Above Photo: Health for all. Associação Brasileira de Saúde Coletiva.
Activists from all over Brazil reaffirm the need to guarantee resources for a 100% public health system.
Hundreds of health activists participated at the Free, Democratic and Popular Health Conference, organized by Frente pela Vida (Front for Life) on August 5 in São Paulo. Health workers, managers, social and political leaders, researchers and public health experts from various parts of the country discussed a health agenda for Brazil. The nation is currently facing challenges including the lack of funding for the Unified Health System (Sistema Único de Saúde, SUS) and accumulated problems due to the COVID-19 pandemic.
The event was attended by former president and current presidential candidate Luiz Inácio Lula da Silva. In his speech, Lula reaffirmed that he intends to revoke the spending cap in the federal budget, which has been in force in Brazil since 2016.
“Between 2018 and 2022, the spending cap—which takes from the poor to give to the rich—has already taken R$36.9 billion (approximately USD$7.2 billion) from the federal health budget. If the practice doesn’t stop, the implementation of the spending cap will end up making the SUS completely unviable, opening the door to the privatization of health,” said Lula.
The conference was held in an atmosphere of consensus regarding the healthcare priorities for the next presidency. “I think that the catastrophe that we lived through during the Bolsonaro administration, including the situation of the pandemic and what we could call the necro-government, has led us to work together a lot recently,” says Rosana Onocko, president of the Brazilian Association of Collective Health (ADBRASCO). “Experiencing a moment where the health movement is united again, as it was during the National Constituent Assembly, during the drafting of the Federal Constitution, I think is very important,” she stated.
Front for Life, formed during the COVID-19 pandemic to counter the federal government’s denialism, handed Lula a letter that outlines priorities for health in case he was to become Brazil’s new president.
Alexandre Padilha, health minister during the Dilma Rousseff administration, reminded the conference about the importance of continuing to enforce public health measures against COVID-19. “We need to advance our vaccination coverage, vaccinate children, vaccinate vulnerable groups with the fourth dose, and care for people suffering from post-COVID conditions,” he says. Efforts are also needed to deal with all the consequences that the pandemic has caused to the health of the general population.
“Surgeries were canceled, examinations were canceled, surveillance and follow-up procedures were canceled, all worsening the health of the people,” he said.
Echoing Lula’s speech a great deal, the first priority mentioned in the letter is the recomposition of the federal health budget. In addition to that, Front for Life is advocating for investments in the health sector equaling at least 6% of the GDP, as well as for a policy of resource allocation aimed at Primary Health Care.
For Fernanda Madano, member of the National Health Council, revoking the spending cap is important, but it is not enough. “The debate about a new financing model for the health system is an equally pressing subject,” she says. “Introducing a different model would allow recovery from historical underfunding and disregard, interference from the legislative and executive branches, and the over-prioritization of the private sector, which unfortunately was guaranteed by the federal constitution. We have to prioritize the public system in general, and the SUS more specifically.”
The letter also mentions the importance of fostering the relationship between health, industrial development and science and technology policy to guarantee public health sustainability and economic development. Front for Life sees the implementation of the Industrial Economic Complex of Health, a set of policies for local production of health technologies, as the best way to achieve these goals and build health autonomy and sovereignty, in addition to reducing dependence on other nations.
The letter quotes additional points calling for attention, including promoting employment in the SUS and social ownership of health policy, and giving adequate attention to the needs of specific groups, such as women, people with disabilities, Afro-descendants, Indigenous populations and the LGBTQIA+ community.
Paulo Conceição, from the Brazilian Association of Doctors for Democracy, highlighted the importance of prioritizing the SUS. “The financing of the SUS is a chronic problem that has become even worse since the coup of 2016 and the approval of the spending cap. One of the propositions on the table right now is the repeal of the cap, so that greater funding for the SUS can be achieved, which is a pressing need.” He also stated that the participation of health professionals at the Conference and in the discussion on Brazil’s health system has a character of reparation, since the Federal Health Council previously offered support for Bolsonaro’s policies.
“Within this mobilization effort, we have tried to bring together what we could call progressive and moderate sectors within the medical profession,” said Vinícius Ximenes from the national coordination of the National Network of Popular Doctors and Physicians. “Our collaboration is linked to the effort of securing Lula’s victory in these elections, to guarantee his inauguration, something that we can achieve only through a certain level of resistance. If we secure this new cycle for our health system, we can rebuild this country and bring back the positive experiences that we had in past decades but lost in the last years.”
The Conference plenary included the participation of dozens of health movements from around the country. Despite the diversity of issues raised, some points were common to most of the statements.
One of them is the struggle to end private management of the SUS. Débora Aligieri, representative of the Municipal Health Council of São Paulo, made a strong speech against the participation of Social Organizations (OSs) in the management of health units in the city. “In the municipality of São Paulo, more than 90% of basic care is managed by OSs, and we have been observing a precarious situation both in terms of the employment relationship and the health care provided to the population,” she said. The Council is demanding the revision of the management policy based on the OSs and the development of strategies and mechanisms to make the SUS 100% public.
Concerns about mental health services were another issue raised by several groups who rely on anti-institutional approaches. Cris Taquá, representative of the National Articulation of the Marijuana Marches, of the Mata Agroecological Community Association, and of the anti-mental institution Women’s Mental Health Collective, defended the agenda.
“We come from a background grounded in anti-manicomialism, community treatment and participation in society. Our background is anti-prohibitionist in the sense that it constructs healing plans according to what people want and approaches based on harm reduction, with the intention of treating people in such a way so they can be a part of society, free of stigmas,” he said.
The health of Indigenous communities was also discussed. Mepana Maguta, general coordinator of the Maguta people in Amazonas, recalled the difficulties of the native peoples during the pandemic. “It was very difficult for us because we lost several relatives who were also leaders; in a very difficult moment, when everyone was in a state of agitation, the greatest leaders died,” she said. It was also difficult for Indigenous communities to get medicines and food at the beginning of the COVID-19 pandemic.
Today, Indigenous peoples seek the guarantee of the right to health. “In the village we are facing a lack of medicines and a lack of transportation, which means that patients are not able to get to the cities to undergo treatment,” Maguta said.