By Paulo Capel Narvai*
President Lula has been reaffirming that he does not want to “do more of the same” and that his government needs to “go further”. We will finally be able to break out of the same old routine and go further. Will we be able to take this step forward in the SUS Career?
Straight to the point: the SUS State career (“Carreira-SUS”) is more, much more than a mere plan of positions, careers and salaries of a public institution or agency. It is an institutional matter of the SUS, in the field of Brazilian Social Security. It is a political issue at the center of which is the place that work should occupy, and who works, in the financialized capitalism that marks Brazil and the contemporary world. I refer to Social Security, because it is the locus of the SUS. Health work, in the SUS, must be understood as a part of social work in Brazil, in an articulated way with social security and social assistance workers, because this work has as its object not a commodity, but a social right.
Although the SUS is responsible for notable achievements in Brazilian public health, the professionals responsible for these achievements do not consider themselves “SUS workers”, but “City Hall employees”, “State government employees”, since they are the ones who pay their salaries – I wrote in 2015. Therefore, there is no functional identification with the SUS. These health professionals “wear another shirt” and not the “SUS shirt”, as they say.
No one (with exceptions, of course) feels like they are “from the SUS” and, therefore, the direction and destiny of the system do not concern them, they mean nothing to them. And this is, without a doubt, yet another symbolic disaster involving the system (another symbolic disaster is that which concerns the hiding the SUS symbol).
Because of this complexity underlying the topic, debates on the SUS Career are crossed by many interests, ranging from various types of corporatism to the many models of public management that impact the SUS, passing through the state bureaucracy, amid the schemes of political domination of the bourgeoisie that controls the Brazilian State, with the well-known iron fist that submits the three powers of the Republic to its economic power.
As a hegemonic social class, the bourgeoisie hates what we call the “ideology of the SUS”: the values that guide it, universality, equity, comprehensiveness (which rejects health and disease as a merely biological phenomenon) and participatory management (based on health councils and conferences under the principles of the Democratic Rule of Law). The social class that rules the Brazilian State does not want financial resources (sufficient, adequate and stable) to be allocated to our universal health system. If it could, it would extinguish the SUS today, or as soon as possible.
It is, however, in this adverse context, hostile to work and workers, that the Career-SUS, as a State career, is either resolved in the National Congress, as the structuring pillar that the SUS lacks, or it will continue to “die on the beach”, as it “has died” since, thirty-six years ago, the SUS was created on that Tuesday when it met, on May 17, 1988, the 267th Session of the Constituent Assembly.
Career simulations
To the dismay of those against the SUS, just like the phoenix, the career that has died on the beach, always rises from the ashes, deformed, transfigured, almost unrecognizable, but there it is, reappearing in various forms, such as that of “Community Health Agent Act", The "National Nursing Minimum Wage Act", The "law of the More Doctors program” and the various bills (PL) that are being processed in the Brazilian parliament, one of which is to equate the “health surveillance agent” to the “community health agent” and to the “endemic disease control agent” and another that “modifies the minimum wage for doctors and dentists”, provided for in Law No. 3.999 of December 15, 1961.
The presidential sanction of laws that deputies and senators are unable to prevent, and which they approve assuming that they will garner votes and “electoral campaigners” in a poorly disguised attempt to commercialize healthcare, ends up creating a legislative thicket about “almost the same thing”, but which cannot hide the fact that a simulacrum of a career, a sham of a plan, a pastiche of positions, a phantom of salaries, like a kind of teratogenic embryo of a Career-SUS, is being instituted in the national State. “Life doesn’t stop”, Cazuza would say.
But this is not the only possible way to finally provide the SUS with a State career that respects health professionals and that operates as a courageous, dignified and forceful confrontation of indecent work and the precariousness of employment relationships, establishing the valorization and recognition of labor rights in public health.
It is necessary to move forward and think of more comprehensive and, therefore, systemic solutions for chronic problems in the SUS, because it is possible to build another story that, denying the simulacrum, effectively institutes a State Career, with the approval of a law to this effect by the National Congress. A law that creates not only an agency in the federal government responsible for coordinating its management at the national level, but that ensures that this agency has a National Fund to finance the Career, managing resources from state and municipal quotas of the National Health Fund allocated to personnel costs.
Instead of transferring resources to states and municipalities, the federal agency managing the SUS Career can transfer the money directly to the salary accounts of the SUS Career members, wherever they are working in the SUS, but always under the management and functional control of the local SUS regional authorities.
