Political action analysis of the Brazilian Health Care Reform Movement in the COVID-19 pandemic: 2020- 2021

Abstract

The aim of this study is to analyze the political action of the Brazilian Health Care Reform Movement (MRSB, Movimento da Reforma Sanitária Brasileira), particularly Cebes and Abrasco, during the COVID-19 pandemic. The data were obtained through the documental review of publications from the abovementioned entities, which describe their positions on government actions implemented between January 2020 and June 2021. The results show that the performance of these entities included several actions, most of them reactive and critical of the Federal Government’s role in the pandemic. Moreover, they led the creation of “Frente pela Vida”, an organization that brought together several scientific entities and civil society organizations, whose highlight was the preparation and dissemination of the “Frente pela Vida Plan”, a document that contains a comprehensive analysis of the pandemic and its social determinants, as well as a set of proposals to face the pandemic and its effects on the population’s living and health conditions. It is concluded that the performance of the MRSB entities reveals alignment with the original project of the Brazilian Health Care Reform (RSB, Reforma Sanitária Brasileira), emphasizing the relationship between health and democracy, the defense of the universal right to health and the expansion and strengthening of the Brazilian Unified Health System - SUS (Sistema Único de Saúde).

Key words:
Politics; COVID-19; Health care reform; Unified Health System

Resumo

O objetivo deste trabalho é analisar a ação política do Movimento da Reforma Sanitária Brasileira (MRSB), notadamente Cebes e Abrasco, face à pandemia de COVID-19. As informações foram obtidas por meio de revisão documental de publicações das referidas entidades, que apresentam seus posicionamentos diante das ações governamentais implementadas entre janeiro de 2020 e junho de 2021. Os resultados evidenciam que a atuação dessas entidades incluiu ações diversas, em sua maioria reativas e críticas à atuação do governo federal na pandemia. Além disso, protagonizaram a criação da Frente pela Vida, organização que reuniu várias entidades científicas e organizações da sociedade civil, e cujo destaque foi a elaboração e difusão do “Plano Nacional de Enfrentamento à Pandemia de Covid-19”, documento que contém uma análise abrangente da pandemia e suas determinações sociais, bem como um conjunto de proposições para o enfrentamento da pandemia e dos seus efeitos sobre as condições de vida e saúde da população. Conclui-se que a atuação das entidades do MRSB revela alinhamento com o projeto original da RSB, enfatizando as relações entre saúde e democracia, a defesa do direito universal à saúde e a expansão e fortalecimento do SUS.

Palavras-chave:
Atividade política; COVID-19; Reforma do setor saúde; Movimento Sanitário; SUS

Introduction

The health crisis caused by the COVID-19 pandemic, considered to date the greatest health challenge of this century¹, has exacerbated the political, economic, social and environmental crisis into which the country has plunged in recent years² and has given visibility to a serious institutional crisis in the scope of the federal government, displayed as tensions and conflicts around the strategies for coping with and controlling the pandemic. The evolution of the COVID-19 pandemic in the country was therefore a real tragedy, measured by the excess of cases and deaths, the deterioration of living conditions for large numbers of the population, and the uncertainty regarding the immediate future.

These multiple crises intensified the political antagonism, which had already been taking shape for several decades, between the representatives of the ultra-neoliberal, authoritarian and conservative project and the political and social forces that defend a democratic project for Brazilian society³. In this context, also marked by the dismantling of previously constructed public policies, the issue of the relationship between health and democracy was placed at the center of the political debate, intensifying the confrontation between political actors placed in government institutions and civil society organizations and entities, in several areas of public policies such as economy, education, health, environment and culture.

The Observatory of Political Analysis in Health (OAPS, Observatório de Análise Política em Saúde), of which headquarter is located at the Collective Health Institute of Federal University of Bahia (Instituto de Saúde Coletiva da Universidade Federal da Bahia, ISC-UFBA - http://www.analisepoliticaemsaude.org/oaps) has been monitoring, on a weekly basis, the pronouncements, news and documents published on official websites and in civil society organizations and entities, aiming to write a follow-up matrix of the main political facts that characterize this circumstance. Seeking to go beyond the description of the facts, according to the actors who carried them out and the effects they triggered during the course of the pandemic, we set out to investigate the political action of the Brazilian Health Care Reform Movement (MRSB, Movimento da Reforma Sanitária Brasileira), thus aiming to analyze it in the light of dimensions and categories proposed by Gohn⁴ for the study of social movements, especially the identification of the political project for health defended by the movement, the types of organization and the actions carried out in the period of 2020-2021.

Therefore, the present study deals with the hypothesis that tensions and conflicts between government actors and institutions and civil society organizations and entities linked to the MRSB during the pandemic have once again demonstrated the dispute between political projects for health, which has been developing over the last 46 years, since the health democratization project that originated from the MRSB in the 1970s in the last century, which defends the universal right to health, values the Brazilian Unified Health System (SUS, Sistema Único de Saúde) and proposes the strengthening of comprehensive care health for the population⁵, has been facing, in different political circumstances, the mercantilist, or liberal-conservative project. The latter considers health as a commodity, and therefore, defends the expansion of the private sector of medical-hospital assistance and foresees the configuration of a “SUS for the poor”, or a “reduced” SUS², in which more complex services are included, even under private management through social organizations or of public-private partnerships⁶.

