Abstract
This propositional document was outlined within the scope of the 13th Brazilian Congress on Collective Health, held in November 2022. The event brought together 6,800 people imbued with hope for the election of a progressive and democratic government, as well as a spirit of articulation, integration, and defense of rights. The document was designed with the objective of contributing to formulating necessary solutions for problems faced by the Brazilian society, presenting proposals to the federal government’s transition commission that are dear to the work management and education in the healthcare field and move towards a strong and egalitarian Brazilian National Health System.
Keywords:
Health Work; Health Education; Health Management; Health Personnel Management; Brazilian National Health System
Introduction
In recent years, we have witnessed the Brazilian social policies be dismantled, and education and health are among the areas which this process affected the most. In education, the federal government adopted measures that weakened free public education by cutting budget and extinguishing public programs and policies. The expansion of distance learning (DL) and the failure to promote inclusion in all social spheres are among the measures criticized by experts. In health, extinguishing public policies had an immediate impact on the quality of care provided to the population. The lack of investment in the public network, scrapping of services and privatization of hospitals and health units are just some of the measures that have hampered the population’s access to health services (Inesc, 2021INESC - INSTITUTO DE ESTUDOS SOCIOECONÔMICOS. A conta do desmonte: balanço do orçamento geral da União 2021. Brasília, DF: Inesc, 2021.; Magnago; Martins, 2023MAGNAGO, C.; MARTINS, C. L. Crises contemporâneas: retrocessos sociais, políticas de saúde e desafios democráticos. Saúde e Sociedade, São Paulo, v. 32, n. 1, p. 1-10. 2023. DOI: 10.1590/S0104-12902023230228pt
https://doi.org/10.1590/S0104-1290202323... ).
As if this scenario were not enough, the COVID-19 pandemic has been further highlighted the lack of investment in health and education. Professionals in these areas were exposed to the risk of contagion and were not provided with the necessary support to face the challenges posed by this health crisis. Given this reality, it is essential that the attention of researchers, teachers, health professionals, public managers, and society in general turns to the maintenance and expansion of social policies, especially in the areas mentioned above, as part of an inclusive and democratic society project.
In this sense, even with the challenging political situation and still under the overwhelming COVID-19 pandemic effects, the 13th Brazilian Congress on Collective Health of the Associação Brasileira de Saúde Coletiva (Abrasco - Brazilian Association of Collective Health) took place in November 2022, in Salvador, state of Bahia. The event, motivated by the hope of electing a progressive and democratic government and by the spirit of articulation, integration, and defense of rights, had as its central theme “Health is democracy: diversity, equity and social justice,” and brought together 6,800 people. The Congress had the participation of professionals, workers, and managers from the Brazilian National Health System (SUS) and representatives from the most different sectors of society, including universities, social movements, and community members (Abrasco, 2022ABRASCO - ASSOCIAÇÃO BRASILEIRA DE SAÚDE COLETIVA. Carta de Salvador - Abrascão 2022. Salvador, 24 nov. 2022. Disponível em: <Disponível em: https://www.abrasco.org.br/site/eventos/congresso-brasileiro-de-saude-coletiva/carta-de-salvador-abrascao-2022/70333/ >. Acesso em: 31 jul 2023.
https://www.abrasco.org.br/site/eventos/... ).
The event highlighted a convergence between the participants’ and Brazilian society’s desires: to overcome the pandemic, increase the importance of scientific knowledge, and recover the fundamental precepts of democracy and solidarity. In this sense, it was a congress with “intense ethical, political and legal positioning, exchanges of knowledge and sharing of experiences around the values defended by the Public Health community and the different groups active in the fight to defend the right to health and equity” (Abrasco, 2022ABRASCO - ASSOCIAÇÃO BRASILEIRA DE SAÚDE COLETIVA. Carta de Salvador - Abrascão 2022. Salvador, 24 nov. 2022. Disponível em: <Disponível em: https://www.abrasco.org.br/site/eventos/congresso-brasileiro-de-saude-coletiva/carta-de-salvador-abrascao-2022/70333/ >. Acesso em: 31 jul 2023.
https://www.abrasco.org.br/site/eventos/... ; our translation).
Abrasco’s structuring groups played an important role in this movement, contributing to debates, reflections, and elaboration of proposals to be incorporated into the agenda of the areas of health, education, and science and technology of the next Federal, State or Municipal government, to contribute to the reconstruction and redirection of public policies that are relevant and strategic for Brazil. This work presents one of the propositional documents formulated within the scope of this congress, designed by Abrasco’s Health Work and Education Thematic Group (TG).
