Crisis in Brazil and impacts on the fragile regional and federative health policy governance.

Alexandre Padilha,Thássia Azevedo Alves,Gastão Wagner De Souza Campos,Danilo Carvalho Oliveira

doi:10.1590/1413-812320182412.25392019

Alexandre Padilha, Thássia Azevedo Alves + Show 2 more

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https://doi.org/10.1590/1413-812320182412.25392019

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Abstract

Since 2014, Brazil has been experiencing an economic-fiscal-political-institutional crisis. This study evaluates whether the implementation of crisis responses contributed to weaken SUS regional and federative governance. This is an implementation study, and two theoretical categories of public health, the power in Testa and the subject in Campos have been incorporated. It presumes that the implementation shifts power and develops subjects. We analyzed public data from 2014 to 2018, organized into four axes of analysis: a) instruments for implementing crisis response; b) parliament and judicial interference in investments; c) legal frameworks of regionalization; d) federative actors and possible defense coalitions. Results show reduced federal resources, specifically for regional care networks; increased parliament and judicial interference with health resources, due to the evolution of congressional amendments and lawsuits, and changes in SUS regionalization guidelines. There is a shift of power from federative regional arrangements to the central government, parliament, the judiciary, and isolated local services. It is concluded that the response to the crisis weakened the regional federative governance of SUS, aggravating the impacts of the crisis on health.

Highlights

IntroductionFor Pochmann[1], the world has been going through a crisis of global capitalism since 2008, of which outputs have reorganized it with new centralities in the world economy and labor exploitation, with Brazil included in it
This study evaluates whether the implementation of crisis responses contributed to weaken SUS regional and federative governance
These changes began with Constitutional Amendment 86/2015, in which Congressional amendments started to have a mandatory budgetary and financial execution; comprising 1.2% of net current revenue (NCR), which is the current revenue of the previous year, less social security contributions, PIS, and PASEP, of which half is destined to health care.Under the new framework, it is up to the Executive to comply, except in cases where there is a technical impediment, with the same possibility being opened for other federative levels. it predicted the incorporation of resources from oil and gas to the minimum values to be applied by the Union in health care, changing the pre-salt regulatory framework rule

Summary

Introduction

For Pochmann[1], the world has been going through a crisis of global capitalism since 2008, of which outputs have reorganized it with new centralities in the world economy and labor exploitation, with Brazil included in it. This author addresses the emergence of the “Uberization” of work, synthetically conceptualizing it as the generalization of the forms of employment that the Uber company popularized in transportation: individual autonomy of precarious contracts, 24-hr availability with long working hours, lack of labor guarantees, nonpre-paid compensation, linked to availability and productivity, bearing labor costs, giving rise to a new standard of work and workers’ organization. The offensive of the neoliberal agenda at this moment in Brazil, brings us to Bordieau[4], for whom the current neoliberal revolutions are conservative revolutions, which restore the past, presenting themselves as progressive

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