During the course of the COVID-19 pandemic, this clash was present within SUS itself, insofar as the assistance network directly linked to the private sector proved to be inefficient in dealing with the clientele linked to health plans and insurance, so that it fell to the public sector, especially, to invest in actions to control the pandemic and provide assistance to the cases of COVID-19⁷. In this context, the absence of integrated planning between the different spheres of SUS management was observed, as well as lack of coordination and conflicts between the Federal Government (FG) and state and municipal governments⁸, in parallel with the mobilization of the scientific community in the health field⁹, of the media and civil society organizations.

The aim of this study is to analyze the political actions of the main entities of the MSRB during the pandemic, namely, the Brazilian Center for Health Studies (Cebes, Centro Brasileiro de Estudos de Saúde) and the Brazilian Association of Collective Health (Abrasco, Associação Brasileira de Saúde Coletiva), selected due to the leadership they exercise in the articulation of the health movement from its inception to the most recent period, in an attempt to characterize the political project for health that underlies the MRSB decisions and actions, as part of the dispute for the hegemony of different political projects for health and for the Brazilian society in the current situation.

Methodology

This study comprises an analysis of the political process in health^10,11, focusing on the actions of MRSB entities and the clashes between them and government institutions, in the period between January 2020, when the World Health Organization (WHO) decreed a global emergency due to the coronavirus, to June 2021, when Brazil recorded 500,000 deaths from COVID-19.

The analysis of the political actions of the MRSB entities was carried out based on categories systematized by Gohn⁴ for the study of social movements, namely: composition, which refers to the identification of the set of entities and subjects that constitute it; sociopolitical project, the set of principles and guidelines that join them; and, finally, organization and practices, that is, the way in which it organizes and acts in the current situation, through formal and informal practices concerning its several opponents.

The production of information was carried out through a literature search of articles, publications and texts that analyze the evolution of the pandemic and the official positions of Cebes and Abrasco in the specified period. As a complement, excerpts from interviews carried out with the heads of the aforementioned entities, in office during the cited period, were used, which are part of an ongoing research approved by the Research Ethics Committee of the ISC-UFBA according to protocol number 50945621.8.0000.503012¹².

The analysis of the information included the characterization of the articulation process of the Brazilian Health Care Reform (RSB, Reforma Sanitária Brasileira) entities, their political project and actions carried out during the pandemic. In this sense, we aimed at describing the organization process of the “Front for Life” (FPV, Frente Pela Vida) and characterizing the political project for health to which the proposals prepared by the entities of the MRSB and the FPV are associated. Then, the actions carried out by these entities were analyzed, seeking to identify the type of action and the nature of their political positioning in the face of the performance of governmental instances, especially the Federal Government (FG), in addition to indicating the reactive, critical and/or propositional characteristic of the documents and the content of rejection or support for decisions and actions taken in the different government spheres.

Results

Considering the previously defined categories of analysis, the results related to the entities’ activities will be presented in three sub-items: a) the FPV organization process based on the mobilization of Cebes and Abrasco within the scope of the National Health Council (CNS, Conselho Nacional de Saúde); b) sociopolitical project for health, updated, expanded and redefined by Cebes, Abrasco and FPV, based on the analysis and creation of proposals to fight the pandemic; c) actions carried out by Cebes, Abrasco and FPV in the period of 2020-2021, aiming to contribute to the debate about the fight against the COVID-19 pandemic.

Cebes and Abrasco actions and the organization of Front for Life (FPV, Frente Pela Vida)

Since March 2020, Cebes and Abrasco, together with scientific entities and other civil society organizations, have taken a critical position regarding the FG’s role in the pandemic and have prepared alternative proposals, aimed at supporting the decisions and actions of subnational governments, as well as informing the general population about the best practices to be adopted during the pandemic period. This dialogue process with different civil society actors, as well as with governmental bodies, resulted in the organization of a large “coalition” of political subjects interested in facing the health crisis, having as its starting point the creation of the “Pact for Life and for Brazil”, launched on April 7, 2020 by the Brazilian Society for the Progress of Science (SBPC, Sociedade Brasileira para o Progresso da Ciência), the National Bar Association of Brazil (OAB, Ordem dos Advogados do Brasil), the Brazilian Press Association (ABI, Associação Brasileira de Imprensa), the National Conference of Brazilian Bishops (CNBB, Conferência Nacional dos Bispos do Brasil), the Brazilian Academy of Sciences (ABC, Academia Brasileira de Ciências) and the Dom Paulo Evaristo Arns Commission for the Defense of Human Rights (Comissão de Defesa dos Direitos Humanos Dom Paulo Evaristo Arns). This document was endorsed by another 100 civil society entities, including Cebes and Abrasco, and already pointed out the need for close collaboration between civil society and the political class (sic), between economic agents, researchers and entrepreneurs in a combination of efforts aiming at a response to COVID-19¹³.