Brazilian Association of Collective Health
Abrasco was created in 1979 to act as a support, strengthening, and coordination mechanism between teaching and research institutions in public health. The expansion of dialogue with the technical-scientific community, as well as the dialogue of such community with governmental and non-governmental organizations, health services, and civil society are among its objectives (Abrasco, 2019ABRASCO - ASSOCIAÇÃO BRASILEIRA DE SAÚDE COLETIVA. Estatuto da Associação Brasileira de Saúde Coletiva. Rio de Janeiro: Abrasco, 2019.). The association is currently organized around a board of directors, a council, and a set of commissions, committees, forums, and TGs, which should “prioritize work processes with flexible action strategies and a focus on political action that articulates different instances of Abrasco” (Abrasco, 2018ABRASCO - ASSOCIAÇÃO BRASILEIRA DE SAÚDE COLETIVA. Regimento interno da Associação Brasileira de Saúde Coletiva. Rio de Janeiro: Abrasco , 2018., p. 1; our translation).
The commissions are groups created for the collective construction of reflections and actions that promote the field of collective health from three structuring areas: social and human sciences; policy, planning and management, and epidemiology. They are permanent and advise Abrasco’s board of directors. Committees are advisory bodies to the board that mobilize authorities, managers, and academics to discuss and design proposals aimed at advancing the areas they study (Abrasco, 2018ABRASCO - ASSOCIAÇÃO BRASILEIRA DE SAÚDE COLETIVA. Regimento interno da Associação Brasileira de Saúde Coletiva. Rio de Janeiro: Abrasco , 2018.).
The forums are spaces for articulation between teaching and research institutions in public health and other government bodies, stimulating debate and sharing of experiences and demands referring to the health professional training and issues of interest to the field-related journal editorial activities (Nunes, 2015NUNES, E. D. Prefácio. In: LIMA, N. T.; SANTANA, J. P.; PAIVA, C. H. A. (Org.). Saúde coletiva: a Abrasco em 35 anos de história. Rio de Janeiro: Fiocruz, 2015. p. 9-14. DOI: 10.7476/9788575415900
https://doi.org/10.7476/9788575415900... ; Abrasco, 2018ABRASCO - ASSOCIAÇÃO BRASILEIRA DE SAÚDE COLETIVA. Regimento interno da Associação Brasileira de Saúde Coletiva. Rio de Janeiro: Abrasco , 2018.). TGs are understood as groups of experts on a given subject, held to deepen the debate and implementation of policies and actions with regard to a given topic (Belisário, 2002BELISÁRIO, S. A. Associativismo em saúde coletiva: um estudo da Associação Brasileira de Pós-graduação em Saúde Coletiva - ABRASCO. 2002. 401 f. Tese (Doutorado em Saúde Coletiva) - Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, 2002.). They are temporary spaces for studies and scientific exchange, organized to hold events and collaborative research projects that contribute to strengthening areas relevant to the field of collective health (Abrasco, 2018ABRASCO - ASSOCIAÇÃO BRASILEIRA DE SAÚDE COLETIVA. Regimento interno da Associação Brasileira de Saúde Coletiva. Rio de Janeiro: Abrasco , 2018.).
Formed from 1983 onwards, the TGs were originally designed to operate on a transitional basis, but broad acceptance made their consolidation, expansion, and diversification possible. Nowadays, Abrasco has groups, including the Health Work and Education TG.
Health Work and Education Thematic Group
The Health Work and Education TG was created in 1994 at the 4th Brazilian Congress on Collective Health, in Olinda, state of Pernambuco, and was then named Human Resources and Professions. Initially, this group carried out a series of actions of a technical, scientific, and political nature, and contributed to the process of the Brazilian health and collective health field reform in a multi-professional and interdisciplinary manner. The group also designed and structured the Health Human Resources Observatory Network. In a second moment, the technical and conceptual renewal that occurred in the field of health work and education required not only the expansion of the theoretical scope and themes to be worked on, but also the increase in the number of members (Abrasco, 2014ABRASCO - ASSOCIAÇÃO BRASILEIRA DE SAÚDE COLETIVA. Linha do tempo GT Trabalho e Educação na Saúde. Rio de Janeiro: Abrasco , 2014. Disponível em: <Disponível em: https://www.Abrasco.org.br/site/gttrabalhoeeducacaonasaude/wp-content/uploads/sites/8/2014/05/Gt-trabalho-e-educa%C3%A7%C3%A3o.png >. Acesso em: 24 abr 2023.
https://www.Abrasco.org.br/site/gttrabal... ).