Doing so is not only more rational, as it puts an end to the “passing” of public money through the current accounts of municipal administrations and from there to third parties hired to do only what can currently be done without intermediaries. It is also much safer and more transparent, as all banking transactions are accounted for and can be audited by public bodies responsible for overseeing public administration.
In this scenario, municipal administrations could give up outsourcing the SUS to privately owned organizations, often called “social”, so as not to have to violate the Fiscal Responsibility Law, as alleged, since they would not be responsible for the entire cycle of administration of the SUS functional staff (such as holding various competitions and burdening their budgets with salary expenditures for these employees), but would only attest to the presence and performance of work activities in the workplace and would meet routine demands of the regional management bodies of the SUS Career, members of the structure of the federal body, which would coordinate it at a national level.
All of this, however, continues to be denied to the workers who give life to the SUS on a daily basis and who, even recently, helped the country to overcome the hardships of the covid-19 pandemic, aggravated by the stupidity installed in the federal power and by the denialism that has befallen authorities, at all levels of management, and a large part of our population.
Much more than a negotiating table
The SUS Career, with the characteristics it needs to have, and which I seek to outline in this article, is not a matter for one or a few departments of a ministry, or for a State ministry, or even for an entire government. It is a subject that involves several sectors of government and, therefore, several ministries. Building it is a time-consuming task, which involves mobilizing and putting to work a relatively large group of qualified specialists and technicians. Everything indicates that carrying out this work will span several governments, in the coming years – perhaps decades.
In this institutional endeavor, in addition to thinking big and setting our sights on a horizon that is still undefined, it is prudent to look to the past, so that by illuminating the future, we can help create what is necessary today and move forward towards this undefined horizon, outlined only in broad brushstrokes. This future should not be imprisoned by the past and, above all, by the mistakes and impossibilities of the past. The world has changed since the SUS was created in 1988 and regulated in 1990, by laws 8.080 and 8.142.
Since the historic 8th National Health Conference, when the SUS was still a proposal – later adopted and approved by the 1988 Constituent Assembly –, the proposal to implement the dream career of SUS workers has been approved at all national health conferences. Despite this, it has never come to fruition. And there are currently no major technical difficulties in building it, with social and professional participation. The difficulties, many of them, are mainly political, and have to do with the characteristics of our Republic, a federation in a continental territory.
Administration, including public administration, has developed significantly in recent decades, especially after the popularization of the internet and the spread of computers, which are now omnipresent in our lives. Thus, what was not feasible when the SUS was created, when it was not even known exactly how many professionals worked in the public health sector throughout the country, is now absolutely feasible. All you need to do is create databases and, in a few days, or even hours, you can have the data needed for national management, and at any level of public administration, of the SUS Career.
There are also many job and salary plans in several companies today, including state-owned companies, such as Banco do Brasil and Correios, to name just two notable examples, in the public sector. But we also have the PCCS of the Armed Forces. Finally, and to reiterate: the central problem for a State Career in the SUS is not technical. It is political. However, in general, SUS managers avoid talking about this. They do not even want to hear about the subject. They are in a comfort zone and do not want to leave it. This may be comforting for managers, but it is hell for workers. And many union leaders too, unfortunately.
The process of 4th National Conference on Work and Education Management in Health (CNGTES), which under the central theme “Democracy, Work and Education in Health for Development: People who make the SUS happen”, began to be promoted with the holding of municipal and regional conferences, ending in June. The national stage of the 4th CNGTES will take place in Brasília, from December 10 to 13. There is much to discuss, but the SUS Career mobilizes hearts and minds, as it could not be otherwise.
It seems that a period in which this subject was treated (when it was treated at all) in a vague manner and with ambiguities and subterfuges, as if it were an irrelevant topic or so complex that people could not understand, has finally been overcome. And that is not the case, of course.
However, it is noticeable that many important political actors in the scene have been trying to shift the debate on the SUS Career from the national level to several localized careers, restricted to a given municipality or state. Or by focusing the debate on details about the working hours of this or that professional category, or the resources transferred to “the municipality to pay the minimum wage” and other issues of this type that, while certainly important, are not always relevant to the challenge of creating the SUS Career. Some are false issues, apparently put forward for debate to occupy a space that should be dedicated to other, crucial aspects of the SUS Career theme.