Inspired by this experience, the group comprising representatives from Cebes, Abrasco, Rede Unida and SBB, which were part of the CNS, alternately occupying the positions of holder, first and second alternate members in the segment of national entities of health professionals/scientific community in the health area, initiated an articulation that culminated in the creation of the FPV. These four entities had, since 2018, formed a collegiate aiming at sharing discussions and positions on the topics discussed at the CNS, holding regular meetings, which favored the strengthening of relations between its members and the development of joint political actions.

The four abovementioned collective health entities (Abrasco, Cebes, Rede Unida, SBB) joined the CNS and later mobilized other national entities (SBPC, CNBB, National Association of Heads of Federal Institutions of Higher Education - Andifes and ABI) to join a meeting in which they discussed joint action strategies in the face of the pandemic. At that meeting, the respective heads decided, by consensus, that the movement that was starting should be called “Front for Life” and would adopt as principles and guidelines, the right to life, the establishment of measures to prevent and control the COVID-19 pandemic, the defense of SUS, solidarity with the most vulnerable groups, in particular, the preservation of the environment and biodiversity, and finally, the defense of democracy and respect for the Federal Constitution of 1988^9,14,15.

The official release of the FPV took place at an online conference held on May 29, 2020, which was attended by leaders of the founding entities and representatives of several invited entities, who highlighted the importance of the initiative, inviting the organized sectors of the society to join the Front, in defense of democracy, the Brazilian Constitution, human rights, the rule of law and the SUS^13-15. This event, broadcast on the Abrasco TV Channel, on YouTube (https://www.youtube.com/watch?v=AX7fg_WNiC4), was shared in the media of the other entities, thus achieving wide simultaneous viewing.

After the release, other scientific health entities joined the movement, such as the Brazilian Association of Health Economics (ABRES, Associação Brasileira de Economia da Saúde), São Paulo Association of Public Health (APSP, Associação Paulista de Saúde Pública), Brazilian Association of Physicians for Democracy (ABMMD, Associação Brasileira de Médicas e Médicos pela Democracia), National Network of Popular Doctors (RNMMP, Rede Nacional de Médicas e Médicos Populares), the Brazilian Association of Nursing and several others. Subsequently, on June 9, 2020, the FPV held the first Virtual March for Life, which had the support of more than 500 entities, in addition to social movements, artists, activists and intellectuals^13,14, thus adding new members, and in 2021, the Front already had more than 560 scientific entities and organizations representing different segments of civil society, such as women, black population, LGBTQIA+, indigenous peoples, urban and rural workers, professionals, students, teachers, SUS users and instances of the social control of SUS, in addition to representatives linked to different religious denominations¹⁴.

Cebes, Abrasco and FPV sociopolitical project for health

The sociopolitical project defended by Cebes, Abrasco and FPV during the analyzed period (2020-2021), is based on the “ideological paradigm”⁴ of the RSB¹⁶, that is, in defense of democracy and the universal right to health, materialized in the proposed construction of the SUS, according to the principles and guidelines that were preserved in the Federal Constitution (FC) of 1988.

In the pandemic context, this paradigm inspired the creation of specific proposals regarding emerging problems, such as the “Guidelines for fighting the pandemic in urban peripheries, slums and along with vulnerable social groups”¹⁷, which had the support of 80 entities from the most diverse sectors of civil society, and the manifesto “Occupy the schools, protect the people, value education”¹⁸, signed by 40 health and education entities, voicing a position that was contrary to the relaxation of sanitary restrictions in the school network of the Brazilian states in a critical moment of the pandemic, a process led by Abrasco and the National Association of Postgraduate Studies and Research in Education (ANPED, Associação Nacional de Pós-Graduação e Pesquisa em Educação).

The document that most broadly expresses the sociopolitical project of the FPV is, however, the “National Plan to Fight the COVID-19 Pandemic”, launched in July 2020¹⁹. According to the presidents of Abrasco and Cebes, the process of preparing the plan included the drafting of a preliminary version, by members of the several Abrasco working groups, under the coordination of one of the entity’s vice-presidents, who subsequently received contributions from the other FPV entities.

The plan initially presents an epidemiological overview of the evolution of the COVID-19 pandemic in Brazil, incorporating, in its analysis, the social determination of the health-disease process, therefore highlighting the economic and social inequality of the living conditions of the Brazilian population, and gender and racial/ethnic inequalities, as an aggravating factor in the health crisis, which translates, within the scope of the proposals, into the recognition of the priority needs of vulnerable populations and the emphasis on measures of social protection and health promotion, aiming to attenuate the pandemic effects¹⁹.

