Another attack on SUS

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By PAULO CAPEL NARVAI*

A "deprofessionalization” is opposed to decent work, weakens the link with the SUS and transforms work into a “little job”, performed by amateurs

There has not been a single day since its creation in 1988 in which the Unified Health System (SUS) has not been attacked in some way. Often, with ignoble ferocity, as one Bolsonaro by posting on Twitter, at the height of the number of deaths from covid-19, in 2020, that a private hospital in São Paulo would have “stabilized” the situation, would have “ICU vacancies”, as “it has already discharged 400 patients” and would have created a “protocol that reduced the time of use of respirators from 14 to 7 days”. He ended the post by complaining: “SUS never contacted her to find out what protocol was used”.

The “protocol” was a hodgepodge that combined hydroxychloroquine, azithromycin and ivermectin, a combination that is not only innocuous for covid-19, but harmful for some users with heart disease. Those responsible for creating such a “protocol” were aware of its innocuousness and risks. Twenty people linked to the company, which it claims to be “victim of the political system”, are accused by the Parliamentary Inquiry Commission installed in the City Council of São Paulo to defraud death certificates and commit 52 crimes.

Subordinating the SUS to a company of the sanbusiness, childishly equating them, and insinuating that he would have something to learn from her about what to do to face the covid-19 pandemic, is a very arrogant inversion and a demonstration of lack of knowledge about what the SUS is, understandable considering the political profile of the author of that tweet, but it is, above all, a way of attacking, disqualifying him, the public health system of the Brazilian State.

It should be noted that attacking, rather than defending, public institutions that should be protected by public authorities legally responsible for them, directly or indirectly (the post was made by a senator who is the son of the President of the Republic), is a striking feature of both, in their public lives.

Some attacks on the SUS are, however, much more harmful to the system and to Brazilians who, in every corner of the country, need, rely on and benefit from actions carried out or controlled by the system.

The main attack, uninterrupted since day one, and very serious to the SUS, is the effect on the resources used to finance it. Already in the “pregnancy” we tried to produce the “starvation of the offspring”, leaving it starving. Under the leadership of then Senator José Serra, the constituents did not approve the institution of stable sources, which should ensure permanence, adequacy, sufficiency and flow of financial resources that should pay for investments and funding of the SUS, in all municipalities, the operational base of the system that was being created.

To protest against the creation of a system without resources being linked to it to make it viable, PCdoB constituents went so far as to vote against the creation of the SUS, in the session of the Constituent Assembly on May 17, 1988. do: once the system was created, the PCdoB has been one of the parties that has most firmly defended the SUS from the attacks I am referring to in this article.

In recent years, attacks on SUS resources have greatly aggravated this chronic situation, further amplifying what is already considered a “defunding” of the system. As I mentioned in the article “Front for Life and the trivialization of violence”, Reliable economic analyzes indicate that more than 48 billion reais were taken from the SUS budget between 2018 and 2022.

In addition to taking money from the SUS, resources that should be used to pay the salaries of health professionals have been diverted from their purposes and used to finance expenses for the Armed Forces, as complaint of the National Health Council (CNS), based on an analysis of the application of budget resources, carried out by economists Francisco Funcia and Rodrigo Benevides, from the Budget and Financing Commission, which technically advises the CNS. According to the study, the Ministry of Defense borrowed more than R$ 150 million from the SUS to repair planes and buy office equipment.

One of the competences of the CNS, established by Law nº 8142/1990, is to evaluate the Annual Management Report (RAG) of the Ministry of Health. The council has been doing its job of overseeing and monitoring the accountability of the Ministry of Health: since 2016 these reports have been disapproved. But the attacks on the SUS do not cease.

If lack of funding is a serious attack, deprofessionalization in the SUS is almost a crime. “Deprofessionalization” is a neologism that I have been using to refer to the long-term political process whose objective is to make work in the SUS precarious, which, transformed into a “little job”, is expressed by amateurism, the instability of the employment relationship and by contract work, according to predetermined actions and operations, and makes it impossible, by action or omission, to promote decent work in the Brazilian universal health system.

Even in states where basic health care is well-organized and the family health strategy is consolidated, such as Ceará and Paraíba, precarious employment prevails (51,3%), represented by temporary work contracts – or not at all. this, as shown study published in March 2022. This picture is even worse in most states.

