With about a month to go before municipal elections, Brazilians are preparing to go to the polls with a new component in their routine. The coronavirus not only changes the date, the time and the health security measures for the election, but places the health issue as the central agenda of the process. Added to this is the fact that mayors have as one of their functions to manage resources, equipment and actions in the area. Therefore, they should be charged by the population to the extent that the position requires.
According to the Brazilian Constitution, the health area is a shared responsibility between the federal government, states and municipalities. But the measures that most impact the daily lives of the population of a city are taken by city halls. Municipal management is responsible for ensuring basic, mandatory care for any municipality, regardless of size. The mayors are also in charge of managing the resources for the area, which guarantee equipment, medicines and structure.
With the pandemic, topics such as financing for the Unified Health System (SUS), valuing professionals in the sector and improvements in care have become more common issues in the Brazilian daily life. The consequences of the covid in other sectors have also become common ground. For the Executive Secretary of the National Council of Health Secretaries, Jurandi Frutuoso, the matter will be inevitable and the population will demand concrete planning.
“The theme strongly impacted people’s lives. It impacted the economy, it impacted survival, it impacted mental health and social and family breakdown. There is no way for a topic, with this volume of problems that it brought, to simply be forgotten or omitted from it. The candidates will have to debate, because we have many mayors running for re-election. ”
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Jurandi also states that the campaign and management challenge will be diversified, depending on the size of the municipality and the problems generated in the region by the pandemic. In the area of health, cases of covid may continue to be recorded, even after the vaccine. The mayors will also have to deal with the demand generated by the stoppage and postponement of other appointments, an increase in chronic diseases, among other consequences.
“This happened in all the cities of Brazil, practically in 100% of the municipalities. The families were devastated and the power will have to answer for that. Therefore, whoever wants this power will have to at least wave a possible solution or mitigation of the problem.”
A recent example: Brazil was unable to reach the vaccination target for this year. Ensuring that the city meets the call of the federal government to go to health units to be immunized next year is a function of city halls. They are the ones who must offer equipped posts, staff and sufficient structure. It is also in the hands of the municipal management to manage the possible consequences of low vaccination, such as new outbreaks of diseases previously eliminated from the national territory.
Investments and budget
If the lack of investment in health was already felt by the population before the pandemic, with the coronavirus it became obvious on all fronts. The defnancing of SUS is a historical problem, which was aggravated by the Temer government’s “spending ceiling” and by the dismantling measures of Bolsonaro’s administration. The doctor and former Minister of Health, Alexandre Padilha, says that the budget set by the current government for the next one cuts even more health funds.
“There are a lot of people who in the middle of the pandemic clapped their hands for SUS. There are people who never defended SUS and are now wearing the SUS vest. Now it is the proof of the nine. Bolsonaro’s proposal, which he sent to the National Congress, withdraws R $ 35 billion from the Ministry of Health’s budget. “
The effects of the pandemic in the cities with more pocket voters are also noteworthy, which can influence the elections. A study by the Federal University of Rio de Janeiro (UFRJ), in partnership with the French Institute for Research and Development, shows the municipalities with the most voters aligned with Bolsonaro suffered the most from the covid-19. There were 11% more cases and 12% more deaths for every 10 percentage points more votes for the president in the last elections.
Padilha points out that candidates who try to paste the image to the figure of the president are already trying to evade the subject. “This right that is against SUS, against the state and against social policies will try to hide this debate from the elections. They are already trying to do that. It is our responsibility, of all those who defend life and defend SUS, to put this issue in the the center of our government programs, the center of the projects, the center of the debate. To demand from the various candidacies what is their commitment to strengthen the Unified Health System? ”
It is the competence of municipal administrations to apply the resources that are allocated by the federal government and the states. It is also mandatory that the city invest a minimum of 15% of the revenue for the health area. With the money, the mayors need to implement national and state policies and coordinate the actions of the Unified Health System. Citizens are responsible for monitoring and reporting problems.
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The danger of valuing the occasion
Rafaela Pacheco, family and community doctor and health worker, says that the discourse of valuing health has already gained prominence in the electoral period. In a pandemic situation, she sees the topic as of greater relevance in the discussions.
The doctor, however, is attentive to the opportunistic instrumentalization of this defense, with candidates who have never defended SUS by expanding the rhetoric, but have no interest in putting the strengthening into practice.
“They wear the vest, they wear the hat, the SUS logo, which was formerly used mainly by us on the left, by the militants and the militants of the Brazilian health reform. Now it is being taken by another semiotic and in the service of a project that, we know well, in nothing dialogues and in nothing strengthens SUS “, reports
“Now is the time for people to look at those entities, people and collectives that, throughout this time, defended and defend that health is not a commodity, it is a human right”, argues Pacheco.
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The challenge of differentiating candidates who really intend to improve the population’s health and strengthen the SUS lies with the voter. A good start is to check statements, attitudes and actions prior to the pandemic. Rafaela Pacheco says that with the attention turned to the Unified Health System, promises of modernizations and changes appear. The doctor recalls, however, that Brazil already has the largest public service system in the world and that it is necessary to strengthen and preserve this structure.
According to the health worker, the SUS legal framework is sufficient and does not require updates. It is necessary to comply with the law that already exists, as well as the deliberative instances of the system. The list of essential guarantees also provides the means to reinforce popular participation in decisions in an organized manner and to strengthen instances of transparency.
“Do you want to defend SUS? You will need to do it in attitudes. The first attitude is the uncompromising defense of the struggle to increase SUS funding. In addition to the applause, which we accept from the heart and thank, we need attitude. For this SUS, this wonderful proposal, not to go exactly because of such opportunistic defenders, who put themselves as defenders, but in the shadows continue to sabotage as they always did “, points out the doctor.
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Edition: Rodrigo Chagas