The 15th National Conference on Health (CNS, its acronym in Portuguese) took place as an impressive ritual of participatory democracy. A celebration, a political mobilization, and a space of management. All at the same time, and mixed. Thousands of delegates discussing and acting on regimental procedures and on various aspects of the health policy. Moreover, the National Conference was the synthesis of a capillary process organized in a network, which involved more than a million people in regional and sectoral meetings, free confe-rences, and also local and state conferences.
The concrete exercise of a management approach in pursuit of direct democracy. A consistent effort to overcome the limitations and defects of the traditional functioning of the modern State and, thus, the bureaucratic or privatized management of public policies. A major bet on a radical reform of the public administration through the invasion of the State by the civil society.
In fact, this exercise of ours in direct democracy, affectionately known as ‘social control’ (the control of the State by the society, and not vice-versa!), has been opening significant space for ‘users’ and health workers to share, to some extent, the power in the conduct of the National Health System (SUS, its acronym in Portuguese). This time, in an unprecedented manner, we had a woman as the chair of the Board and of the Conference in addition to a female representative of the users: Maria do Socorro de Souza.
It has been noted, however, that this innovative performance in popular democracy has not automatically secured the political effectiveness for this form of exercising power. The resolutions of the various conferences have not guided the SUS’ planning and management. Chronic insufficient funding has forced the CNSs to repeat; the claims of the 15th conference largely restated those of the 14th, which, in turn… Again, a majority of the delegates rejected the trend towards the commercialization and privatization of the management and provision of services in the SUS, as this hinders the essence of the right to health, and, in practice, damage fairness and completeness. Over and over, the anti-policies practiced by the SUS’ staff were denounced. The system's management, fragmentation, the low levels of investment, the disrespect for the needs of both the health area and of its users, were criticized. Again, once more.
However, nothing can guarantee that the managers will abide by these guidelines and collective deliberations. Even worse, it does not seem that the resolutions of the 15th CNS will reach the hearts and minds of society. Who can recall the final document of the 14th CNS? Who read it? Who will hear about the indignation and paths pointed to for defending the SUS and the right to health during the 15th conference?
The power of participatory management depends on its connection to social movements and public opinion. And we are experiencing a weakening all forms of popular representation. The vitality of the boards and conferences depends on a radical reinvention of the policy. It depends on the extensive reconstruction of the parties, of the social movements themselves and, especially, of the discourse and values of the heretofore generically denominated ‘left.’
The 15th CNS took place in an unstable political, social, and economic context. Days before the date the event was scheduled to begin on, there was no certainty it would actually happen. During the conference, the speaker of the House of Representatives authorized the opening of an impeachment process against the president of Brazil. The conservative, anti-popular siege forced the delegates to a majority reaction in defense of the democratic system, with a pronouncement against a coup de’état disguised as an impeachment. The presence of President Dilma, on the last day, set fire to the floor, supporting her despite several constraints and criticism of aspects of her economic and social policies and even of the health policy approved during the meeting.
One warning: Despite the political weakness and mistakes of our democratic management experience, I do not authorize conservatives and opportunists to take advantage of these flaws to suggest the end of social control and of popular participation. I advocate the opposite: I try to acknowledge the issues and criticize them so they can be overcome in favor of the strengthening of direct democracy.
Despite all the ills of democracy, the goal should be to always improve, enhance, and deepen it, not replace it with a dictatorship.
Gastão Wagner de Sousa Campos
Full professor of Public Health at the School of Medical Sciences, State University of Campinas, and president of the Brazilian Collective Health Association (Abrasco, its acronym in Portuguese).
Publication Dates
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Publication in this collection
Jan-Apr 2016