The analysis of the set of proposals contained in this document shows that, overall, they are aligned with the original sociopolitical project of the RSB²⁰ and incorporate problems and requests that have gained greater visibility due to the dynamics of contemporary social movements, such as of women’s, black people’s, and indigenous population’s movements¹⁹, as well as incorporating the recognition of environmental problems, in the country and in the cities. This reveals the interest of the MRSB leaderships in “updating” the original project considering changes in the economic, political, social and environmental scenario worldwide and in Brazil, incorporating, on the one hand, the advancement of scientific knowledge in the field of collective health, and, on the other hand, the recognition of the plurality of collective political subjects in movement, with their agendas, requests and claims.

From this perspective, the chapter dedicated to SUS incorporates the set of analyses about the chronic problems and acute challenges faced by the system during the pandemic, such as underfunding/defunding, privatization of management, the precariousness of health work, topics that have been the subject of several studies and research. Moreover, it presents several proposals that rescue the defense of constitutional SUS and indicate strategies for the resumption of the direction foreseen in its legal bases and for the strengthening of essential policies and programs to face the pandemic and the negative effects on the population’s health, which were potentialized by pandemic, thus emphasizing actions of Health Promotion and Surveillance, expansion and improvement of primary care quality and the expansion of the industrial health complex¹⁹.

The “National Plan to Fight the COVID-19 Pandemic” was delivered to the Ministry of Health by the presidents of collective health entities and CNS, being received by the secretaries of Primary Health Care and Science, Technology and Strategic Inputs of the Ministry of Health, in a virtual meeting held in July 2020, which was also attended by the president of CONASS. This document was also delivered to the legislators of the House of Representatives in a public hearing held in the following month²¹. The plan is available for consultation on the entities’ websites, aiming to support the continuity and extension of the debate on the pandemic, which is still ongoing, and the action strategies of the Government and the society in defense of health and life.

Actions carried out by CEBES, ABRASCO and FPV

The performance of Cebes and Abrasco during the pandemic took place through different actions carried out both alone and together with other entities, especially after the creation of the FPV (a general overview of these initiatives is depicted in Chart 1). This multiplicity of actions can be further subdivided in terms of characteristics into two types, reactive and propositional. The first type was predominant and mainly reflected the criticism of the Government’s actions/omissions in health policy conduction regarding the COVID-19 pandemic, while the second type reflected the proposal of actions for the adequate fight against the pandemic^13,14,22.

Chart 1
Actions carried out by Cebes, Abrasco and FPV during the 2020-2021 period, distributed by type and topic.

Actions	Type/Topic
Preparation of documents and other materials	. Notes of repudiation to the president’s actions and statements
	. Letters (addressed to the health authorities, requesting the implementation of a series of emergency measures in the economic and social sphere, and to the Brazilian people in defense of a vaccine for all, the return of emergency aid, more resources for the SUS and ‘Fora Bolsonaro’(“Out with Bolsonaro”’)
	. Analyses, documents and proposals on specific topics (defense of the rights and needs of vulnerable groups) and broader plans to fight COVID-19
	. Positions on different topics
	. Related to the pandemic (Requests for revision and/or revocation of documents/ordinances/decisions such as the Clinical Management Manual and the National Vaccination Plan, among others; Contrary to the reduction of the health budget and funding of ICU beds, to the presidential veto to provisions of the Emergency Plan to Fight COVID-19 in Indigenous Territories, quilombola communities and other traditional peoples and communities, to the changes implemented in the epidemiological monitoring Panel, to the revocation of the inclusion of COVID-19 in the List of Work-Related Diseases, the late launching of the National Vaccination Plan against COVID-19, the omission related to the lack of medication necessary for the sedation of intubated patients and the permission to hold the ‘Copa América’ soccer championship; and in solidarity with the lives lost in the pandemic, among others
	. Regarding the SUS and the Education, Science, Technology and Innovation Systems (rejection of the Creation of ADAPS, the military occupation of the Ministry of Health, the National Special Education policy, the ordinance that creates additional barriers for access to the abortion procedure provided according to the law and the regulation of the embracement of adolescents in therapeutic communities; contrary to the Constitutional Amendment (CA) 95, the reduction of the contribution of resources for the aforementioned systems, the threats to the exercise of the autonomy of the universities and the freedom of teachers and researchers, to the dismantling of the Psychosocial Care Network and the uncoupling of the health and education budget) among others. . Recommendations, Motions and Guidelines (produced by CNS on several topics related to the COVID-19 pandemic) . The Comunica SUS Project (04 Radio plays with visual material about COVID-19 and SUS)
Virtual public acts	. National act of the campaign in defense of the SUS (held on December 15, 2020 with the release of the letter: “Brazil Needs the SUS - Letter to the Brazilian People”) . An ‘Act for health, life and democracy’ (held in March 2021, when the country reached new peaks in cases and deaths from COVID-19, in addition to the saturation of the maximum capacity of health networks in several municipalities)
	. Facing hunger with the strength of our struggles’ (held in April 2021, in view of the increase in hunger and poverty in Brazil due to the pandemic)
	. Virtual Marches for Life (with a significant participation of more than 500 entities, institutions and organizations from all sectors, in addition to artists. The program included local/regional activities and debates transmitted on social networks)
	. June 2020 (defense of the adoption of effective measures to face the pandemic)
	. June 2021 (against the federal government’s failure to face the pandemic, in defense of life and the SUS)
Virtual manifestations	. “Tweetathons” using the hashtag #MarchForLife
	. Real-time demonstrations via the Manif.app application
Street manifestations	On May 29 and June 19, 2021 (defense of the guarantee of rapid vaccination for the entire population, emergency aid of BRL 600.00 until the end of the pandemic and the impeachment of the president of the Republic)
Campaigns	. “Beds for all”
	. ‘In defense of the SUS’ . ‘Protection of workers in essential services’
Conduction of Webinars	Dialogues and debates with different audiences, involving guests from the scientific community, managers and former Ministers of Health, on the most diverse aspects of the COVID-19 pandemic: . Cebes (‘Cebes Debate’, Lives) . Abrasco (Agora’, Colloquia) . United Network (Debates, panels, interviews, conversation circles) . SBB (Lives, Round Tables, Classes, Seminars and Debates)
Activation of the Legislative power	. Sending of letters addressed to the National Congress in defense of the SUS, for the repeal of CA 95 and for the lives of indigenous peoples, quilombolas, artisanal fishermen and other traditional communities and peoples
	. Hearings with progressive legislators from the House of Representatives in which the National Plan to Fight the COVID-19 Pandemic, produced by the FPV, and the manifest against Emergency PEC 186 were presented
	. Contribution in authoring an impeachment request against the President of the Republic filed in the Senate
Activation of the Judiciary	Defense of democratic principles, suspension of the effects of CA 95 on the Immunization Plan against COVID-19, against PEC 186, which proposed the uncoupling of health and education budgets (with the extinction of the mandatory minimum amount for investment in both areas) and the adoption of strict restrictive measures at the peak of cases in March 2021.