However, in my opinion, the debate on this subject needs to consider that it requires a national scope, taking into account the characteristics of our federal system and the extremely successful governance model built by the social actors who take care of the SUS, as a public system, of the Brazilian State. The fundamental actors, in addition to dozens of professional health organizations and social movements, are the National Health Council (CNS) and the Councils that bring together and organize politically, the state health secretaries (CONASS) and the municipal health departments (CONASEMS).
Just as the SUS is not a single, state-owned mega-organization that operates nationwide as a “single health service,” the Carreira-SUS must be conceived and instituted as something more than a PCCS for a “single service,” but as a “personnel policy” for a “health system.” This systemic aspect is decisive, both for the SUS and for the Carreira-SUS.
For the SUS, because its systemic characteristics, although based on the so-called “health sector”, require that the SUS articulate public policies formulated and managed in other “sectors”, such as the environment and education, to stay in just two classic sectors, which impact the health of people and animals, as very well formulated by “One Health” ( "One Health”) or “One Health”. “One Health” proposes an integrated approach, recognizing the connection between human, animal, plant and environmental health.
For Carreira-SUS, since its interfederative governance needs to be in line with the SUS governance model, with participatory management and protagonism of all federative entities, added to the representations of SUS workers and users of our universal health system, at all levels of the SUS structure. In this sense, the National Health Council approved resolution which recommends the creation of Local Health Councils in all SUS health units with the aim of strengthening democratic co-management processes in the SUS. For a single system, a single career. But, for a system with governance shared by all federative entities, also a career with governance compatible with the system of which it is a structural part.
Structural features
In more recent years, many SUS worker leaders, committed to the interests of these professionals, have been converging in defense of a State Career for the SUS in which at least the following requirements are contemplated:
State Career – must effectively be a State Career, therefore covering and involving all federative entities, under the coordination of the federal government;
Interfederative – all federative entities must contribute and have their attributions and competencies defined for its viability at national level, including participation in the co-financing and management of the SUS Career, at national, local and municipal levels. This characteristic of the SUS Career requires that its operational base be municipal, with management shared between the municipal, state and federal federative entities, with the creation of a specific instance in each of the 456 SUS Health Regions, which articulates, plans, organizes, supervises the execution and permanently evaluates the flows and dynamics of the SUS Career in the region, under national coordination of the federal government, with a National Executive of the SUS Career installed in the Ministry of Health. I repeat what I have said for almost ten years, since, on 16/5/2015, the Federal Supreme Court (STF) decided that it is constitutional for public resources to be transferred to social health organizations (OSS).
The STF decision requires those who think about the current situation and the future of the SUS to consider the viability of creating a powerful organization, under public control and state ownership, with national scope, capable of institutionalizing itself as an alternative to the OSS, so that the SUS does not succumb to them, definitively surrendering to privatization. I believe that this alternative corresponds, for those who oppose the privatization of the SUS, to the creation of an agency responsible for coordinating and managing, nationally, the SUS Career;
Multiprofessional – contain several staff groups, all classified according to the different professional categories that work in the system, considering their origin of graduation, breaking down these groups by levels of training, from auxiliary and technical professionals to post-doctorate, and activity sectors according to the areas of activity of the SUS, such as surveillance, administration, continuing education in health, assistance (provision of care directly to people).
The positions in the SUS Career should be designated not by reproducing the names of the categories, but in a generic way and with scales of levels, so that a given category in the SUS Career simultaneously includes several professional categories, technically distinguishing the names of the positions from the names of the functions. Doctor, for example, does not need to be a position, but a function. Nor does the word "sanitarian" need to be the name of a position, since its functions can be performed by professionals with different degrees.
In addition to rationalizing job descriptions, this way of organizing them mitigates corporatist pressures on the State Career. A range of functions as broad as necessary can adequately, dynamically and satisfactorily contemplate and accommodate varied professional expectations;
Unique – the SUS Career needs to include everyone, throughout the country. It must be unique, as is the SUS. Unique in its systemic characteristics, but multiple and plural, and it is soon seen that its structure is quite complex, considering the various possibilities of employment relationships provided for in Brazilian labor legislation. This, being unique, opens up a direct conflict with the idea that the SUS should have Careers, in the plural, with each State and Municipality having its own “career”. Although this perspective has until now served as a “carrot” to deceive unionists and enable “snake charmers”, who have done very well in this illusionism, SUS workers should not be fooled.