In this movement, the TG went through a process of reformulation, in which its first Master Plan was drawn up and the group was renamed as Heath Work and Education TG, adopting the following definition:
Such TG is constituted as a questioning, investigative and propositional group of actions for the fields of Work and Education, offering subsidies and information to process of Health Reform and the Brazilian health system, expanding and strengthening the groups and scientific production in the area of its competence and dedicating itself to its dissemination. (Abrasco, 2014ABRASCO - ASSOCIAÇÃO BRASILEIRA DE SAÚDE COLETIVA. Linha do tempo GT Trabalho e Educação na Saúde. Rio de Janeiro: Abrasco , 2014. Disponível em: <Disponível em: https://www.Abrasco.org.br/site/gttrabalhoeeducacaonasaude/wp-content/uploads/sites/8/2014/05/Gt-trabalho-e-educa%C3%A7%C3%A3o.png >. Acesso em: 24 abr 2023.
https://www.Abrasco.org.br/site/gttrabal... ; our translation)
Members of the Heath Work and Education TG played a leading role in the debate and formulation of conferences in the area of work and education management, also contributing to proposals that resulted in the creation of the Secretariat of Health Work and Education Management of the Ministry of Health, an important milestone for the area (Pinto, 2017PINTO, I. C. M. A interlocução com as instituições acadêmicas e os órgãos gestores da política de saúde. Ensaios & Diálogos em Saúde Coletiva, Rio de Janeiro, n. 4, p. 15-16, jun. 2017. ).
In a third moment, among the several activities carried out by the TG, the following stand out: elaboration of its second Master Plan; development of a monitoring project for the then newly created Undergraduate Courses in Public Health; participation in the creation of the Abrasco Public Health Undergraduate Forum; survey on scientific production in the field and its subsequent publication in a catalog, and intense activity in preparing and organizing the Brazilian Congresses on Public Health and Health Policy, Planning and Management.
Adopting a different management format, developed by a coordinator and a managing group, the TG is currently in its seventh coordination period. Regarding congresses, in addition to being part of the organization and scientific committees, participating in round table debates and panels, the TG organizes, in the pre-congress period, the International Symposium on Health Work and Education, which has already had three editions11The 1st Symposium was held in Natal, in 2017, on the occasion of the 3rd Abrasco Congress on Health Policy, Planning and Management; the II Symposium took place in Rio de Janeiro, in 2018, as part of the 12th Brazilian Congress on Collective Health; and the III Symposium took place in 2022, in Salvador, as an activity prior to the 13th Brazilian Congress on Collective Health.. The symposium brings together national and international researchers, managers, field workers, and aims to reflect on the changes, challenges, and perspectives specific to the field of health work and education.
The III International Symposium on Health Work and Education, held in 2022, had debates about cuts to labor rights; the then management of the federal government during the COVID-19 pandemic, and the need to think about the country, SUS, public health, Brazilian population, and people who provide care. At the end of the event, one decided to forward a document signed by such TG to the then Transition Commission for the Federal Government that would take office on January 1, 2023, containing proposals for strengthening the area of health work and education management, which are presented below.
Proposal of Abrasco’s Health Work and Education TG to the Federal Government Transition Commission22This proposal was forwarded in December 2022 to the Government Transition Commission of the current Federal Government - President Luís Inácio Lula da Silva and Vice-President Geraldo Alckmin.
The government change that will take place from January 1, 2023, is an opportunity to redefine the national agenda in the field of health work and education management. In this sense, the first aspect to be highlighted is the central role of health workers regarding the consolidation process of SUS, which employs more than 3.5 million people directly. Even with the increasing incorporation of technologies in the area, including robotics and artificial intelligence, most health actions require the encounter and direct and effective communication between service users and health workers.
Health work and education management is an interdisciplinary, inter-professional, and inter-sectoral area, structured by different knowledge types and practices. Formed by phenomena that constitute the spaces of health professionals’ training and qualification, work management, and regulation, it has mobilized different segments of society, even against an adverse situation, which includes the restriction of the democratic environment and changes in the State financing logic and management established by neoliberal policies. Due to the scope and complexity of the issues that permeate the debate surrounding the area, multiple dimensions of analysis can be highlighted:
political dimension, in which it is necessary to reflect on the deregulation of labor protection, structuring of the private health labor market, growing and uncontrolled expansion of the educational market, and the fragility of mechanisms for monitoring the quality of professional training and practice.
economic dimension, within which the SUS importance in generating jobs and the need to reverse the setback produced by the implementation of fiscal austerity policies stand out;
management dimension, where the challenge of decentralized management and the need to align health work and education management strategies are emphasized, with a view to universality, inclusion and meeting the population’s needs.
dialogic dimension, in which the highlight is the importance of exploring the potential of communication and knowledge management for the formulation and implementation of concrete actions that favor changes in the practices and relationships of teams and health workers.
international or global dimension, where the possibilities for dialogue with other countries should be strengthened, at the various interfaces both of professional training and of the health job market.
