Former Minister of Health, current advisor at Fiocruz and associate researcher of the Center for Bioethics and Diplomacy Studies in Health, raises burning discussion on the future of the Brazilian health system. Public financing of health is a recurring theme on the agenda of health in the context of international relations, as Agenor Álvares evokes mentioning the testimony of the Director General of WHO 35 years ago. For the Nethis Coordinator, José Paranaguá de Santana, this is a question that throughout this period acquired greater impact under the ethical perspective, that is, of the rights of all the peoples of Earth to health as a fundamental human right.
By JOSÉ AGENOR ÁLVARES DA SILVA, former Minister of Health
SUS, from the greater social inclusion policy arised from the Constitution, is on its way to collapse, more like a patient terminally ill
The Constitutional amendment # 86/2015, better known as the amendment of the “Tax Budget”, will bring highly negative consequences for the health financing in Brazil from 2016. This is what public managers evaluate and ten out of ten economists who analyze federal spending with the sector. By failing to approve a project of popular initiative, with more than two million and two hundred thousand signatures, which proposed linking the resources of the federal Government in 10% of gross income streams for health has created a vacuum. The project has lost the initial spirit and heavily damaging modifications were made to the sector.
The main modification was due to binding 15% of liquid revenue , staggered over five years, starting in 2016 with 13.2% of the budget, until the amount approved only in 2020. As the example of what happened with the 2015 budget for health, this value can be modified with contingencies without considering the industry’s priorities. Two other measures, also damaging to the financing of the health sector, have also been included: the allocation of imposed parliamentary amendments to make up the budget of the Ministry of Health and the resources from the exploitation of oil in the pre-salt layer. These two measures have been stated, not as additional sources as expected, but as sources of budget, absolutely against any political rationality.
The first measure is aimed at parish appointments of parliamentarians with their political bases, that even fair, most of the time, do not keep direct relation to health policy. The second, from the extraction of oil in deep waters, with initial expectation of becoming a complementary source of resources for the already meager budget, became frustrated, because it was considered a substitute source.
This amendment further deepened the gap between the needs of attention to people’s health and the ability of the State to provide them. So, the Unified Health System (SUS), from the greater social inclusion policy arised from the Constitution, is on its way to collapse, more like a terminally ill patient. Will it be in any course of study to an alternative model, of a contributory or subsidized type, to be offered to the population to “free choice”?
At the opening of the 7th National Conference on Health, held in Brasilia in 1980, the President at that time of the World Health Organization, Halfdan Mahler, in opening remarks that the Conference, asked the Brazilian leaders there: “Are you willing to face the abyss that separates the ‘privileged ‘ of the ‘dispossessed ‘ on health and to adopt concrete measures to reduce it? And how to design the most effective system of delivery of health services starting from the basis that what really matters are the people? ”
This speech of Mahler became the struggle undertaken by large sectors of the Brazilian society at the time of change of a social and exclusive security system, then in force, for a public health system without distinction. This social struggle culminated in the creation of SUS, laid down in the Constitution. The SUS, which has always been the mark of citizenship and rights to the entire population, without distinction of class, calls for public funding, with civic responsibility of the Executive, the Legislative, the Judiciary and also of society. Because what really matters are the people.