• Source: Authors.

The production of documents was extensive and diversified, thus constituting the most frequent action carried out by the entities (Chart 1). As for the first type, i.e., the notes of repudiation, their orientation was identified, for the most part, as regarding the actions and statements by the President of the Republic, whose attitude in the face of the pandemic was characterized as an illicit (crime) of responsibility and genocide, pointed out by entities as sufficient reason for his impeachment, considered an immediate task to face the current crisis¹³. Through letters, the MRSB entities appealed to the other health authorities, for an adequate confrontation of the pandemic, and to the Brazilian people, to adhere to the health measures and defend the SUS.

The preparation of analyses, documents and proposals on specific topics related to the health needs of specific groups, such as indigenous populations, homeless people and the LGBTQIA+ populations are examples of propositional actions, also contained in the “National Plan to Fight the Covid Pandemic-19” by the FPV^13,21. Short documents included solidarity manifestations with the thousands of lives lost due to the federal government’s omission, and joint actions with CONASS and CONASEMS, such as the criticism of the risk matrix for the flexibilization of social distancing in the country produced by the Ministry of Health and the support of the FPV to the “National Pact for Life and Health”, signed by 21 of the country’s 27 governors in response to the FG’s omission in the face of the pandemic^13,14.

The MRSB entities also took a stand against the actions carried out by the FG during the pandemic period that contributed to the dismantling of the areas of Health, Education and Science and Technology, which also contributed to the worsening of the pandemic in the country²³. They also took a stand against the implementation of the Agency for the Development of Primary Health Care (ADAPS, Agência para o Desenvolvimento da Atenção Primária à Saúde), against the dismantling of the Mental Health Policy and the changes in the National Policy on Drugs and several other political-legal changes against the Brazilian Psychiatric Reform, in addition to denouncing setbacks in the field of sexual and reproductive rights.

Many of the previously mentioned topics were also pointed out by Cebes, Abrasco and FPV in the virtual acts promoted by other entities, in the virtual Marches for Life carried out by the FPV, in the virtual campaigns and street demonstrations resumed, with restrictions, in May 2021^13,14,22.

The entities also promoted several editions of webinars, which allowed dialogues and debates on different aspects of the COVID-19 pandemic, with different audiences, involving guests from the scientific community, managers and former ministers of Health. These events conveyed reliable and scientifically-based information, in an attempt to face the “fake news and disinformation campaigns stimulated and disseminated by political actors in the context of this pandemic”^13,21.

Finally, the entities activated the other powers of the Republic, appealing for the adoption of effective measures to control the COVID-19 pandemic in the country and highlighted the important role of the Parliamentary Inquiry Committees (CPIs, Comissões Parlamentares de Inquérito) in determining responsibility for preventable cases and deaths that occurred during the pandemic, when Cebes created, together with several other entities, the request for impeachment of the president of the republic that was presented to the Senate^13,14,22.

In view of the abovementioned facts, the incorporation of new technologies and information and communication tools to the organization and political action of the MRSB entities during the COVID-19 pandemic stands out, with increased use of social networks, digital media (websites, blogs, podcasts, video channels) and messaging applications for the dissemination of their documents (texts, podcasts, videos, among others) and events. Therefore, virtual meeting and streaming platforms were widely used in public events transmitted in real time over the internet to viewers anywhere in the world, whose recordings were made available for later access. Also noteworthy are new forms of virtual mobilization through specific applications (such as Manif.app), “Tweetathons” (coordinated posts on specific dates and times with the use of certain hashtags, aiming to place a topic at the top of the list of most commented topics), campaigns in social networks and media (encouragement to post texts, audios or videos).