From this perspective, Abrasco’s Health Work and Education TG, with the aim of contributing to the adoption of necessary solutions for Brazilian society, presents below proposals to the Federal Government Transition Commission, which have enormous value for the area of Health Work and Education Management and move towards a strong and egalitarian SUS.
General scope proposals
To increase the budget of the Secretariat of Health Work and Education Management (SGTES), strengthening it as a space that ensures the implementation of actions under the Health Work and Education Management Policy.
To establish mechanisms for tripartite financing of the National Health Work and Education Management Policy.
To improve the National Health Work and Education Management Policy, within the SUS scope, reviewing the Principles and Guidelines of the Basic Operational Standard for Human Resources for the SUS (NOB/RH-SUS), established through Resolution No. 330, of November 4, 2003.
To hold the IV National Conference on Health Work and Education Management.
To reverse the processes of deregulation of labor law, materialized through labor and social security reforms, and of the Outsourcing Law, aiming to protect workers against harmful acts that prevent or hinder the guarantee of healthy, humanized, and dignified working conditions.
To restart and strengthen the Health Human Resources Observatory Network as a space that gathers information about the health workforce and conducts investigations into health work and education, in order to contribute actively to refining and improving public policies and management, regulation and training strategies directed at the SUS.
Work management scope proposals
To expand the debate on the health work regulation, ensuring different social actors’ participation in the search for answers and creative strategies that ensure the supremacy of the public interest over corporate and private interests.
To establish comprehensive and effective telework regulation, considering the structural conditions and ethical precepts necessary for its implementation.
To improve the current regulatory system for health professions, aiming to harmonize current regulations and direct them towards organization of the scopes of practice of different professions, with the aim of meeting the population’s health needs integrated with health policies.
To support the regulation of the public health profession by law, as a higher education profession, enabling its inclusion in the health systems of the Union, States, and Municipalities, including through civil service examinations.
To re-implement the Health Professions Regulation Chamber at the federal level, in order to harmonize the regulations issued by the currently existing 13 higher education health professional councils.
To develop and stimulate studies that support the implementation of SUS career systems as a way of valuing health workers, reversing the precariousness of employment relationships and ensuring labor rights to make working at SUS an attractive professional option, considering all health professions.
To adopt mechanisms for valuing work and workers, ensuring: better working conditions, correspondence between service demands and staffing throughout the health care network, and continuing worker education and health care processes that include mental health.
To re-implement the SUS National Permanent Negotiation System, with special attention to the re-deployment of the SUS National Permanent Negotiation Panel and promotion of state and municipal panels.
To create strategies aimed at revising the legislative apparatus that affect health work directly, compromising its results, such as the Fiscal Responsibility Law, the Labor Law, and the Outsourcing Law.
To ensure financial resources for health actions and workers’ safety, with an emphasis on monitoring, promoting, and protecting workers’ health and reducing morbidity and mortality resulting from development models and productive work processes.
To re-activate the National Interinstitutional Committee on Improvement of Work at SUS, to develop strategies that reduce worker precariousness and vulnerability, incorporating the assumptions of decent work in policies related to health work.
To propose instruments that ensure the adequate supply of workers, encouraging the structuring of sustainable processes for planning and sizing the health workforce.
Health education management scope proposals
To strengthen the regulation of the provision of undergraduate health courses, with special attention to distance learning (DL), with a view to ensuring quality in training processes.
To adopt the concept of “SUS as a school,” complying with article 200 of the Federal Constitution and the set of actions and pieces of evidence that highlight the centrality of work in the training process.
To strengthen the National Policy on Permanent Health Education and stimulate decentralized training actions in daily work that enable the redefinition of professional practices.
To create policies to stimulate High Education Institutions to offer undergraduate health courses and residency programs, based on scarcity research.
To create mechanisms to encourage changes in the teaching-learning processes of health professionals’ training at all levels, strengthening interdisciplinarity and continuing health education, and the inclusion of interprofessional education as a curricular component of undergraduate health courses. Interprofessional education refers to shared learning, in an interactive manner, between students and professionals from different areas, with the explicit purpose of developing skills for teamwork and collaborative practice.
Insertion, permanence, and increase of affirmative actions in higher education institutions.
