The Forum for Defence of the Brazilian Unified Health System (Sistema Único de Saúde) and its role in building community participation in the fight against the privatization of health (original) (raw)
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Ciência & Saúde Coletiva, 2017
Supervision of a health system presupposes keeping an attentive eye on the health situation of populations, so as to understand health, illness and healthcare as indissociable manifestations of human existence. Taking this point of view, this article examines health practices from the basis of some of their processes of communication. These are markedly professional-centered in their logic, with their emphasis on scientific, vertical and authoritarian discourse, predominantly in the spaces of the Unified Health System (SUS). In the territory, the process of communication is determinant. As a result of social interaction in daily life, the communication process reterritorializes the elements of the social totality: people, companies, institutions are re-dimensioned in the logic. It is a characteristic space for activities that aim for a more horizontal and democratic flow of communication.
Engaging citizens: Lessons from building Brazil's national health system
Social Science & Medicine, 2008
Brazil's Sistema Único de Saúde (SUS), a universal, publicly-funded, rights-based health system, designed and put in place in an era where neo-liberal reforms elsewhere in the world have driven the marketization of health services, offers important lessons for future health systems. In this article, we focus on the innovative institutional mechanisms for popular involvement and accountability that are part of the architecture for governance of the SUS. We argue that these mechanisms of public involvement hold the potential to sustain a compact between state and citizens and ensure the political momentum required to broaden access to basic health services, while at the same time providing a framework for the emergence of “regulatory partnerships” capable of managing the complex reality of pluralistic provision and multiplying sources of health expertise in a way which ensures that the needs and rights of poor and marginalised citizens are not relegated to the periphery of a segmented health system.
Contextualizaciones Latinoamericanas, 2018
Abstract This paper analyses how the Brazilian Collective Health Movement (CHM) and its main representatives have influenced the policymaking process for health policy during distinct political periods: from regime transition/re-democratization to democracy (1970s to 2014). We will answer two main questions: In what ways did the Brazilian collective health community/actors and their ideas influence the health care policymaking process in Brazil? Why and in what context can we understand the present call of the collective health care community for a renewal of the health care movement in Brazil? We develop a contextual descriptive analysis, involving a literature and documentary review, and interviews with key players. We take into account the political macro contexts (democracy and economic model), governmental coalitions, ideas and actions of the CHM, relationships of the CHM within society, institutionalization of participatory channels, and the interrelations between the Ministries of Economics, of Health and of Social Security. Three main periods were identified: 1) The transition to democracy and Constituent Assembly period, with the fight for and creation of the new national Unified Health Care System (SUS). 2) The first years of re-democratization, during the implementation of the institutional foundations of the SUS (1989-2002). 3) The period of democracy with neoliberalism (from 2003-2014), when a managerial and participative approach coexisted and conflicted with attempts to subordinate health care policy to the developmental model. The results indicate that the influence of the CHM was less dominant in subsequent years, characterized by the institutionalization of civil participation in health councils, by the prominence of the economic model, and by a more institutionalized political action of movement leaders in the Health Secretaries and the Ministry of Health. In conclusion, we highlight the relevant political lessons regarding the CHM's possibilities of effective revival in the years to come. Resumen Este trabajo explora las formas en que el Movimiento Brasileño de Salud Colectiva y sus principales representantes han influido en el proceso de formulación de políticas de salud durante el período de transición y consolidación de la democracia en Brasil (1970s-2013). Desarrollamos un análisis contextual descriptivo, con una revisión bibliográfica y docu-mental. Se identificaron tres períodos claves: 1) Entre finales de los años setenta y 1988 ve-mos la formación del movimiento de salud y el desarrollo de una lucha política socialmente arraigada para la creación del nuevo Sistema Único de Salud (SUS). 2) Entre 1989 y 2002 se implementaron las principales bases institucionales del nuevo sistema de salud brasileño. 3)
The current challenges of the fight for a universal right to health in Brazil
2020
Desde a promulgação da Constituição federal de 1988, o Brasil mudou muito. Na saúde, embora tenham ocorrido avanços importantes, persistem problemas antigos e novos têm surgido. O objetivo maior de assegurar o direito universal à saúde não foi alcançado. Em 2019, realiza-se a 16ª Conferência Nacional de Saúde, momento oportuno para analisar a história, o momento presente e as tendências que se anunciam. Este texto busca contribuir para essa análise, com base nos resultados de estudos sobre a evolução das condições de saúde da população e do sistema de saúde brasileiro nos últimos 30 anos. Identifica o fortalecimento do setor privado e do capital na área da saúde, em detrimento do interesse público e do SUS. Por fim, discute as estratégias de luta pelo direito à saúde necessárias e possíveis no contexto atual24827832792Brazil has changed a lot since the enactment of the 1988 Federal Constitution. Although substantial advances have occurred in the health sector, old problems persist a...