In 1999, the International Labor Organization (ILO) proposed the concept of “decent work” as work activity “adequately remunerated, carried out in conditions of freedom, equity and security, capable of guaranteeing a dignified life”.

Laís Abramo, director of the ILO office in Brazil, explains that the “decent work” rests on four pillars: “the fundamental rights and principles of work, the promotion of quality employment, the extension of social protection and social dialogue” and aims to “encourage the creation of more and better jobs, reduce informality, combating child labor, slave labor and all forms of employment discrimination, promoting youth employment, expanding and improving social protection coverage, boosting education and job training, strengthening business productivity and competitiveness, and strengthen labor rights”.

For Abramo, decent work is considered a human right and a key factor in “boosting a more equitable distribution of the benefits of economic growth, favoring social inclusion” and “overcoming poverty, reducing social inequalities, guaranteeing good governance”. democracy and sustainable development”.

However, in the SUS, the opposite of decent work has prevailed. Indecent work is the form that deprofessionalization has taken in the system, which represents a frontal violation of the 2030 Sustainable Development Agenda, of the United Nations, whose Sustainable Development Goal number 8 (SDG #8) requires signatory countries, such as Brazil, to seek to “promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all ”. SDG#8.8 further states that it is incumbent upon countries to “protect labor rights and promote safe and secure working environments for all workers, including migrant workers, in particular migrant women, and people in precarious employment”.

It is common for analyzes of work in the SUS to refer to terms and expressions such as “human resources”, “occupations”, “work force”, “workers”, “health personnel”, among others. These are ways of referring that are consistent with different alignments and theoretical frameworks for dealing with the subject. They are technical approaches, allegedly objective, and that seek legitimacy from this approach. I do it myself, in several situations. But, in this article, I would like to emphasize the relevance of using the term “professionals” to refer to the subject, because that is exactly what it is about, considering that the words are not neutral or innocent, but, on the contrary, come from laden with meanings.

The affirmation of the professional condition of those who work in the SUS is of strategic importance because, 34 years after the creation of the system, workers continue to be seen and treated as mere “human resources”, which make up the “SUS staff”, which in different “ occupations” are distributed among “servants”, which together form the “work force” of the sector. Often, they are reduced to a euphemistic form, with an ideological origin in the private sector, which sees them as “collaborators”.

There is talk, here and there, about plans for jobs, careers and salaries, integration or articulation at the national level, negotiation tables, management, productivity, continuing education and “delivering”, more and better. During the covid-19 pandemic there was no lack of complimentary qualifiers such as “heroes","nobles"and "altruists” and mentions of “commitment and selflessness" and to "Sacrifice of his own life and that of his family”. They are fair recognitions.

However, not just heroes, much less suicides. Neither philanthropists, nor amateurs, nor charitable, nor nobles, nor improvised, nor collaborators, nor dilettantes, nor altruists, nor “odds”. Professionals.

Rejecting party-political clientelism and nepotism, SUS workers want to be recognized as the professionals they effectively are. Whatever the level of training, whatever the degree of performance they manage to achieve, whatever their role in the system, they aim for professionalism. They reject indecent work, precarious labor relations, unprotected and unstable employment, unhealthy and pathogenic work environments and processes.

This is what can be seen from the proposals approved at all national health conferences held since 1986, when the historic 8th Conference, the participants approved the need for “dignified remuneration and salary equality among the same professional categories at the federal, state and municipal levels, and the urgent and immediate establishment of a job and salary plan”. The approval of proposals calling for the institution of a State Career for SUS Professionals took place in all conferences that followed.

On April 7, 2022, 'Frente Pela Vida' launched the National Free, Democratic and Popular Health Conference, organized to gather, across the country, proposals for the SUS and to ensure the effective exercise of the right to health in Brazil. The purpose of the conference, which will end on August 5, the National Health Day, is to produce an agenda to dialogue with the candidates for the presidency of the Republic and, also, to function as a reference for the debates of the 17th National Health Conference, summoned for 2023.

The Health Conference and presidential candidates need to combat deprofessionalization in the public health system. Today, many initiatives can be launched for this purpose. But, whatever they may be, they have a duty to respect the wishes of professionals and assume a clear commitment to the establishment of a State career for SUS professionals.

*Paulo Capel Narvai is senior professor of Public Health at USP. Author, among other books, of SUS: a revolutionary reform (authentic).

 

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