The Health and Safety Policy for Federal Public Servants and the Integrated Health Care Subsystem for Federal Public Servants: contributions to the Sustainable Development Goals

Abstract

Introduction  The implementation of the Sustainable Development Goals (SDGs) requires public entities to ensure adequate working conditions supported by efficient organizational structures.

Objective  To discuss the paradox between the potential of the Health and Safety Policy for Federal Public Servants (PASS) and the Integrated Health Care Subsystem for Federal Public Servants (SIASS) to contribute to the SDGs and the challenges of their implementation.

Methods  A qualitative theoretical-reflective essay.

Results  The implementation of PASS and SIASS faces challenges that limit their transformative potential, necessitating the overcoming of structural barriers, increased investment in resources, and deeper integration with the National Network for Comprehensive Workers’ Health Care (Renastt) to strengthen and align their actions with the SDGs.

Conclusion  Despite these challenges, PASS and SIASS should not be dismantled but rather reinforced as strategic public policies, as their principles of universality, comprehensiveness, and equity align with the SDGs. However, they require political commitment, sustainable investments, and a cultural shift to transition from a bureaucratic framework to a proactive approach centered on the well-being of federal public servants.

Keywords:
Work; Occupational Health; Occupational Health Policy; Sustainable Development Goals

Resumo

Introdução  A implementação dos Objetivos de Desenvolvimento Sustentável (ODS) exige que entes públicos garantam condições adequadas de trabalho, com estruturas organizacionais eficientes.

Objetivo  Discutir o paradoxo entre o potencial da Política de Atenção à Saúde e Segurança do Trabalho do Servidor Público Federal (PASS) e do Subsistema Integrado de Atenção à Saúde do Servidor Público Federal (SIASS) para contribuir com os ODS e os desafios de sua implementação.

Métodos  Ensaio teórico-reflexivo de abordagem qualitativa.

Resultados  A implementação da PASS e do SIASS enfrenta desafios que limitam seu potencial transformador, havendo a necessidade de superação de barreiras, investimento em recursos e maior integração com a Rede Nacional de Atenção Integral à Saúde do Trabalhador e da Trabalhadora (Renastt) para o fortalecimento e alinhamento das ações aos ODS.

Conclusão  A despeito dos desafios, a PASS e o SIASS não devem ser desconstruídos, mas reforçados como políticas públicas estratégicas, pois seus princípios de universalidade, integralidade e equidade são compatíveis com os ODS. Contudo, eles requerem vontade política, investimentos sustentáveis e mudança de cultura para migrar de uma lógica burocrática para uma abordagem proativa, centrada no bem-estar do servidor público federal.

Palavras-chave:
Trabalho; Saúde do Trabalhador; Política de Saúde do Trabalhador; Objetivos de Desenvolvimento Sustentável

Introduction

The Sustainable Development Goals (SDGs) are part of the 2030 Agenda in Brazil, which establishes comprehensive guidelines aimed at promoting the integration of social, economic, and environmental development, essential for tackling contemporary global challenges¹. There are 17 of them and they express, through targets and indicators, the United Nations’ (UN) strategic paths for eliminating poverty, protecting the environment and the climate, and ensuring that people everywhere can enjoy peace and prosperity².

Implementing the SDGs requires public bodies to guarantee adequate working conditions, with efficient organizational structures and qualified human resources. Among the goals, four stand out for their direct relationship with the health and well-being of public servants: SDG 3 (Good health and well-being), SDG 8 (Decent work and economic growth), SDG 10 (Reduced inequalities), and SDG 16 (Peace, justice, and strong institutions).

SDG 3 aims to “ensure healthy lives and promote well-being for all at all ages” and includes specific targets to reduce rates of premature mortality from non-communicable diseases through prevention and treatment, as well as promoting mental health and well-being with access to health services³. SDG 8 seeks to “promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all”. Its main focus is the promotion of sustainable economic growth, decent work, and productivity, highlighting safety in the workplace as a global priority⁴. SDG 10 seeks to “reduce inequality within and among countries”⁵ and SDG 16 aims to “promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels”⁶.