Serious work is needed to create the SUS Career, which must be flexible and plural, so as to be compatible with the different needs of public services and administrative modalities. The word “unique” does not correspond to a straitjacket that standardizes everything and everyone and restricts positions and functions. It is the opposite. “Unique” because everything related to positions and functions in the SUS, including the provision of management and advisory positions, must be done “within” the SUS Career, in accordance with transparent democratic statutes, and not to lend itself to political bargaining with city councilors and party leaders.
The path that many seek to follow using the SUS structures to pursue their political-partisan business is the opposite of that of a single career: it is the path of local, parochial careers, those that “bind” SUS employees by “tying them” to the interests of those who “sponsor” them, contrary to the public interest in health. Being “single”, the SUS Career needs to operate, politically, as a reference for the structure of positions, functions and salaries, even for municipalities that do not adhere to it, for various reasons. For this reason, the strategy for its gradual implementation must consider that the autonomy of the federative entities, enshrined in the 1988 Constitution, must be respected, and, therefore, its link to the SUS Career must always be based on the municipality’s adherence.
However, even though its scope is small in the early years, the SUS Career may have an important impact in the medium term in areas such as indigenous health, whose subsystem is directly managed by the federal government, in addition to serving as a model for all federative entities. This characteristic of a model for municipalities is an institutional reference of enormous importance for the SUS and its professionals;
National – The scope must be for the entire Brazilian territory, because, I reiterate, municipal or state careers are not enough. National scope is essential in a SUS Career, because its design must provide for the possibility of practicing the profession in the SUS in any of the 5.570 Brazilian municipalities, without transfers implying the loss of functional ties and labor rights. The workplace, of labor importance, cannot imply the loss of rights guaranteed by Brazilian labor legislation.
In this sense, the SUS Career must reaffirm the ethical principle of the preponderance of labor over capital, and its national scope contributes to this. The SUS Career must periodically hold public selection processes for entry into the SUS and organize a “national bank of clears”. All of this needs to be planned, organized and executed routinely, taking into account this national dimension of Brazil.
In addition to ensuring the necessary mobility at a national level for those who are part of it, it is essential to define rules for entry into the SUS Career, promotion to different levels, in the various job categories, definition of working hours, awards for exclusive dedication, guarantees of rights and establishment of duties, as well as the conditions for effective public control by local health councils, the existence of which in all SUS health units has been emphatically recommended by the National Health Council.
The SUS Career needs to establish rules for dismissal/resignation to be considered in administrative processes, under a co-management regime by regional management committees of the SUS Career. Such committees, within the framework of participatory management, which characterizes the struggle historically waged by the builders of our universal health system, need to be composed of representatives of the municipalities of each SUS Health Region, of workers, through their unions, and of users of SUS public health services, through the municipal health councils of the respective region. Unless otherwise decided by the workers themselves at the municipal level, the federal government must assume responsibility for the administration of retirement and pensions of the SUS Career and will ensure a salary base and equality at the national level.
It is from this perspective that the aforementioned career is a state career and seeks to qualify public servants, ensuring that their work is protected and not precarious, in accordance with the terms of the International Labor Organization. States and municipalities will link their direct financial contributions to this national base, through various incentive mechanisms and additional payments for work location and others. In addition to the social security aspects that justify federal coordination of the management of the Career-SUS, there is no reasonable reason to justify that financial resources intended for the payment of salaries and social security contributions be transferred, as “transfers from the Union”, to states and municipalities.
And these are transferred – and often in a very obscure way – to private companies, owned by individuals, which, after charging administrative fees, make contributions to social security. That is, when there is no default by unscrupulous employers. This “public money trip” is currently unnecessary, in the information age – and ends up costing the public coffers a lot. There is no reasonable technical justification for this, and besides, this model of financing the SUS workforce is clearly not in the interest of the system’s workers. Thus, the federal basis of the SUS Career makes it possible to ensure a national salary base and, above all, equality at the national level, a long-standing aspiration of SUS workers.
The objections
Many people who are against a single, interfederative, multi-professional, national Career-SUS claim that this would not be possible because it would be: “illegal”, “violate the federative pact”, not have “political viability in Brazilian federalism”, and not be “feasible, given the characteristics of public administration”, among other difficulties.
These are all sensible considerations, coming from experts, researchers, and professionals who do not just have an opinion on the subject, but who are dedicated to studying the topic. These experts argue that it is not that we do not have a SUS Career today simply because we do not want to have one or because of a lack of “political will.”
