SUS management

Image: Alexey Demidov


Why wasn't a federal plan for positions, careers and salaries created in the SUS?

The effective universalization of the right to comprehensive, resolute and quality health care is inseparable from overcoming the precariousness of work in the SUS. In other words, without a job and salary plan it will not be possible to advance in the construction of an assistance network – with primary care services, exams and specialized hospital care effectively integrated.

However, 34 years after its creation, there is no trace of a career in the SUS for its workers, as there is for workers at federal universities, the Judiciary and the Federal Police.

In SUS, what is observed is a progressive deterioration of working conditions and precariousness of bonds over time. According to research carried out by Maria Helena Machado, nursing professionals, for example, who are mostly women, “live in precarious conditions of survival”, have multiple employment contracts and live with unsafe work environments “which prevent them from exercising with dignity of their work activities”.

In the process of redemocratization of the Brazilian State, after the Federal Constitution of 1988, several areas of social life gained an unprecedented constitutional condition. In addition to public health, the expansion of education and social assistance rights exemplify this condition. However, contrary to the public legitimacy that these agendas assumed, labor legislation and public servants received criticism from several sides.

In connection with these attacks, the long march of discrediting the public administration of the Brazilian State also deepened.

Nowadays, when we observe these two historical movements – the crisis of legitimization of labor rights and the public administration of the Brazilian State – we better understand why, in these thirty years of SUS, there is no career for its workers.

Developmentalist tradition x delegitimization of the State

As pointed out by many studies, the structure of public careers in Brazil is directly linked to what is conventionally called the national-developmentalist tradition, which was structured from 1930 to pre-1964. The Department of Public Sector Administration (DASP) was created in 1938 to think about the structure of public careers that would put the Brazilian State on its feet.

In this conception, there was the valorization of the State as the core of a modernization conceived from the public planning point of view, in which functionalism assumed great centrality.

Historical records such as the proposal for a Popular Amendment taken to the 1987 and 1988 constituents attest to the concern with a national human resources policy that would guarantee health professionals a job and salary plan, with decent remuneration, isonomy, admission through public competition , job stability and incentives for full-time and exclusive dedication, in addition to adequate working conditions.

Awareness of the importance of a state career for SUS workers was present in the design of the system. Until the beginning of the 2000s, proposals for a federal plan for positions and salaries were strongly present in debates about the construction of the SUS.

In the post-1988 period, the legitimization of work coincides precisely with the disorganization of this tradition of national development, which had work regulated by rights as part of its political program. In place of this paradigm, the thesis was imposed that the State was inefficient, wasteful, patrimonialist and corrupt, in short, a burden for the integration of the country to the dynamism of the international market.

Paradoxically, it was in this moment of crisis of legitimacy of the State, of the culture of public planning and of labor law that the expansion of the SUS began.

In place of the state tradition, a new language was established: the new public management (or new public management). From then on, the previous grammar of public administration, which sheltered important labor conquests such as continued progression and job stability, began to be replaced by the ideology of supposed 'efficient management', combined with increasing flexibility and cost reduction.

Gradually, public careers became a language of the past and work ties in the SUS became an almost exclusive responsibility of the municipalities.

Such a line would define a process of profusion of contract models and partnerships with the private sector such as OSSs and OSCIPs, which have the health sector as one of their main sectors of penetration. In the midst of a process of communicational war, the so-called new public management asserted itself in the center of the Brazilian State, functioning as a true regressive labor reform.

As a consequence, the weakening of the state tradition and the devaluation of labor rights deepened challenges for the implementation of the health system. A SUS career offers the possibility of offering dignified working conditions and, at the same time, overcoming issues such as the unequal distribution of health professionals, in addition to contributing to the regionalization and structuring of the health care network.

It is necessary to understand that an important part of the problems of the SUS is directly linked to the issue of work. In summary, the public right to health is inseparable from the public rights to work.

*Ronaldo Teodoro is a political scientist and professor at the Institute of Social Medicine at UERJ.

Originally published on the portal BrasildeFato.

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