In this context, decent work, the concept proposed by the International Labour Organization (ILO) and defined as “work adequately remunerated, carried out in conditions of freedom, equity and security, capable of guaranteeing a decent life” is based on four essential pillars (“respect for international labor standards, in particular fundamental labor principles and rights”, “promotion of quality employment”, “extension of social protection”, and “social dialogue”)⁷which constitute a global priority with a view to promoting fair working conditions, respecting the diversity and specific needs of each worker⁴, thus aligning directly with the SDGs and reinforcing the commitment to a more inclusive economy.

Thus, the link between SDGs 3, 8, 10, and 16 reveals the interdependence between workers’ health, equity, and institutional development, constituting an essential cycle for social transformation. This convergence requires the integrated promotion of conditions that guarantee equal work opportunities and economic growth, respecting workers’ rights, reducing regional and sectoral disparities, and strengthening public governance: elements that feed back into the concept of decent work formulated by the ILO³-⁶.

From this perspective, Brazil’s federal public institutions are both implementing agents and a necessary target for policies that promote safe and inclusive working environments. While the quality of public services, essential for the 2030 Agenda, is directly linked to the well-being and quality of life of the almost 1.1 million public servants⁸, the effective construction of environments that balance productivity and labor rights remains a structural challenge, the progress of which is decisive for achieving the SDGs.

It is in this context that the Health and Safety Policy for Federal Public Servants (PASS)⁹and the Integrated Health Care Subsystem for Federal Public Servants (SIASS)¹⁰ take center stage. Both are legal instruments that guide the implementation of occupational health actions and were created to fill historical gaps in health care for federal public servants. These initiatives address aspects such as disease prevention, health surveillance, and the promotion of quality of life at work⁹,¹⁰, and can contribute directly to building fairer, healthier institutional environments in line with the SDGs.

However, despite representing important advances for public servant health, some challenges limit the effectiveness of PASS and SIASS, such as those related to the unequal coverage between federal public administration bodies and entities in the various regions of the country¹¹ and the lack of unified and systematized general data on the epidemiological profile of workers in the federal public sector. This lack is evident when contrasting the scarcity of national databases with specific studies such as those on the epidemiological profile of federal public servants in Tocantins on sick leave¹², which, although relevant, do not allow for a systemic analysis. Such operational bottlenecks have a direct impact on strategic planning capacity, reduce the effectiveness of interventions, and consequently jeopardize the achievement of the SDGs.

Martins et al. examined the trajectory of PASS, and the challenges faced in implementing SIASS in Rio de Janeiro, and pointed out that after 2013 there was a shift towards a more conservative occupational health model. The research highlighted the need for greater integration between health, labor, and public management policies to ensure the universality and comprehensiveness of the workers’ health system¹³.

From this perspective, considering that the alignment between national federal occupational health policies and the SDGs has the potential to strengthen occupational health governance, improving results and expanding social impacts, the relevance of this study lies in the urgency of understanding the evolution of PASS and SIASS and, based on this, begin to rethink models of occupational health management in the federal public sector, especially in a scenario of budget restrictions and pressures for greater efficiency in the state machine.

For this reason, a critical and reasoned discussion is proposed, by means of a theoretical-reflective essay with a qualitative approach. The analysis is based on a normative review of Sigepe Legis^d, the authors’ professional experiences in managing the health of federal public servants, and specialized scientific literature. The aim is to discuss the paradox between the potential of PASS and SIASS to contribute significantly to the SDGs and the challenges of their implementation, which is marked by fragmentation, regional asymmetry, and an excessively reactive approach, focused on expertise, to the detriment of prevention and health promotion¹⁴.

To ensure a logical flow and facilitate reading, the text has been organized into three axes: History of PASS and SIASS: milestones and normative evolution; Challenges in implementing PASS and SIASS: gaps and tensions; and Final comments and proposals for strengthening public policies.

