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Translator: Emily Ciccarelli
Without democracy there are no social rights and, in Brazil, the Sistema Único de Saúde (SUS) is the demonstration of this fact. After years of struggle by social movements, trade unions and health workers, the political dispute in the constituent process was victorious for those who advocated for a universal health system, with a comprehensiveness care of the patient and social participation. That was the culminant point of a process and the trigger of another: the organization and consolidation of the system.
The participation of the community is one of the directives of SUS; it is an ascendent and permanent process from which the health conferences are a special moment. The everyday life of this participation alongside the local health services moves forward to discussions of a specific territory, from a county, a state, reaching national scope. This participation implies the formulation of guidelines for the health policy, the definition and supervision of the public budget for the sector, such as in the execution of health plans in the various stances of the government.
Starting from local problems, health advisors and activists expand their comprehension of collective health conditions, its causes, consequences and needs for revising the health policy. The community’s participation in SUS is a directive in construction, a daily challenge for those who comprehend its importance and necessity, especially regarding to its dissemination by society as a whole. In that sense, the National Health Conference is a highlighted moment of the process and can be extremely productive if there is a democratic government supporting it, as it is an institutional event.
Foto do companheiro Eduardo Zanatta
Held since 1941, in another historical context, it acquired new configuration, theoretical force and policy since the 8th National Health Conference, held in 1986, during which were structured the bases for the configuration of SUS in the Constitution of 1988. After 7 years of the social policies’ destruction in Brazil, we have once again a democratic government that is focused on reconstruction and that have prioritized social participation: the 17th National Health Conference happened in the beginning of July earlier this year, 20 years after the passing of one of the main leaders of the Brazilian sanitary reform, the public health doctor Sérgio Arouca, intellectual and activist fundamental in all of the process that was culminated in the 8th Conference.
The most recent conference was held with many difficulties, with the Lula government being in power for only 6 months and with a budget elaborated by the antecessor who left a sad memory. Still, provided a leap in quality with the innovation expressed in the realization of free conferences, in addition to the institutional ones already planned – regional pre-conferences, municipal and state conferences. There was an intense mobilization of social and trade union movements, as well as social organizations, resulting in 99 free conferences that elected deputies and built guidelines and propositions that were discussed in the National Conference. This initiative was very important for the ampliation of discussions concerning the health policy and integration of movements and organizations active in other social policies. Out of the 3.526 deputies, 373 were elected by free conferences and, between the 245 guidelines and 1.198 propositions that have been approved, there are those built in these spaces.
Borrowing a verse from our poet Chico Buarque de Holanda, and not by accident, the general theme of the 17th National Health Conference was “Tomorrow will be another day”, with the following axes: I – The Brazil we have, the Brazil we want; II – The role of social control and the social movements; III – Ensure Rights and defend the SUS, life and democracy; IV – tomorrow will be another day for everyone. Deputies and guests have chosen the axes and the discussions were developed in many groups, with the deliberations submitted to a final plenary.
The approval of guidelines and propositions in a democratic event that, since the initial discussions, moved approximately 2 million people was a special moment of synergy and hope, words frequently used by all the participants to refer to the 17th Conference. Nowadays we have a federal democratic government, committed to the improvement of social policies, that worries with the well-being of its people, but there are many challenges to face. A health conference portrait a society, including its conflicts.
Beyond all the financial and operational difficulties faced to hold the Conference, the appetite of political groups that joined the broad coalition that elected Lula and Alckmin has led to an attempt of destabilizing the Health Minister, Nísia Trindade, respected professional always present in the fight for the right to universal and comprehensive health care with social participation. The conferential moment was also a strong manifestation of support to Nísia Trindade and her work conducting the Ministry of Health.
As Sonia Fleury points out, many themes were left out of the discussions in the event of July, such as: a) the causes and consequences of the Covid-19 pandemic, that has killed around 700 thousand people in Brazil due to postures adopted by the government of sad memory; b) the defunding imposed on SUS in the recent years and the urgent reposition of approximately 70.4 billion reais lost by the system since 2018, due to the Constitutional Amendment 95/2017, that froze the amounts allocated to health and education, the main social policies of a nation; c) the privatization in course, with private entities managing services with public resources, with damages to the population’s health and the very public management; d) the use of Artificial Intelligence in healthcare, its risks and benefits, in addition to the importance (and necessity) of consistent public regulation.
However, as previously highlighted, it is a political space and these questions have occupied the many debates that are still happening in the country – within social movements, social organizations, and varied groups. If not highlighted in the Conference, they are present in guidelines and propositions brought to conference discussions, such as the ones that resulted from free conferences held by RBCE – Brazilian Network of Cooperation on Emergencies, WSFHSS and Continental Cry of the Excluded. Being present in society, they won’t be out of the debate.
The axes that conducted the 17th National Health Conference allowed for reflections in the sense that the defense of SUS holds and demands actions of system’s improvement, which today shows to be smaller than it can be for the Brazilian people. It is essential the denaturalization of scarcity logic – in the precise formulation of Dr. Armando De Negri Filho -, logic that has oriented the management of SUS since its creation. It is imposed a hospital reform, adjusting the proportion of the number of effective beds for the population to international patterns of sufficiency.
The improvement of SUS demands a restructuring with short, medium and long-term plans, focused on the elevation of its quality and the level of social consciousness that health is a constitutional right and from this comes the right to a system that offers quality service, with health prevention, promotion and recuperation with resolvability for everyone, regardless of the region where the citizen lives.
We are now in the post-Conference moment, with the accompaniment of transformation of guidelines approved in public policies and analysis of sectors of civil society and specific deliberations. The social participation process is permanent, and we live the creation of new spaces and the construction of a new day that grows stronger and stronger.
September 5th, 2023
Curatorship of the World Social Forum on Health and Social Security
USED MATERIALS
Constituição Federal de 1988 - Constituição (planalto.gov.br)
Os trabalhos do FSMSSS são revisados por Isadora Borba e Rafaela Venturella De Negri