They recognize that the demand is fair, but that it would not be feasible in the Brazilian federal context, and in a continent-sized country like Brazil. They may be right. But, in that case, what do they propose to stop the precariousness and devaluation of SUS health professionals?
The arguments presented in opposition to the SUS Career reiterate the “problem” of the type of federalism and the federative pact derived from the 1988 Constitution and the determination that the SUS should have “single command in each sphere of government”. They also say that there are marked differences between the federative entities, whose “autonomy” is also recognized by the 1988 Constitution. They speak of cultural contrasts and the organization of public administration. Furthermore, because the SUS is a health system and not a “national service”, that is, a mega-organization with a national scope and administered solely by the federal government, a single, national career would not be politically viable, nor feasible in technical terms. The governance of the SUS would be incompatible with this concept of a mega-organization centralized in Brasília.
These are all consistent arguments that should be taken into account in any debate about a State Career in the SUS. The problem, however, is that these findings are seen as a kind of “end point”. And that, as such, there would be nothing to do, except to try to improve what we have today. But what we have today is the growing, overwhelming outsourcing of SUS healthcare services.
Except for incompetent or lazy managers, politicians and businessmen (and, in some cases, even criminals…), who make a lot of money by keeping everything as it is, no one wants outsourcing. Many managers want to get rid of the burden of managing personnel. Politicians, with exceptions that justify the rule, want to use outsourcing to do political business. Businessmen want to make money by getting their hands on the public budget of the SUS, which is already underfunded and clearly insufficient.
Workers, however, do not want outsourcing because they aspire to have some control over their own work and, in certain situations, want to co-manage the production of health care. From the perspective of participatory management, a condition sine qua non For the proper administration of health services, outsourcing is a disaster. From an epidemiological point of view, there is scientific evidence that, in health, outsourcing adds problems and difficulties to health systems and not the other way around. The so-called “greater efficiency” of the private sector is just ideology. There is nothing, in the scientific plan, that proves this. It is the opposite.
A significant challenge, added to the creation of a Career-SUS, is that it rejects the centralization of its management in the Ministry of Health, which must continue to fulfill the important role of national coordination of the Brazilian health system. Its management must be regional, based on each territory in which there is a SUS health unit. The reformers who created the SUS always proposed that “in health, the closer to the users, the better and more appropriate are the administrative decisions related to the implementation of actions and services”.
But, and this warning has been going on since the 1980s, it is not enough to municipalize. There is no magic in that. No one believes, and today there is evidence to support this, that with municipalization, and with decisions taken at the local level, “all our problems will disappear.” Professor Paulo Eduardo Elias, from USP, one of the most vocal critical in this regard, and one of the first to oppose municipalization as a mere “prefecturalization” of health, he always warned that “municipalization is not enough, it is necessary to democratize and publicize the SUS”, as many local leaders could be as harmful or more harmful to democracy than some general-dictators.
Institutional project and health region
Currently, it is clear that the management of the SUS, at all levels, must advance in the institutionalization of regional health care networks, without reducing the decentralization of the system to “prefecturalization”.
For this reason, for those who oppose the privatization of the SUS and continue in the camp that defends a state-owned and 100% public SUS, opposition to privatization is inseparable from the fight for a State Career in the SUS. They argue that the current scenario, in which the aforementioned set of objections to the SUS Career emerges, should be seen as a “starting point” and not the “end of the road”.
They propose that, given this scenario, the SUS urgently needs an “institutional project” that addresses and presents solutions to this set of objections, to overcome them and move forward, making the creation of the SUS Career compatible with Brazilian federalism. For these leaders, the worst scenario is the current one. It is not enough to “try to improve what we have”, because what we have prevails in the precariousness of labor, the fragility of employment relationships, the lack of professional perspective and the lack of identification of SUS employees with the SUS itself.
Almost four decades after the 8th National Health Conference proposed the creation of a State Career for the SUS, stated as the need for the “urgent and immediate establishment of a job and salary plan (…) with adequate remuneration and salary equality among the same professional categories at the federal, state and municipal levels”, we should no longer accept postponements and delays. It is necessary to reaffirm in no uncertain terms that, without the SUS Career, we will continue to go around in circles in defense of the SUS, promoting the precariousness of health work, maintaining amateurism in the management of professionals, and the SUS will continue to be swallowed up by “social” “health” organizations until it is finally completely swallowed up by capital and rentierism.
