By PAULO CAPEL NARVAI*

With an eye on the SUS outpatient network, “sanonegócio” wants to expand its participation beyond the hospital sector, reaching primary care

The age of the SUS matters

The age of the SUS returned to the debate in the week of spring arrival. Several activities marked what, for some, corresponded to the “30 years of the SUS”, which would have been “born” with Federal Law 8.080, of September 19, 1990. There is an error in this interpretation.

As soon as the “30 years celebrations” began, I granted a interview for Conceição Lemes, from the website vimundo, in which I explained the reasons for this error. The SUS does not have 30, but 32 years, as I wrote in the earth is round, on May 6, 2020.

In the interview I commented that the SUS came with the 1988 Constitution and that it would not be in the Magna Carta, without the historic session of May 17 of that year, when it effectively “came to light”. Therefore, the birthday of SUS should be celebrated on May 17th. It is enough, therefore, to do the math: it is 32 and not 30 years.

The mistake of confusing the birth of the SUS with the date of one of the laws that regulate it (the other is law 8142, of December 1990), must be credited to the communication area of ​​the Ministry of Health, which a few years ago began to disclose the date of law 8080, as being “the birthday of the SUS”. As the source (of the error, I reiterate) was the Ministry of Health, many people just followed the date, without bothering to check the information. The problem, however, is that these two years “stolen” from the age of the SUS, from 1988 to 1990, correspond to a period of dramatic struggles, in which the newborn struggled valiantly to survive, something, incidentally, that never ceased to exist. to do. Many people bet that SUS would be a stillbirth. They gambled and lost, luckily.

Fernando Collor de Mello, as is known, did his best not to implement the SUS. He was defeated by the power of the newly enacted Constitution and the mobilization around the Health Reform, boosting the movement known as “municipalization of health”. But Collor mutilated the SUS as much as he could, starting a process that has not stopped until today, with the system debating between financial suffocation, its territorial dismemberment by private concessionaires almost always more interested in access to public resources than with the health of populations, and the deliberate scrapping of SUS public services, among other chronic ills.

Therefore, accurately identifying the age of the SUS is important. It is important to know that this is not a matter of preciosity, nor a minor issue, as those were really decisive years and shaped the SUS as we have it today.

It is important to analyze, however, why this error persists at this moment. I've been saying that I don't believe in bad faith, or anything like that, but that this is due to misinformation about the origin of the SUS and, above all, the desire to support our universal system, which continues to be heavily attacked in various ways. People understandably want to defend the SUS from these ongoing threats. They are, so to speak, keeping an eye on what will come to the SUS, in the post-COVID-19 pandemic period and are already seeking to emphasize the importance of the system for public health, supporting it. It is known or intuited that the attacks on the SUS will be intensified.

Incompetence or irresponsibility have been marking the actions of many municipal and state governments. But the federal government has been notable for the feat of combining incompetence with irresponsibility. In other articles published on the website the earth is round commented on the reasons for incompetence and irresponsibility ('epidemiological flat earthism,Drummond, the stone and the loss', among others). I will not tire the reader by repeating myself.

in the post-pandemic

However, it is important to point to the post-pandemic period. It is not enough, currently, to defend the SUS, to celebrate its 32 years. This is important, but clearly insufficient, as the broad recognition of the role that our universal system has been playing in confronting the pandemic from its local, municipal base, fighting, sometimes tenaciously, against the disservice rendered by the federal government, has placed the SUS under the spotlight.

The system currently enjoys, throughout the country, a credibility never seen before. The pandemic revealed to society the importance of SUS. It is understandable, therefore, that at this moment there is this impetus, this motivation to effusively celebrate something positive in Brazil, as is the case of SUS, despite all the difficulties that the system has been facing. For this reason, if there is something to celebrate in these 30 years of law 8080 and 32 of the creation of the SUS, it is only its remarkable resistance to the extermination of social policies that marks the Bolsonaro government.

At the same time, a broad political spectrum is concerned about the unbelievable and very serious policy of acting by omission, of manipulating data for ideological purposes, not applying financial resources approved by the national congress to fight the pandemic and dismantling teams and health programs whose construction took decades . A common voice in the corridors of the Ministry of Health is the heavy, “barracks” atmosphere in the body, produced by the increase in threats to public servants. People no longer believe, especially on the left, but also on the right and in the political center, in the capacity of the federal government to conduct any health policy based on the recognition of the importance of public health for society as a whole.

Bolsonaro left the country for 123 days without a health minister and allocated the portfolio’s governing bodies among 28 military personnel without qualifications or professional experience to carry out the functions in which they were assigned. It innovates, negatively: it created a kind of “military clientelism”.

