Social organizations against SUS



Social Health Organizations are not equal and can contribute to the SUS. But only if they are really social and under the control of users and workers

“When we found out, the process was already under way”. The statement is from Professor Emidio Matos, from the Federal University of Piauí (UFPI), and first secretary of the State Health Council. He was referring to the process by which the government of Piauí handed over the management of three hospitals from the Unified Health System (SUS) to companies owned by private individuals, self-styled social health organizations (OSS). The process was developed without the “community participation”, through instances that represent it, as is the case of the State Health Council (CES), and the state government’s decision took place without the consent of the State Health Council, violating, therefore, not only laws 8.080 and 8.142, both from 1990, but the Constitution of the Republic itself (art. 198; III).

The highlight of the privatization of the SUS in the state was the inauguration, on July 28, 2023, of Maternidade Dona Evangelina Rosa, with 293 beds. According to the government of Piauí, R$ 175 million were invested in the construction of the maternity: R$ 129 million from the State's own resources, destined for the SUS and another R$ 46 million from transfers from the Union, linked to the SUS budget.

The pattern is repeated throughout Brazil, regardless of the political party alliances that govern each state. From Acre to Rio Grande do Sul, passing through the Federal District, resources from the public budget, destined for the SUS, are used to build and equip state-owned health units, which, continuously, are outsourced to private individuals to take care of the management , including hiring health professionals.

Municipal, state and national Health Councils, public health entities, civil servants' unions invariably take a stand against managers and other public authorities who, despite the general outcry against this course that is imposed on the SUS, remain indifferent in their purposes privatists. “It is neoliberalism destroying the SUS!” – denounce trade union leaders and social movements that work in the health area. “Whoever is assisted in these units approves the management by the social health organizations” – counterattack managers and entities linked to the companies, in the midst of denunciations of illegalities, financial mismanagement, misuse of public resources and tax and labor defaults.

They are shabby social health organizations, most of the time. Companies that are constituted only to, having Legal Entity registration, advance on public resources, in precarious public administrations or that, often deliberately, have fragile public controls and where there is no effective participation of the community. The actions of these social health organizations leave a trail of crimes and even deaths.

But it should be noted that not all social health organizations are the same and many can contribute to the SUS – and have been doing so in several municipalities. The condition for this to occur, with transparency and within the framework of the democratic practices that are in the DNA of the SUS, is simple: it suffices that the social health organizations are in fact social, their members and leaders are known, they only act in the places where they were established. created and are organized, have their projects and reports submitted and approved by health councils and are co-managed by health professionals, within the framework of the principles of co-management of health work. It is not much. No “megaOSS”, therefore. There is no reason for a social health organization in Paraná to be, for example, the manager of the SUS in Roraima. No single social health organization would assume the management of several billion reais.

This is the path of sanitary gangsterism, the end of any perspective of participatory management and the violation of the laws that govern the SUS. Certainly, for some façade social health organizations, these are requirements that make them unfeasible. The Brazilian universal health system, created by the 1988 Constitution, has nothing to do with the direction it is being given and which has been frontally rejected by the National Health Council, currently committed to moving forward in the deliberation of ensuring that, in each unit from SUS, act a health board to deliberate on the unit's plans, programs and projects, be it a basic unit, an outpatient clinic or a hospital.

The decision in Piauí draws attention, above all, for the fact that it involves a state government that, in principle, does not receive pressure from the political alliance that guarantees governance, as occurs in states such as São Paulo and Rio de Janeiro. On the contrary, the Workers' Party (PT) has a position in defense of a “100% public and state-owned SUS”, the same one that has just been reiterated by the delegates who participated in the 17th National Health Conference (CNS). PP, FEDP, EBSERH), with the establishment of a schedule of actions for this purpose”. The decision of the Piauí government presents, therefore, an apparent inconsistency, as it would be opposing not only an orientation of the party that leads the hegemonic political alliance in the state, but the orientation of the 2th CNS, with whose decisions both President Lula and the minister of Health, Nísia Trindade made the commitment to respect.

At the same time as the Piauí imbroglio, and after the closure of the 17th CNS, President Lula signed law 14.621/2023, which redefined the Mais Médicos program and transformed the Agency for the Development of Primary Health Care (ADAPS), created in the Bolsonaro government , in the Brazilian Agency for the Support of SUS Management (AGSUS). The law establishes that the AGSUS statute will be approved by the agency's Deliberative Council, within 60 days, counting from its installation.

AGSUS will continue to be an autonomous social service, in the form of a non-profit legal entity governed by private law, of collective interest and public utility and, according to reported, will be responsible for managing the doctors' program and will support the management of Special Indigenous Health Districts (DSEI), at all levels of care. The labor contracts entered into by AGSUS, according to Law 14.621/2023, will take place “under the regime established by the Consolidation of Labor Laws, approved by Decree-Law No. and wages”, with the admission of “AGSUS employees” taking place “by means of a public selection process”.

In social movements and health entities, the reaction to the creation of AGSUS has been one of astonishment and a certain perplexity, because “none of that was said during the campaign” and the 17th CNS reiterated the need of “creating the Single Interfederative Career, with tripartite funding, national salary floor for all professional categories, with exclusive hiring through public tender, combating outsourcing, valuing health workers and prioritizing those who work in the territory, expanding policies permanent education, meeting the real needs of the Brazilian population”.

*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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