Taken as a gateway to the SUS, primary health care units have become the focus of the government’s Concession and Privatization Program, PPI (Investment Partnership Program). A decree including a primary health care policy in the interest of the program was published Tuesday (27) in the Official Gazette.
The measure generated a reaction from health experts and entities, who fear “privatization” in the area, which is now one of the pillars of the service in the public system.
The decree was signed by President Airair Bolsonaro (without a party) and Economy Minister Paulo Guedes. In practice, the text envisages studies “on partnerships with the private sector for the construction, modernization and operation of basic health care units”.
The idea of the government is to structure pilot projects for this type of partnership. The selection will be the responsibility of the Special Secretariat of the PPI in the Ministry of Economy – the decree does not mention the Ministry of Health.
А. sheet he doubted whether the portfolio of the initiative had been announced, but did not receive a response until the report was published.
According to JPI, the main point of the project is “to find solutions for a significant number of basic health units that have not been completed or are not operating in the country.” When asked who would be a counterpart to the private sector, the program says only that the measure is under analysis of possible “business models”.
“It is important to emphasize that the PPI will be to coordinate efforts in building business models, but the implementation of public policy will be carried out by the Ministry of Health. It is not about delegating the functions of the state to the private sector, but about improving the provision of services. services “, informs.
The agency also says it will work with the Ministry of Health and the BNDES to define project development guidelines, and then select municipalities and consortia “interested in these partnerships”.
“We are aware of the challenge of bringing more infrastructure and quality services to different municipalities in Brazil and we believe that the PPP model will be key to achieving the results that the population deserves,” also said in a note, PPI Special Secretary Martha Seillier.
There is still no estimate of how many units can be involved in these partnerships. Currently, the country has 44 thousand basic health units. THEY sheet he asked how many others have been detained or have not yet completed the work, but so far there has been no answer.
The possibility of opening space for the private sector in the construction and operation of these places, however, provoked a reaction from specialists and entities in the health field.
In a video released Tuesday, National Health Council President Fernando Pigata said he saw the measure as privatizing health facilities. According to him, the council is conducting an analysis of possible legal measures in the case.
For Gulnar Azevedo, president of Abrasco (Brazilian Public Health Association), the situation is “worrying”.
“Even though it is a pilot study, this is how things start. This is an open door for the deconstruction of the SUS. It is not known whether they will comply with the terms of the system,” she said, questioning the lack of government consultation. , health entities for the proposal.
A similar risk assessment is made by Ricardo Heinzelmann of the SBMFC (Brazilian Society of Family and Community Medicine), which brings together physicians working in primary care.
For him, the situation jeopardizes national policies that have taken place through primary health care – the Family Health case, which has helped reduce indicators of chronic illness and death in the country. “What would be the interest of the private sector to operate in this market array?” He asked.
“There is a risk of losing important family health activities, such as community access. “We are talking about a vulnerable population.”
Heinzelmann sees a difference in the proposal compared to the model of OSS (social health organizations) operating in part of the country.
“Operating systems do not build, while PPP goes further: this can be built and owned by that service. “There is more progress in the area of privatization when we talk about this logic,” he said.
When asked about the risks pointed out by the experts, the Ministry of Health did not answer.