The inauguration ceremony of the current minister, on September 16, was the stage for yet another eulogy by the President of the Republic, with electoral purposes. He boringly praised chloroquine and, repeating himself, attacked “opposition” governors and mayors. To distract the unwary and impress the government's electoral base, the minister of health, a specialist in "logistics", spoke of a "macrostrategic plan", which should "encompass structuring projects" and adopt the "best management practices". compliance” to manage “human resources in health”.

Nevertheless, the SUS resists, despite being attacked daily from the inside, with the liquidation of specific programs and policies, the dismantling of teams, the suspension or even stoppage of services and the reorientation of actions, leaving them in compliance with the neo-fascist ideology that governs the federal government and the gradual but steady replacement of scientific evidence by common sense, beliefs and religious dogmas. It is not that one actually believes in this ideology. It is because it lends itself to what matters to Bolsonaro: deepening the ultraliberal character of the government and making this ideology penetrate deeply into the Brazilian state. Amidst hypocrisy and cynicism, the SUS resists; you have to resist. But I'm sure it hasn't been easy.

The resolution of the pandemic will come, sooner or later, not as a product of the strategy adopted by the federal government, which celebrates its preposterous “score of cured” on a daily basis, but according to the forecast of epidemiologists, given the characteristics of COVID-19, whose lethality is relatively low, although the transmissibility of SARS-CoV-2, the new coronavirus, is high, as also suggested by the data available for Brazil, albeit precarious.

It is the post-pandemic SUS that is already beginning to be the object of attention of parliamentarians and leaders from various social segments, including Rodrigo Maia (DEM-RJ), president of the Chamber of Deputies, who wants to “modernize” it. As far as we know, this should occur in accordance with the advisory boards of the World Bank and Brazilian business sectors, from various segments, including those in the “necrobusiness” that operate the poorly named “health plans”.

With an eye on the SUS outpatient network, “sanonegócio” wants to expand its participation beyond the hospital sector, reaching primary care. Recent changes in this policy are just part of the formatting of the business, with a view to the destruction of primary care and its replacement by primary health care restricted by sector and based on measurable (and therefore accountable) procedures. The structural base of the SUS is being prepared for its complete privatization.

Several possibilities are being opened for the reorientation of the post-pandemic SUS. For this reason, it is essential to reaffirm that the SUS that wants the health reform movement must be even more, not less, in tune with the deliberations of the national health conferences, which clearly pointed out where our universal system should be directed. In this process of “modernization and strengthening” of the SUS, mentioned by the president of the Chamber of Deputies, special seats should be allocated not to advisors from the World Bank, the IMF and the like, but, above all, to national, state and municipal health advisors and the representations of health professionals, without whom there is simply no SUS.

Any reorganization and strengthening of the SUS must take place respecting and not violating the principles that govern the system. Special emphasis should be given to some axes, among which: a) the expansion and stabilization of SUS funding, revoking Constitutional Amendment 95, of 2016, which strangles it financially; b) the expansion and deepening of participatory management in all services and instances of system organization; c) the creation of a SUS State Career, inter-federative, multidisciplinary, with national scope and which, coordinated by the Ministry of Health, has a regional organizational base, with the creation of clear, regional, state and national banks and, therefore, free flow of professionals throughout the Brazilian territory, and is managed by inter-agency commissions in which representatives of social movements and SUS workers have a seat; d) the definition of a permanent education policy articulated with the structuring of the voluntary civil service, with linked scholarships, for graduates of health courses and curricular internships for undergraduates; e) the redefinition of relations between the SUS and entities or social organizations, under the control of the health councils, considering that under no circumstances can the management of the SUS be carried out by a company owned by private individuals; f) the creation and consolidation of organizational instances of SUS that make possible the co-management of services and local-regional health systems, always in articulation with the State Career of SUS, based on the current base of 438 health regions; and, g) the rearrangement and development of the industrial park in health, which must operate under federal strategic planning and ensure the sovereignty of the country, based on a national policy on science, technology and innovation in health designed and implemented in a democratic manner and with participation of entities representing Brazilian researchers.

These restructuring axes of the post-pandemic SUS should enable universal access to health actions and services, which should be organized in an intersectoral way based on social health needs and not just the sectoral offer of procedures, actions and operations that the market uses. be willing to offer, ensuring that its management is participatory, democratic and carried out according to the ethical-political principle that health is a social right and not a commodity.

* Paulo Capel Narvai is senior professor of Public Health at USP.