Abrasco launches a new phase of its electoral campaign focusing on municipal elections » Abrasco

In 2022, the Brazilian Public Health Association (APRASCO) put SUS at the heart of the presidential debate with the SUS Promotion Campaign. In 2024, with the municipal elections approaching, APRASCO resumes the initiative with a second phase. The movement now aims to ensure that SUS is also on the agenda of municipal candidacy proposals.

For Abrasco’s president, Rosana Onoco Campos, the 2022 campaign has opened an important movement for the organization. “The initial campaign had a lot of support, we got more than 60,000 signatures, and we see how this mobilization takes public health issues outside the public health bubble,” she says.

Strengthening SUS in municipalities

In 2024, the campaign brings together the main formulas of Abrasco to strengthen the work of mayors and councilors. “From the cities we will transform Brazil. There are ways to organize work, a unified subscription system, financing that advances towards what we have advocated, which is to strengthen the 100% universal unified subscription system,” stated the president of Abrasco.

Rosana highlights that the municipal manager is responsible for organizing and managing SUS. “The transfer of funds from the Federation and the states goes to the municipalities, who are the implementers. This shows the responsibility of more than 5,000 municipalities, which vary greatly in size, technical and political capacity and budget.

At this stage, Abrasco is part of the discussions related to the municipal candidacies, providing technical and scientific support so that future municipal managers can structure SUS operations in all areas of the country. “Any citizen who goes to vote can pay attention to the candidate’s program and see if the proposed axes are anticipated, which is why we have produced a short material, but which highlights the main issues at stake in these elections when we look at SUS;”

Discover Abrasco’s five structural proposals to strengthen the SUS system in municipalities:

Investing in workforce care: Continuing education, supervision, and humanizing local management

As a result of the privatization process, SUS workers have suffered from extreme administrative management. The demand for productivity without concern for working conditions and quality, high employee turnover rates and inattentive or authoritarian management models have weakened the SUS workforce, in addition to the fatigue caused by the pandemic, environmental disasters and other social problems. Democratic management, continuous education and health care for workers are indispensable conditions for the effective work of health workers. Exhausted professionals tend to defend themselves psychologically by creating barriers to access, which is characteristic of bureaucratic processes. Bureaucracy has a cure! Workers, as well as users, benefit from having spaces for democratic management, continuous education and reflections on the centrality of the patient and his or her safety.

Implementing social control and involving its bodies in strategic resource planning

The Unified Health System provides for municipal health councils that are responsible for defining the guidelines for local health management. The current situation requires a radical implementation of the councils, away from government choice and closer to the demands of social movements. The entry into the scene of a significant amount of resources resulting from parliamentary amendments makes it possible to fear that these resources will be used in a way that is not well articulated with the local planning of care networks. It is therefore up to the councils to develop action plans, and we strongly suggest that the proposed parliamentary amendments could also be developed in dialogue with them, to contribute more effectively to the clarification of care and monitoring networks.

Integration of municipalities in regions and regional agreement forums as a means of achieving the completeness and integration of care networks

Most Brazilian municipalities are small and medium-sized. Access to comprehensive health care, as well as to less frequent but important practices (such as some elective surgeries, new diagnostic and therapeutic techniques) is only possible if health regions act as regional regulators of flows. This agreement cannot leave small cities without assistance and remain hostage to large urban centers.

Ensure primary care is welcomed, prepared and resolved.

The Brazilian proposal to create a primary health care network based on family health has not been fully implemented by all municipalities. There are barriers to access, such as distance, restricted working hours and long delays in scheduling appointments, which still need to be overcome in many neighborhoods and communities. Furthermore, the effective implementation of nursing consultations and the development of comprehensive family therapy projects is essential due to the complexity of the problems. Clinic expansion is one of the most important determinants of prevalent mental health problems, chronic diseases and non-adherence to treatment. The prevalence of these diseases has increased and it is possible to assume that this trend will continue as the Brazilian population ages. The creation of multidisciplinary teams in the network (eMulti) should be accelerated in this process, to ensure that the health needs of the population are addressed.

Defending the public sector SUS, through management and contracting methods that guarantee health responsibility

The privatization of primary health care has led to problems related to the effectiveness of its practices: it is impossible to talk about family health with a high turnover of staff. The widespread proliferation of social organizations in Brazil is accompanied by the misuse of public resources, with multiple shortcomings and cases of corruption – not infrequently. The stability of technical staff is essential to ensure that decisions are made on a scientific basis and that priorities are set based on technical criteria. Health cannot be a subject of opinion. Municipalities need to exercise health responsibility on their territory and implement effective monitoring systems. In this public and socially oriented health planning, it is also necessary to adapt the service to current climatic and environmental challenges, in dialogue with other municipal government departments.

The importance of the 2024 municipal elections for public health was the subject of the final episode of the first season of the Abrasco podcast. The interview was with the president of Abrasco, Rosana Onoco Campos.