Em article In an article I published in 2015, I mentioned the embarrassment of realizing that the Ministry of Health itself does not have the staff it needs to perform its role of managing the SUS at the national level. It uses management tricks, via supranational organizations, to hire people. Thus, exotic administrative figures emerge in the SUS, such as “UNESCO Consultant”, among other oddities. In fact, the hiring method (a “training grant”) used to make the “Mais Médicos” program viable, a government priority and one of the most successful health “programs” in Brazil, as proven by credible research, is sufficiently clear in this regard.
The urgency of providing doctors is certainly understandable, but it is a problem that the employment relationship is established this way. If we had a Career-SUS, many of these difficulties would be avoided, from the staffing of the Ministry of Health to the “More Doctors” program. I reiterate that without the Career-SUS, linked to a strong state institution with national scope, the SUS tends to evolve into something we never wanted: to become a system of health services only, poor, underfunded, for the poor. The Health Reform Movement has always proposed the opposite of this: a universal, comprehensive, equitable health system, with participatory management and excellent quality programs.
Reducing the SUS to precarious services, produced by workers without rights and without protection, is equivalent to transforming it into a terrible caricature of itself. Those who work in the SUS reject this fate outright and want to be “proud to be part of the SUS”. But let us remember: the situation of the SUS was much worse, even recently. During the Temer-Bolsonaro governments, it was said that it was “dying” or that it “had already died”. “All that was left was to bury it”, others would say ironically. But the SUS, through its state and municipal base, resisted, survived and continued, as best it could, caring for and protecting our population and fulfilling the mission that the 1988 Constitution gave it.
Creating a government career for the SUS is, therefore, the most strategically relevant decision currently concerning our universal health system. There is no point in “more resources for health” if this money is not allocated to health workers, but rather used to facilitate outsourcing and shady deals involving the SUS. But there is a rush to make this strategically important decision. For many health workers, more than a rush, there is actually a great deal of urgency, given the terrible working conditions, professional devaluation and salary reductions to which they are exposed. It is worth reiterating that without health workers, there is no SUS.
However, as I wrote Site the earth is round, “without a State career that values them, there are not, properly speaking, workers, but an amorphous, diffuse and confused group of semi-professionals, amateurs, odd-jobbers, hourly workers, Uber drivers, entrepreneurs, precarious workers”. Weak link in SUS resource application chain, workers foot the bill. They have no career, low wages and inadequate working conditions prevail, and precariousness is rampant. There is no decent work in many services owned and contracted by the SUS.
Therefore, for this institutional project, under the leadership of the Ministry of Health, the CNS, CONASS and CONASEMS must participate, as well as, of course, the professional health representatives at a national level.
We need to start. And the beginning, in this case, depends on a political decision that is still pending on the Esplanada dos Ministérios and Praça dos Três Poderes.
The 4th National Conference on Management of Work and Education in Health currently has the opportunity to outline a SUS Career and provide elements to the federal government so that it can establish a Working Group, composed of experts on the subject, with the mission of preparing a Bill that the Executive must forward to the National Congress.
The “Committee for Discussion and Preparation of Career Proposals within the Unified Health System”, established by Ordinance GM/SM No. 3.100/2024, can take on this role. This is the path to approving a SUS State Career Law and, 26 years after the publication of the Basic Operational Standard for Human Resources for the SUS, finally “forwarding a bill to create” the SUS Career to the Legislative Branch.
One might question whether there is really a need for a law for this. My answer has been yes, because any serious, responsible, non-demagogic proposal that takes Brazilian federalism into account requires the participation of the National Congress. It is not feasible through a presidential decree or ordinance, even if it is interministerial, for example, or, even worse, through agreements and pacts at union-based negotiating tables. These are all strategies that SUS workers should not accept, because they are paths that will lead to defeat. Yet another.
President Lula has been reaffirming that he does not want to “do more of the same” and that his government needs to “go further”. We will finally be able to break out of the same old routine and go further. Will we be able to take this step forward in the SUS Career?
No one expects things to be easy. Just look at the composition of the National Congress. But regarding difficulties, I prefer to consider the warning on the t-shirt of a young woman I saw selling snacks on a bus the other day: “It won’t get any easier. You have to stay strong.”
*Paulo Capel Narvai is senior professor of Public Health at USP. Author, among other books, of SUS: a revolutionary reform (authentic). [https://amzn.to/46jNCjR]
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