By AMELIA COHN*
Nísia Trindade's departure would mean that, no matter how strong her replacement is, health has entered the political (and economic) negotiation market.
In the wake of the news “leaked” yesterday afternoon about the announcement of the change of the head of the Ministry of Health – Nísia Trindade, I made some indignant remarks. When she was nominated, I wrote a text defending her name and arguing that precisely because she is not a member of any political party and is an institution builder, she would be kept on. That her strength lies in this: her technical competence and her commitment to the SUS. In fact, she took over the position, rebuilt the Ministry of Health destroyed by the previous government, and made progress in programs and in implementing structural priorities to maintain constitutional precepts in health.
The minister has been following this path all along, having in her wake the resistance of the private health sector to the advances she was promoting in the SUS and the greed not only of companies but also of politicians for health resources and their territorial and social reach, which, when misused, allow them to be politically instrumentalized in the pernicious game of political currency. Nísia Trindade has faced this resistance with firmness and elegance, demonstrating that to be firm and strong it is not necessary to speak harshly.
Resuming vaccination coverage, an area in which Brazil is internationally known for its efficiency, and which has regressed alarmingly during the denialist period that preceded this government; implementing a solid investment policy in the crucial sector of the Health Industrial Economic Complex, which is fundamental economically and socially, not to mention achieving our national sovereignty in the production of medicines and vaccines; rebuilding the Farmácia Popular practically from scratch, with 100% participation from municipalities; instituting actions to reduce the waiting time for the population to access medium and high complexity care and surgeries, however, do not seem to be enough.
After all, Nísia Trindade is competent, but she did not pursue a political career. She is an institutional builder, and does not act with “her” political future in mind. Calm down. Being a politician is not a bad thing in itself. But neither does not doing your homework well and putting the right to health and the principles and guidelines of the SUS back on the agenda seem to be proving to be insufficient to meet current political demands.
It doesn't matter who will replace her. There are two well-known names in the arena, a politician who has already held the position, and another who is not so much of a politician, at least in the foreground, and who has also held the position. Therefore, the issue here is not one of competence, of having a minister who had never even heard of the SUS. But rather that they are both men. After all, the question that begs to be asked: how can a woman of excellence in terms of her professional competence, but without a political career or appetite for it, occupy a position that is the second largest budget among the ministries?
Wouldn't that be a waste? Why not take political advantage of this incredible volume of resources and healthcare network? Or, better said, more politically? After all, Nísia Trindade systematically negotiates with municipalities, states, universities, managers, and social movements about the policies she has been implementing. In fact, without this constant and tireless negotiation by the minister, not even a tenth of what she has done during this period would have been possible. But why is she so discreet? Is this her sin? I believe that her greatest sin is being independent. And precisely because she is independent, she is loyal to the government, but not docile to all its demands.
But what is most worrying is that health may be the victim, in this episode, of a brutal mutation in its place of importance: from being a State policy, as it had been conducted, that is, creating short, medium and long-term roots to resist periods of political regression, to becoming a government policy.
This hypothesis does not seem unreasonable. From the point of view of affirming the presence of women in public policies, the ministries currently headed by them, with the exception of health, are ministries with few or very few resources and/or undervalued within the management, as is the case of the environment. And from the point of view of structural actions and projects, it is with sadness that we see the launch of the New Single Registry for Social Programs, which opens the door to 40 government programs, having had no resonance within the government.
This is a structuring program involving several ministries and departments, which is proving to be a cross-cutting instrument for encompassing all social programs and expanding and shortening access for vulnerable and low-income segments to the social protection network of the three levels of government. The actions of the CEIS are structuring, breaking the dichotomy between social policies that only create expenses and others that generate revenue. Not to mention the economic and social inputs and outputs of medium and high complexity actions in health, and of the popular pharmacy.
Thus, Nísia Trindade's departure would not only mean that a woman leaves and a man enters. Perhaps that is the least of the problems. It would mean that important positions cannot be filled by people with a strict sense of management, even if they are politically sensitive. What is at stake is that, no matter how strong her replacement may be, health has entered the market of political (and economic) negotiations. It has transformed from a state policy to a government policy. It could be the first domino that will successively cause the others in the social area to fall. As if the timidity with which they have been implemented were not enough, with the exception of the real increase in the minimum wage and the positive reaction of the formal labor market, essentially the result of economic policies with a strong social impact.
*Amélia Cohn, sociologist, is a retired professor at the USP Faculty of Medicine. Author, among other books, of Letters to President Lula: Bolsa Família and social rights (editorial quicksilver).
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