Justiça social, democracia com direitos sociais e saúde: a luta do Cebes
Saúde em Debate, 2018
Social justice, democracy with social rights and health: the struggle of Cebes THE CREATION OF THE UNIFIED HEALTH SYSTEM (SUS) as a universal policy for all constitutes one of the most important achievements of the brazilian society in the XX century. Consecrated in the Federal Constitution of 1988, in its articles 196 to 198 1 , the SUS must be valued and defended as a milestone for citizenship and civilizational advancement. The universalistic, egalitarian and integral character of the constitutional health project, since its inception, faced resistance from economic and political forces that have barred and hampered its implementation. The main mechanism used is to prevent adequate and permanent financing of the System. The recurrent arguments are that health spending is too low and resources are poorly applied, when it is known that Brazil invests a few public health resources-less than 4% of the Gross Domestic Product (GDP)-, while countries with similar systems invest about 8%. In addition, it is important to emphasize that the enormous social inequality in the Country produces vulnerabilities that, along with the aging of the population, increase the consumption of health services. Therefore, the health financing debate must start from the premise that the healthier a people has, the more care and assistance it will need. The projections are that health care would require an additional resource input of about 37% over the next 20 years 2. Contrary to health needs, present and future, of the population, the government that took power after the coup in 2016, at the service of national elites, was able to approve in the national Congress amendment to the Constitution that freezes the primary expenditures of the federal government for 20 years 3. While expenditures on public debt will remain unlimited, health, education, social security and social assistance expenditures, infrastructure, defense, culture and all other public management expenditures will be corrected only by inflation measured by the Broad National Consumer Price Index (IPCA). Health, as a right provided for by the Constitution, established a system essentially public and unique, reserving the private sector a complementary role, in other words, to act where the public system was not present, through explicit needs under the decision and regulation of the SUS. This would prevent imbalances or even the replacement of the public sector. But it has not been so. What was seen in the three decades of existence of SUS was an exponential growth of the private sector and the financialisation of the sector, as health became a profit and interest of financial capital. Among the 200 million brazilians, a quarter is covered by private health plans in a heterogeneous way, since the higher income sectors have plans with greater coverage of procedures and different hotel services. Among those earning 20 minimum monthly salaries or more, coverage is about 80%. Most of the plans are contracted by employers, and the employer's contribution, evidently, is passed on to the final price of the product or service and, therefore, paid by the final consumer. By the condition of benefit, it is not taxed as income of the worker.
2018
Brazil has established a constitutional right to health for its citizens. The attention of commentators and the legal community has been focused on the role of the courts in defining the state's obligation to provide access to certain forms of healthcare services. This dissertation focuses on a rather neglected aspect of Brazil's right to health: citizen participation in health governance. v Lay Summary This dissertation is about citizen participation in health governance in Brazil. I argue the Constitution creates a state duty to implement a health system that incorporates citizen participation in health planning. The objectives of this dissertation were to determine the constitutional requirements for participation and to evaluate whether the National Health Council-the participation body at the national level of governance-has fully met those requirements. I analyzed the constitutional and legislative framework for participation, interviewed a selection of Council's members, and conducted naturalistic observations of Council meetings. My research shows that the Council has not been as effective as it should be, partly because members lack clarity with respect to the scope of the Council's role, and partly because the statutory provisions that create the Council curtail its legal authority to carry out its legal mandate. I conclude the dissertation by providing recommendations to overcome these issues. vi Preface This dissertation is an original intellectual product of the author, Regiane Alves Garcia. The research for this dissertation was conducted in Brazil's National Health Council in Brasília, Brazil. The design and methods of this research were submitted and approved by the Behavioural Research Ethics Board (BREB) of the University of British Columbia (Canada), and by the Comitê de Ética em Pesquisa (CEP) [Research Ethics Committee] of the University of Brasília (Brazil). The BREB's Ethics Certificates are: H13-02662 and H15-03121, and the CEP's Ethics Certificate is: 34492514.0.0000.5540. Parts of this dissertation have been published in Regiane Garcia, "Expanding the Debate-Citizen Participation for the Implementation of the Right to Health in Brazil" (2018) 20:1 Health and Human Rights Journal. Some of the interview data collected in my dissertation research has been published in
Health reform and the creation of the Sistema Único de Saúde: notes on contexts and authors
Within the context of the return to democracy, the new constitution enacted in 1988 transformed health into an individual right and initiated the process of creating a public, universal and decentralized health system, profoundly altering the organization of public health in Brazil. This article discusses the main institutional, political and social aspects of this health reform, along with the changes, the continuities and the major initiatives, based on the literature published by the most widely read authors in this field of study. Without purporting to offer an exhaustive analysis, we discuss how the historiography written by authors who were also actors in the process assess its main features, along with the genesis of the process and the legacy of health reform in Brazil.
The genesis of collective health in Brazil
Sociology of Health & Illness, 2013
During the 1970s in Brazil a social space directed towards health problems on the population level, called collective health, was created and institutionalised. To what extent did this Brazilian invention correspond to a specific socio-historical practice? The works published on this topic have considered social medicine as a homogeneous phenomenon without empirically studying the specificities of national experiences. To bridge this gap, a historical study on the genesis of collective health in Brazil was carried out based on Bourdieu's field theory. The interaction between the paths of the founders and the conditions of historical possibilities were researched through documentary and bibliographical sources, as well as through in-depth interviews of the founders. This social space originated from a meeting of agents with different social backgrounds but who interconnected, creating a structure that was independent of each agent considered individually. One of the components of this establishment was the joining of theoretical production and the implementation of health reforms that resulted in the organisation of a universal health system. This study attempts to show how the international political situation and the contradictions of the national crisis created a universe of possibilities, allowing for the genesis of this sui generis space in Brazil.
Public/Private Mix in the Brazilian Health System and the Quest for Equity
Global Social Welfare, 2016
The paper discusses the intricate relationship between the public and the private sectors in the current configuration of the Brazilian health system. Although not foreseen in the universal and public model created by the 1988 Constitution, this setting has been consolidated, making it challenging and politically difficult to change. Its expression is a fragile regulation of the private sector, the expansion of private participation in the provision of services, especially in human resources, and the reduction of public funding. In this account, we analyze the Brazilian health system and the political and institutional settings that contributed to the publicprivate mix and the conflicts it generates. We conclude that Brazil is characterized by a unique process where public and private systems grow together and in conjunction with one another. Such a mix may compromise the equity objectives of universalizing equal access to quality of care for all of Brazil's population.