20 years of “smiling Brazil”

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By PAULO CAPEL NARVAI*

The oral health program that was integrated with other public health practices within the SUS was an advance and an achievement for the population

20 years ago, on March 17th like today, Brazilian oral health policy registered a profound change: the then “Brasil Sorridente” (BS) program was launched in Sobral, CE, by President Lula.

But Brasil Sorridente was not created in Brasília. He was born in the many municipalities that, since the 1980s, had been reorienting programs in this area. Without these innovations there would be no Smiling Brazil, or it would be something else. Some examples: from Curitiba, with its “modular clinics”, a reference for the public network, Antonio Silveira proposed what would become the Dental Specialty Centers (CEO), of which today there are 1.229 throughout Brazil.

From Belo Horizonte, with the training of technicians and assistants, under the leadership of Eugênio Vilaça, at the Catholic University, came the recognition of the importance of the Oral Health Team, an idea that Sylvio Gevaerd and Djalmo Souza put into practice when proposing the team, and not just the dentist, in Family Health. 

From Santos came the recognition that it is fair for the SUS to offer dental prosthetics, with zero profit, as Vitor Gomes Pinto had proposed. Marco Manfredini and Mayor David Capistrano concluded that it was possible to deliver prosthetics without even charging production costs.

From São Paulo, with the consolidation of water supply fluoridation, collective actions in schools and daycare centers, under the leadership of Luiza Erundina and Douglas Schneider, came the conviction that it was possible to integrate oral health with other health practices, in the SUS. Thus, from the experiences of dozens of municipalities (it is impossible to list them all, of course), came the foundations of what would become Brasil Sorridente, in Lula's first government.

Since then, important achievements for the population in this area have been consolidated and expanded. The municipalization of actions and the presence of oral health in Family Health took off with Brasil Sorridente.

But, in these 20 years, there were many difficulties, too. The biggest came with Michel Temer, the government that succeeded Dilma Rousseff. It was a period of serious underfunding in the sector, marked by the removal of the obligation for municipalities to implement Brasil Sorridente, with its ill-fated National Primary Care Plan. Then came Jair Bolsonaro, who committed one mistake after another, dismantled the SUS, broke the federative pact and maintained the financial asphyxiation of the BS, which was left hanging by a thread. A disaster. 

In the current government, however, oral health has been actively participating in the reconstruction of actions and strategies to get the SUS back on track. In fact, oral health is one of the most successful areas in this reconstruction effort. Prioritizing and relaunching Brasil Sorridente, now established as a National Oral Health Policy (PNSB), with federal law no. 14.572, of May 8, 2023, the Lula government has been promoting, over the last 15 months, a few dozen actions to not leave the SUS oral health law just 'on paper'.

Amidst so many achievements, which deserve celebration on Brasil Sorridente's 20th anniversary, only a few voices are disagreeing. They are people who disagree for the sake of disagreeing, babbling confusing, disconnected arguments, detached from the reality of the municipalities. Salary difficulties in many places, which need to be faced and resolved, give rise to fair criticism, but which are taken advantage of by some “saviors of the Fatherland”, who remained silent when Brasil Sorridente was attacked by Michel Temer and Jair Bolsonaro but who, now, nothing concretely proposes. You never know exactly what they want or what they propose. They only reiterate attacks on Minister Nísia Trindade and the Oral Health coordinator of the Ministry of Health, Doralice Cruz.

But Nísia Trindade and Doralice Cruz are investing even more in rebuilding Brasil Sorridente. It is this important work, for which they were called by Lula, that has made the transfer of resources from Brasília to the States and Municipalities viable. To this end, the Ministry of Health's guidance has been to recognize the efforts of municipalities, in this post-covid-19 pandemic period, and consider that the performance in the area of ​​oral health has been the best possible.

For this reason, municipalities are receiving the maximum amount of additional resources provided by Ordinance 960/2023, with each transfer. So much so that, in addition to the amounts transferred regularly, the federal government sent R$565 million to the municipalities, from July last year until this month of March. This extra money for municipalities, no less than 0,5 billion reais, needs to continue, to recover losses of resources, resulting from the pandemic and which are necessary so that municipalities can continue to provide salary justice for health professionals mouth – as occurs in hundreds of municipalities, but which is still challenging many mayors and SUS managers. 

Congratulations to Brasil Sorridente, now with More Oral Health in the SUS.

*Paulo Capel Narvai is senior professor of Public Health at USP. Author, among other books, of SUS: a revolutionary reform (authentic). [https://amzn.to/45IhkhQ]

Originally published on the website of Brazilian Center for Health Studies (CEBES).


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