Precarization of work in healthcare and the impacts of labor reform on the National Occupational Health Policy: a scoping review

Bernardes, Rebeca Camille; Campos, Célia Maria Sivalli; Bertolozzi, Maria Rita

doi:10.1590/2317-6369/12825pt2025v50e30

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Review article • Rev. bras. saúde ocup. 50 • 2025 • https://doi.org/10.1590/2317-6369/12825en2025v50e30 linkcopy

Precarization of work in healthcare and the impacts of labor reform on the National Occupational Health Policy: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction The precarization of working conditions in the healthcare sector, intensified after Brazil’s 2017 Labor Reform, has compromised the implementation of the National Occupational Health Policy (NOHP), particularly in Primary Health Care (PHC).

Objective To review the literature on the impacts of the Labor Reform on the implementation of the NOHP, with a focus on PHC.

Methods This is a scoping review. The search was conducted in PubMed, SciELO, LILACS, Web of Science, and gray literature sources (BDTD, CAPES, COFEN), including studies published between 2012 and 2024 in Portuguese, English, and Spanish.

Results From an initial 510 records, 32 studies were included (14 from indexed databases and 18 from the gray literature). Findings revealed unstable employment arrangements, outsourcing, and high turnover, in addition to work intensification through overload and extended working hours. Reported impacts included health problems among workers, especially mental health disorders, and weaknesses in NOHP enforcement, which exposes PHC professionals’ vulnerability in the face of labor reforms.

Conclusion Labor precarization compromises the implementation of the NOHP in PHC, highlighting the need for stricter regulation of outsourcing, more professional recognition, and reinforced of public policies.

Keywords:
Occupational Health; Primary Health Care; Working Conditions; Health Policy; Unified Health System

Scientific databases
PubMed (MeSH descriptors and free terms)	(“Occupational Health”[MeSH Terms] OR “Occupational Health”[Title/Abstract]) AND (“Primary Health Care”[MeSH Terms] OR “Primary Health Care”[Title/Abstract]) AND (“Labor Reform”[Title/Abstract] OR “Precarization of Work”[Title/Abstract] OR “Working Conditions”[MeSH Terms])
SciELO (DeCS descriptors and free terms)	(“Saúde do Trabalhador” OR “Condições de Trabalho”) AND (“Atenção Primária à Saúde”) AND (“Reforma Trabalhista” OR “Precarização do Trabalho”)
LILACS (DeCS descriptors)	(“Saúde do Trabalhador” OR “Precarização do Trabalho”) AND (“Atenção Primária à Saúde”) AND (“Reforma Trabalhista”)
Web of Science (free terms)	(“Occupational Health” OR “Working Conditions”) AND (“Primary Health Care”) AND (“Labor Reform” OR “Precarization of Work”)
Gray literature
BDTD	(“Saúde do Trabalhador” OR “Condições de Trabalho”) AND (“Atenção Primária à Saúde”) AND (“Reforma Trabalhista” OR “Precarização do Trabalho”)
CAPES Thesis Database	(“Saúde do Trabalhador” OR “Condições de Trabalho”) AND (“Atenção Primária à Saúde”) AND (“Reforma Trabalhista” OR “Precarização do Trabalho”)
COFEN	(“Saúde do Trabalhador” OR “Condições de Trabalho”) AND (“Atenção Primária à Saúde”) AND (“Reforma Trabalhista” OR “Precarização do Trabalho”)