Discussion and conclusions

The RSB process over the last 40 years²⁴ has alternated periods of greater or lesser social mobilization, observing, however, the permanence of the political protagonism of Cebes, a collective subject that has periodically updated its theses²⁵, due to changes in the circumstances. Abrasco, in turn, has invested mainly in expanding and consolidating the field of collective health²⁶, especially regarding its scientific dimension, in the several areas and subareas of knowledge, however, without disregarding the taking of a position regarding health policy directions, through its participation in the construction of the agendas of the MRSB^13,27.

In the current situation, marked by an intense setback in public and health policies in particular²⁸, the emergence of the COVID-19 pandemic, simultaneously configured as a problem and an opportunity, or rather, a need to reactivate the political debate about the role of the Government and social responsibility in the health field, as well as requiring adaptation and creativity from civil society organizations. From this perspective, Cebes and Abrasco experimented with new forms of political articulation and intensified the use of information and virtual communication mechanisms that ensured the continuity and even the amplification of activism, given the limitations imposed by social distancing measures. Thus, they managed to build a broad articulation with several entities from the most diverse areas - health, education, science and technology, environment, communication, law - establishing a new collective political subject, the Front for Life.

Hence, the historical opportunity/necessity created by the COVID-19 pandemic constitutes a new turning point in the RSB process, insofar as, in order to respond to the complexity of the pandemic phenomenon²⁹ and the threats to democracy and previously attained social rights, the MRSB was challenged to reinvent itself, mobilizing historical activists linked to Cebes, Abrasco and other FPV entities, as well as old and new subjects linked to professional health associations, intellectuals in the field of collective health, leaders of identity movements, ultimately, a plurality of activists who have in common their commitment to the fight for democracy and the defense of life.

As a result, the sociopolitical project of the MRSB has been updated and expanded, with the incorporation of new topics and proposals, such as meeting the health needs of specific population groups and minorities, defending and protecting the environment, the critical analysis of the financialization of healthcare, and, above all, the need to rethink the strategies for strengthening the SUS and restructuring the Government and mobilizing the Brazilian society to face the tragic effects of the economic and social crisis exacerbated by the pandemic.

The FPV played a leading role in the defense of a 100% public, universal, integral and quality SUS, and, following the historic commitment of health reform entities, mobilized representatives of the critical aspect of collective health, also producing an understanding of the determinants of the pandemic and of coping strategies, which highlights the limits of biomedical, clinical and hospital-centric care, and even of institutionalized Public Health actions, indicating the need to adopt an expanded perspective of Health Surveillance³⁰, articulated to a set of intersectoral policies that contribute to improve the living conditions of the population. Moreover, it strained relations between civil society organizations and the FG, adding to a growing process of popular dissatisfaction with the current government’s actions at the beginning of the pandemic (2020-2022), contributing to highlight its incompetence, denialism and authoritarianism, largely responsible for the extent of the crisis related to the absence of health promotion measures, specific protection, surveillance and control³¹.

Considering the challenges to the guarantee of the right to health in Brazil, evidenced by the setback through which the RSB² is going, and also in the strengthening of the private sector and capital in the health area⁵, in addition to the weakening of the SUS over the more than three decades since its implantation^2,32, it is objectively necessary to recognize that the sociopolitical project of the MRSB remains subordinate to the mercantilist, liberal-conservative project, which has even become stronger during the pandemic. However, the analysis of the performance of the movement’s entities in this period indicates the possibility of moving forward in the fight against the ultra-neoliberal project in action, signaling a possible way of revitalizing the “socio-community pathway”², by mobilizing political party, institutional, and trade union leaders and diverse social movements (women’s, LGBTQIA+, black people’s, indigenous people’s, landless workers’, workers’, etc.), as well as legislators linked to progressive parties and leaders of the Judiciary.

Therefore, it should be recognized that the radicalization of the counter-reforms and the threats to democracy in the most recent circumstances have motivated the growth of mobilization, articulation and organization of the democratic and popular sectors, with an expansion of requests and fight for other constructions of rights, among which, the fight for the Right to Health remains, the resistance in defense of the SUS and the participation in the debate on the reconstruction of the government and the consolidation of democracy.

