume the recognized national vaccination program.

If it weren’t for the SUS and the brave health workers, the current government’s irresponsibility in the pandemic would have cost more lives” (Guideline 23) and they argue that “in the Lula and Dilma governments, health has been treated as a central public policy, as a right for all Brazilians and as a strategic investment for Brazil.” sovereign”, reaffirming “our commitment to strengthening the public and global SUS, improving its management, evaluating and training health professionals, resuming policies such as Mais Médicos and Farmácia Popular, as well as rebuilding and strengthening the health economic and industrial complex” (Guideline 24).

It’s really very little. Insufficient, even if general guidance in the context of the above four axes, given the enormous expectations about the direction of the SUS and the overcoming of the many pitfalls that define and harm it at the moment.

In the face of an acute shortage of funding, it is not enough to acknowledge that “investments are not available,” but to identify a way around it.

In the face of outsourcing that disintegrates SUS with its municipal base, deepens the fragility of professional and work relationships and does not solve the poor working conditions in many health units, it is not enough to talk about “general and global SUS strengthening”, or to acknowledge the good acceptance of the “Mais Médicos” programme, emphasizing On a strategy to meet the challenge of creating tools to improve public administration and the Brazilian State, and to overcome the difficulties facing the interventional management of health areas, in light of the impasse that represents the process of municipalization of health, which today is unable to enable municipalities to overcome the obstacles to Universal access and universal health care.

Municipalities, which is very strategic for SUS consolidation, have been shifted to a kind of preferential path of privatization of services and even municipal health systems as a whole, making it possible for many municipalities to be taken over by Social Health Organizations (OSS).

OSS, the main complementary health tool for SUS privatization, is not mentioned in the guidelines.

Nor is there anything about supplemental health and the absorption of public resources through tax breaks and free use of public services, for private benefit.

The guidelines are inadequate in these and many other respects. It is necessary to improve it. This improvement will be made, one way or another. Coming from within the Labor Party itself, and from the allied parties, there are clear signs that this will be done.

However, I am concerned about the low density of Progressive Sphere formulations, defending the right to health and the SUS, with respect to some critical aspects of SUS management, in this historical period.

Oddly enough, criticism of the Guidelines has revealed, once again, that the field from which contributions are expected to help overcome pitfalls, has not been able to formulate and advocate feasible and viable proposals for these SUS problems, despite the large backlog you can do. Meets.

Assuming the hypothesis that I may not be aware and that there are, on the contrary, such formulations, it is necessary to realize that there were, then, difficulties in giving them the necessary publicity.

In order not to get into examples, I will focus on just two of these “crucial nodes” of strategic importance to SUS: the SUS State Career and the SUS Territorial Administration.

Both continue as a kind of sphinx of Thebes to challenge the hygienic movement that mostly speaks of both.

Due to minor issues (“administrative issues”, “management problems”…) in the face of major health issues and the SUS, the Career-SUS and the regional administration of the SUS were ignored.

There are dire consequences for this disdain, as there is no shortage of “projects”, created in pro-market sectors, to solve “management problems” in SUS, especially those interested in “bringing the excellence of the private sector to public administration”.

There are three references to the functions of public officials in the guidelines, but they are all in the field of public security.

Defenders of the SUS need to open their eyes, more than point out shortcomings and similarities, present and publicize their proposals, and give them proper publicity.

Until today, the history of SUS has been the history of many clashes from which the sectors with which it has a project have won. And these sectors, which make up the SUS in their projects, are increasingly moving them away from what was established by the 1988 Constitution.

Complementary health, for example, feels, acts and imposes decisions on the Brazilian state as if it were a separate thing, unrelated to the Ministry of Health. Under Bolsonaro, daring turned daring with the organization of such a “National Council for Complementary Health.”

In this context, if the defenders of SUS do not put forward their proposals against the commodification of health and deal with “minor management problems”, then the enemies of SUS will go ahead with their project.

Suffice it to see how, with what ease and ferocity, Bolsonaro has attacked the daily SUS since his inauguration.

It has not fulfilled the commitment of its government programme, recorded in electoral justice as “The Path to Prosperity”, that it would create “a profession of state doctor, to help remote and needy regions of Brazil”.

I am not a doctor, nor any other health professional, nor any profession.

This was always Bolsonaro’s “cattle sleep” talk, even the cattle knew.

The problem is knowing what the opposition camp proposes to Bolsonaro, for the state career of the SUS. About health district management.

What do the front parties suggest in this regard? “Let’s go together for Brazil”?

More: What does critical thinking suggest in this regard, in line with the ideals of Brazilian health reform?

What I’ve read and heard is disconcerting, as I see excuses and a lot of “more of the same”.

It’s troubling, because the perception is that we “fall asleep right away”, “stopped on the side of the road”, without projects.

I could be wrong. will take. But I, fans of Flamengo and Corinthians together, are sure that no interactive platform will solve the problem of purposeful shortage.

Noting insufficient guidelines, and simply dismissing them, won’t solve anything either. As Amílcar Cabral used to say, denial, dialectically speaking, does not mean a refusal, but an affirmation of something else.

There is another meme, very popular on social media, which leaves no room for doubt: “Who wants to fight!”

But it is not enough to fight only if you do not know what you want.

What do we want, after all, for health and the SUS in the next federal government?

The People’s Plenary in Defense of Health and the SUS, held in different locations and social groups, within the scope of the Free, Democratic and People’s Health Congress, organized by the Front, are expressions of popular struggles to defend the right to health and seek to collect and organize proposals for this.

All this proposed fortune will, somehow, converge, I think, to the interactive platform Together for Brazil.

After that, it will be possible to take many steps forward and bypass the generality of the guidelines announced on the first day of winter.

When September comes, we will be a few months away from the summer of 2022-23.

So if all goes well in the spring and we don’t samba, with the blessing of Nelson Cavacinho, “the sun will rise again.”

*Paulo Capel Narvay He is a senior professor of public health at the University of the South Pacific