Author/Year	Type of study	Country	Population/professionals	Main objective	Main results related to precarization and NOHP
Sibbald et al., 2006¹⁶	Literature review	United Kingdom	PHC nurses	To analyze the advanced role of nurses in PHC	Expansion of functions with increased workload
Mills et al., 2010¹⁷	Qualitative study	Australia	Rural nurses	To assess the status of rural nursing after 12 years	Overload and lack of institutional recognition
Smith, 1990¹⁸	Opinion study	USA	Health professionals	To discuss health policy in the USA	Fragility of the health system affects working conditions
Currie et al., 2019¹⁹	Mixed study	Australia	Self-employed nurses	To evaluate the practice of self-employed nurses	Professional isolation and lack of institutional support
McDonald et al., 2009²⁰	Qualitative study	United Kingdom	PHC nurses	To analyze the effects of a new national contract	Intensification of care activities
Souza et al., 2023²¹	Qualitative study	Brazil	Surveillance professionals	To assess perceptions of Chagas surveillance	Report overload, lack of staff and precarious infrastructure
Simas & Pinto, 2017²²	Cross-sectional study	Brazil	Community agents	To portray the working conditions of CHAs	Low pay, temporary contracts and job insecurity
Santos, 2011²³	Qualitative study	Brazil	PHC nurses	To contribute to the health of nursing workers	Identify physical and mental illness related to precarization
Racic et al., 2019²⁴	Survey	Bosnia	Nurses	To evaluate expectations and perceptions about work	Inadequate conditions and low satisfaction
Cote et al., 2019²⁵	Qualitative study	Canada	PHC nurses	To understand meanings attributed to work	Report emotional distress and overload
Ehlers et al., 2000²⁶	Case study	South Africa	Health professionals	To discuss politics and nursing in South Africa	Situations of vulnerability and social insecurity
Marceau et al., 2021²⁷	Qualitative study	Canada	PHC nurses	To assess the sustainability of funding models	Financial insecurity and temporary contracts
Rodrigues, 2017²⁸	Theoretical study	Brazil	PHC professionals	To discuss precarization as a bioethical issue	Identifies naturalization of precarization
Rocha, 2018²⁹	Qualitative study	Brazil	Social workers	To analyze working conditions in SUAS	Low appreciation and lack of institutional recognition
Ribeiro, 2019³⁰	Case study	Brazil	FHS professionals	To evaluate FHS	Excessive workload, fragile contracts
Silva, 2022³¹	Institutional study	Brazil	PHC nurses	To analyze labor relations in a local management model	Precarious contracts, high turnover
Oliveira, 2020³²	Qualitative study	Brazil	PHC teams	To analyze collaboration between teams	Limited resources and weak links
Sousa Junior, 2019³³	Critical analysis	Brazil	Health professionals	To relate labor counter-reform and class struggles	Dismantling of labor rights
Fonseca, 2020³⁴	Case study	Brazil	PHC professionals	To analyze labor relations under management by SO	Fragile ties, high turnover
Vicente, 2020³⁵	Qualitative study	Brazil	PHC professionals	To analyze safe access strategies in the face of urban violence	Occupational overload and stress
Sousa, 2019³⁶	Qualitative study	Brazil	EFHC professionals	To evaluate the work process and workers’ health	Overload, precarious contracts and illness
Sá, 2022³⁷	Documentary study	Brazil	PHC professionals	To analyze public management and employment relationships	Precarization via temporary contracts
Orrillo, 2019³⁸	Ethnographic study	Brazil	Community workers	To study the training of community workers	Lack of labor rights and high turnover
Rosa, 2020³⁹	Qualitative study	Brazil	Care network professionals	To evaluate coping with violence	High emotional burden
Carneiro, 2019⁴⁰	Qualitative study	Brazil	Social workers	To analyze work in the EFHC	Precarious working conditions
Dimarzio, 2018⁴¹	Quantitative study	Brazil	PHC workers	To assess absenteeism	High rate of sick leave
Almeida, 2021⁴²	Qualitative study	Brazil	FHS nurses	To analyze the repercussions of productive restructuring	Intensification of work, fragile bonds
Martins, 2021⁴³	Comparative study	Brazil/Spain	PHC nurses	To compare working conditions between Brazil and Spain	Greater precarization in Brazil
Jesus, 2019⁴⁴	Theoretical essay	Brazil	Nurses	To reflect on the precarization of nursing	Low salaries and overload
Pereira et al., 2022⁴⁵	Documentary study	Brazil	Nurses	To analyze the impacts of the Labor Reform on nursing	Loss of labor rights
Lopes et al., 2023⁴⁶	Documentary study	Brazil	PHC workers	To assess the organization of the PHC workforce	Reduction in stable jobs and increase in outsourcing
Barreto & Mendes, 2023⁴⁷	Qualitative study	Brazil	Health professionals	To assess overexploitation during the pandemic	Intensification of working hours, increase in mental illness

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[TFN1001] DeCS: Health Sciences Descriptors; SciELO: Scientific Electronic Library Online; LILACS: Latin American and Caribbean Health Sciences Literature; BDTD: Digital Library of Theses and Dissertations; CAPES: Coordination for the Improvement of Higher Education Personnel; COFEN: Federal Nursing Council.