Referências

• ¹
  Roser M, Ritchie H, Ortiz-Ospina E, Hasell J. Coronavirus Pandemic (COVID-19) [Internet]. 2020. [cited 2022 jul 10]. Available from: https://ourworldindata.org/coronavirus
  » https://ourworldindata.org/coronavirus
• ²
  Paim JS. A covid-19, a atualidade da reforma sanitária e as possibilidades do SUS. In: Santos A, Lopes LT, organizadores. Reflexões e futuro. Brasília: CONASS; 2021. p. 310-324.
• ³
  Souza Neto CP. Democracia em crise no Brasil: valores constitucionais, antagonismo político e dinâmica institucional. São de Paulo: Editora Contracorrente; 2020.
• ⁴
  Gohn MG. Teorias dos movimentos sociais: paradigmas clássicos e contemporâneos. São Paulo: Loyola; 2014.
• ⁵
  Souza LEPF, Paim JS, Teixeira CF, Bahia L, Guimarães R, Almeida-Filho N, Machado CV, Campos GW, Azevedo-e-Silva G. Os desafios atuais da luta pelo direito universal à saúde no Brasil. Cien Saude Colet 2019; 24(8):2783-2792.
• ⁶
  Romano CMC, Scatena JHG, Kehrig RT. Articulação público-privada na atenção ambulatorial de média e alta complexidade do SUS: atuação da Secretaria de Estado de Saúde de Mato Grosso. Physis 2015; 25(4):1095-1115.
• ⁷
  Scheffer M, Bahia L. Planos e seguros de saúde privados na pandemia de covid-19 no Brasil. In: Santos AO, Lopes LT, organizadores. Planejamento e gestão. Brasília: CONASS; 2021. p. 256-270.
• ⁸
  Lima LD, Pereira AMM, Machado CV. Crise, condicionantes e desafios de coordenação do Estado federativo brasileiro no contexto da COVID-19. Cad Saude Publica 2020; 36(7):e00185220.
• ⁹
  Souto LRF, Travassos C. Plano Nacional de Enfrentamento à Pandemia da Covid-19: construindo uma autoridade sanitária democrática. Saude Debate 2020; 44(126):587-589.
• ¹⁰
  Paim JS. Pósfacio - Análise política em saúde: um pensamento estratégico para a ação estratégica. In: Federico L. Análise política em saúde: a contribuição do pensamento estratégico. Salvador: EDUFBA; 2015. p. 279-286.
• ¹¹
  Esperidião MA. Análise política em saúde: síntese das abordagens teórico-metodológicas. Saude Debate 2018; 42(Esp. 2):341-360.
• ¹²
  Santos JS. Movimento da Reforma Sanitária Brasileira na conjuntura 2013-2020: posicionamentos e formas de atuação [tese]. Salvador: Universidade Federal da Bahia; 2020.
• ¹³
  Associação brasileira de Saúde Coletiva (Abrasco). Posicionamentos oficiais [Internet]. 2021. [acessado 2021 jun 21]. Disponível em: https://www.abrasco.org.br/site/categoria/noticias/posicionamentos-oficiais-abrasco/
  » https://www.abrasco.org.br/site/categoria/noticias/posicionamentos-oficiais-abrasco
• ¹⁴
  Frente pela Vida (FPV). 2021. [acessado 2021 jun 21]. Disponível em: https://frentepelavida.org.br/
  » https://frentepelavida.org.br
• ¹⁵
  Sociedade Brasileira para o Progresso da Ciência (SBPC). Lançada a Frente pela Vida [Internet]. 2020. [acessado 2021 jun 21]. Disponível em: http://portal.sbpcnet.org.br/noticias/lancada-a-frente-pela-vida/
  » http://portal.sbpcnet.org.br/noticias/lancada-a-frente-pela-vida
• ¹⁶
  Paim JS. Sistema Único de Saúde (SUS) aos 30 anos. Cien Saude Colet 2018; 23(6):1723-1728.
• ¹⁷
  Abap, Abong, Abramd, Abres, AGB, Anpur, Anparq, ARL, Atua Porto Alegre, BR Cidades, Cebes. O combate à pandemia Covid-19 nas periferias urbanas, favelas e junto aos grupos sociais vulneráveis: propostas imediatas e estratégias de ação na perspectiva do direito à cidadania e da justiça social [Internet]. 2020. [acessado 2021 jun 21]. Disponível em: https://www.observatoriodasmetropoles.net.br/wp-content/uploads/2020/04/Documento-pol%C3%ADtico-unificado-vFINAL-3.pdf
  » https://www.observatoriodasmetropoles.net.br/wp-content/uploads/2020/04/Documento-pol%C3%ADtico-unificado-vFINAL-3.pdf
• ¹⁸
  ABdC, Aben, Abrasco, Abrastt, Abres, Andifes, Anped, Cebes. Manifesto "Ocupar escolas, proteger pessoas, valorizar a educação" [Internet]. 2020. [acessado 2021 jun 21]. Disponível em: https://www.abrasco.org.br/site/wp-content/uploads/2020/10/MANIFESTO-_OCUPAR-ESCOLAS-PROTEGER-PESSOAS-RECRIAR-A-EDUCACAO_2-1.pdf