To stimulate the qualification of dialogue and integration between training institutions, health services, and civil society organizations.
To strengthen SUS public health schools and technical schools as spaces for worker training and appreciation.
This document was based on the debates that took place at the III International Symposium on Health Work and Education, held on the 13th Brazilian Congress on Collective Health, in Salvador/state of Bahia. Through it, we defend proposals that rescue the democratic and participatory SUS ideology, honoring historical commitments in the field of health work and education management in favor of effective and necessary changes to SUS strengthening. Therefore, the board of Abrasco’s Health Work and Education TG makes itself available to carry out studies that help mature these propositions, and also to work on their implementation.
References
- ABRASCO - ASSOCIAÇÃO BRASILEIRA DE SAÚDE COLETIVA. Carta de Salvador - Abrascão 2022. Salvador, 24 nov. 2022. Disponível em: <Disponível em: https://www.abrasco.org.br/site/eventos/congresso-brasileiro-de-saude-coletiva/carta-de-salvador-abrascao-2022/70333/ >. Acesso em: 31 jul 2023.
» https://www.abrasco.org.br/site/eventos/congresso-brasileiro-de-saude-coletiva/carta-de-salvador-abrascao-2022/70333/ - ABRASCO - ASSOCIAÇÃO BRASILEIRA DE SAÚDE COLETIVA. Estatuto da Associação Brasileira de Saúde Coletiva. Rio de Janeiro: Abrasco, 2019.
- ABRASCO - ASSOCIAÇÃO BRASILEIRA DE SAÚDE COLETIVA. Linha do tempo GT Trabalho e Educação na Saúde. Rio de Janeiro: Abrasco , 2014. Disponível em: <Disponível em: https://www.Abrasco.org.br/site/gttrabalhoeeducacaonasaude/wp-content/uploads/sites/8/2014/05/Gt-trabalho-e-educa%C3%A7%C3%A3o.png >. Acesso em: 24 abr 2023.
» https://www.Abrasco.org.br/site/gttrabalhoeeducacaonasaude/wp-content/uploads/sites/8/2014/05/Gt-trabalho-e-educa%C3%A7%C3%A3o.png - ABRASCO - ASSOCIAÇÃO BRASILEIRA DE SAÚDE COLETIVA. Regimento interno da Associação Brasileira de Saúde Coletiva. Rio de Janeiro: Abrasco , 2018.
- BELISÁRIO, S. A. Associativismo em saúde coletiva: um estudo da Associação Brasileira de Pós-graduação em Saúde Coletiva - ABRASCO. 2002. 401 f. Tese (Doutorado em Saúde Coletiva) - Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, 2002.
- INESC - INSTITUTO DE ESTUDOS SOCIOECONÔMICOS. A conta do desmonte: balanço do orçamento geral da União 2021. Brasília, DF: Inesc, 2021.
- MAGNAGO, C.; MARTINS, C. L. Crises contemporâneas: retrocessos sociais, políticas de saúde e desafios democráticos. Saúde e Sociedade, São Paulo, v. 32, n. 1, p. 1-10. 2023. DOI: 10.1590/S0104-12902023230228pt
» https://doi.org/10.1590/S0104-12902023230228pt - NUNES, E. D. Prefácio. In: LIMA, N. T.; SANTANA, J. P.; PAIVA, C. H. A. (Org.). Saúde coletiva: a Abrasco em 35 anos de história. Rio de Janeiro: Fiocruz, 2015. p. 9-14. DOI: 10.7476/9788575415900
» https://doi.org/10.7476/9788575415900 - PINTO, I. C. M. A interlocução com as instituições acadêmicas e os órgãos gestores da política de saúde. Ensaios & Diálogos em Saúde Coletiva, Rio de Janeiro, n. 4, p. 15-16, jun. 2017.
- 1The 1st Symposium was held in Natal, in 2017, on the occasion of the 3rd Abrasco Congress on Health Policy, Planning and Management; the II Symposium took place in Rio de Janeiro, in 2018, as part of the 12th Brazilian Congress on Collective Health; and the III Symposium took place in 2022, in Salvador, as an activity prior to the 13th Brazilian Congress on Collective Health.
- 2This proposal was forwarded in December 2022 to the Government Transition Commission of the current Federal Government - President Luís Inácio Lula da Silva and Vice-President Geraldo Alckmin.
- Authors’ contributionThe Health Work and Education TG of the Brazilian Association of Collective Health was responsible for all stages related to the elaboration of this document.
Publication Dates
- Publication in this collection
19 Jan 2024 - Date of issue
2023
History
- Received
31 July 2023 - Accepted
31 July 2023