  » https://www.abrasco.org.br/site/wp-content/uploads/2020/10/MANIFESTO-_OCUPAR-ESCOLAS-PROTEGER-PESSOAS-RECRIAR-A-EDUCACAO_2-1.pdf
• ¹⁹
  Abrasco, Cebes, Rede Unida, Abres, Abrasme, Abrastt, Aben, SBV, SBB, CNS, SBMT, Sobrasp, RMMP, ABMMD, SBMFC. Plano Nacional de enfrentamento à pandemia da Covid-19 - Versão 3 [Internet]. 2020. [acessado 2021 jun 21]. Disponível em: https://frentepelavida.org.br/uploads/documentos/PEP-COVID-19_v3_01_12_20.pdf
  » https://frentepelavida.org.br/uploads/documentos/PEP-COVID-19_v3_01_12_20.pdf
• ²⁰
  Paim JS. Reforma Sanitária Brasileira: contribuição para a compreensão e crítica. Salvador, Rio de Janeiro: EDUFBA/Fiocruz; 2008.
• ²¹
  Conselho Nacional de Saúde (CNS). Plano Nacional de Enfrentamento à Covid-19, construído pelas instituições que compõem a Frente pela Vida, foi entregue ao Ministério da Saúde e CONASS [Internet]. 2020. [acessado 2021 jun 21]. Disponível em: http://conselho.saude.gov.br/frente-pela-vida
  » http://conselho.saude.gov.br/frente-pela-vida
• ²²
  Centro Brasileiro de Estudos de Saúde (Cebes). Posicionamentos políticos [Internet]. 2021. [acessado 2021 jun 21]. Disponível em: http://cebes.org.br/categoria-documento/posicionamentos-politicos-do-cebes/
  » http://cebes.org.br/categoria-documento/posicionamentos-politicos-do-cebes
• ²³
  Aragão ES, Funcia FR. Austeridade fiscal e seus efeitos no Complexo Econômico-Industrial da Saúde no contexto da pandemia da COVID-19. Cad Saude Publica 2021; 37(9):00100521.
• ²⁴
  Virgens JHA, Teixeira CF. Reforma Sanitária Brasileira: uma revisão sobre os sujeitos políticos e as estratégias de ação. Saude Debate 2022. 46(133):534-550.
• ²⁵
  Centro Brasileiro de Estudos de Saúde (Cebes). Saúde é democracia, democracia é saúde [tese]. 2022. [acessado 2022 jun 21]. Disponível em: https://cebes.org.br/site/wp-content/uploads/2022/01/TESE-CEBES-2021-2022-SAUDE-E-DEMOCRACIA-DEMOCRACIA-E-SAUDE.pdf
  » https://cebes.org.br/site/wp-content/uploads/2022/01/TESE-CEBES-2021-2022-SAUDE-E-DEMOCRACIA-DEMOCRACIA-E-SAUDE.pdf
• ²⁶
  Vieira-da-Silva LM, Esperidião MA, Silveira AS, Paim JS. A construção do campo da Saúde Coletiva e as políticas de saúde - Contribuições da Revista Ciência & Saúde Coletiva. Cien Saude Colet 2020; 25(12):669-4680.
• ²⁷
  Associação Brasileira de Pós-Graduação em Saúde Coletiva (Abrasco), Associação Brasileira de Saúde Mental (Abrasme), Associação Brasileira Rede Unida (Rede Unida), Associação Paulista de Saúde Pública (APSP), Centro Brasileiro de Estudos de Saúde (Cebes), Conselho Federal de Medicina (CFM), Conselho Nacional de Secretarias Municipais de Saúde (Conasems), Sociedade Brasileira de Medicina de Família e Comunidade (SBMFC), Sociedade Brasileira para o Progresso da Ciência (SBPC). Agenda estratégica para a saúde no Brasil - 5 diretrizes de uma política de saúde 5 estrelas para pobres ou ricos [Internet]. 2011. [acessado 2021 jun 21]. Disponível em: https://www.abrasco.org.br/site/wp-content/uploads/2017/02/agendasus.pdf
  » https://www.abrasco.org.br/site/wp-content/uploads/2017/02/agendasus.pdf
• ²⁸
  Teixeira CFS, Paim JS. A crise mundial de 2008 e o golpe do capital na política de saúde no Brasil. Saude Debate 2018; 42(Esp. 2):11-21.
• ²⁹
  Almeida-Filho N. Modelagem da pandemia Covid-19 como objeto complexo (notas samajianas). Estud Av 2020; 34(99):97-118.
• ³⁰
  Teixeira C. Desafios da Vigilância em Saúde no momento atual. Epidemiol Serv Saude 2022; 31(2):e2022357.
• ³¹
  Duarte AM, César MRA. Negação da política e negacionismo como política: pandemia e democracia. Educ Realidade 2020; 45(4):e109146.
• ³²
  Cohn A, Gleriano JS. A urgência da reinvenção da Reforma Sanitária Brasileira em defesa do Sistema Único de Saúde. R Dir Sanit 2021; 21:e0012.

• Funding

  Financial support for the translation of the manuscript into English: Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).

Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva

Publication Dates

• Publication in this collection
  12 May 2023
• Date of issue
  May 2023

History

• Received
  30 June 2022
• Accepted
  12 Sept 2022
• Published
  14 Sept 2022