History of PASS and SIASS: milestones and normative evolution

In 1988, the Federal Constitution, in its Article 39, determined that “The Union, the States, the Federal District, and the Municipalities shall institute, within the scope of their competence, a single legal regime and career plans for public servants in the direct public administration, municipalities, and public foundations”¹⁵. In this sense, the single legal regime (RJU) is the set of rules that establish the rights and duties of public servants. Within the federal public service, the legal provision that deals with the RJU is Law No. 8^.112, of December 11, 1990¹⁶. It contains very few articles on occupational health and safety (e.g. Arts. 69, 72, 206-A, 212, 213) and, at the time it came into force, there was no national policy on these aspects for public servants of any career. It was therefore up to the agencies and ministries of the Federal Administration System of Civilian Personnel (SIPEC) to create health services to support this group.

With the lack of regulation, the inequality of actions drew attention and contributed to hindering the creation of a national database that would provide quality epidemiological information on workers’ health.

In 2003, with the creation of the general coordination of social security and public servant benefits, an attempt was made to eliminate the disparities between the health services offered by SIPEC bodies by systematizing a health policy for public servants based on equity and universality¹⁷,¹⁸.

In 2005, with Interministerial Ordinance No. 800, of May 3¹⁹, a new framework for the health and safety of public servants was inaugurated, and they became part of the list of individuals considered workers for the purposes of the Brazilian National Policy on Occupational Health and Safety (PNSST)²⁰.

In 2006, other two important pieces of legislation were published: Ordinance No. 1.675, of October 6 (revoked)²¹, and Decree No. 5.961, of November 13 (revoked)²². The first, through the Manual for the Health Services of Federal Public Servants, presented norms and criteria to be adopted as a “reference for expert procedures in health, and for clinical and epidemiological use”, as well as addressing issues relating to the formation of the multi-professional health team (doctors, nurses, safety engineers, safety technicians, etc.)²¹. The aim of the second was to standardize administrative and health procedures in human resources management and health promotion for public servants by creating the Integrated Occupational Health System for Federal Public Servants (SISOSP):

carrying out medical and expert examinations; carrying out outpatient procedures relating to occupational diseases; managing public servants’ occupational health medical records; providing assistance to public servants injured on the job, suffering from or suspected of suffering from a service-related disease, as well as those requiring rehabilitation or functional readaptation; controlling health risks and hazards in work processes and environments; assessing the healthiness and dangerousness of work environments and workstations; issuing environmental assessment reports and granting bonuses; carrying out studies, research, and assessments of health risks and hazards in work processes and environments; preparing the Environmental Risk Prevention Program (PPRA); preparing the Occupational Health Medical Control Program (PCMSO); assessing the impact of service organization methods and technologies on public servant health, including analysis of building, equipment, machine, and product projects; and producing, systematizing, consolidating, monitoring, analyzing, and disseminating information on the risks of accidents and service-related illnesses, on the results of inspections, environmental assessments, and health examinations and on public servant health in general²².

Since December 2007, under the coordination of the Department of Health Policies, Social Security and Employee Benefits (DESAP) of the Human Resources Department of the Ministry of Planning, Budget and Management (SRH/MPOG), meetings, workshops, and gatherings have been held with the aim of gradually building and implementing, with the collective participation of public servants, a PASS, which is based on the development of health care actions based on epidemiological information, multidisciplinary work, and the evaluation of work environments and relationships⁹

This policy is underpinned by five pillars: health promotion for public servants, prevention of damage or harm to public servants’ health, health surveillance for public servants, health care for public servants, and official health expertise⁹. Health promotion encompasses a set of actions aimed at protecting the individual and collective health of public servants. The prevention of damage or illness aims to reduce or avoid the process of becoming ill, both at an individual level and in collective relations in the workplace. Surveillance involves monitoring the determining and conditioning factors of health related to the environment and work processes, with the aim of planning, implementing, and evaluating measures to reduce or eliminate health risks²³.

Health care focuses on prevention, early detection, disease treatment, and rehabilitation, and is organized through a network of services. According to Article 230 of Law 8^.112/1990, the need for health care for public servants, active or inactive, and their families, includes medical, hospital, dental, psychological, and pharmaceutical services. The main guideline of this assistance is the implementation of preventive actions aimed at promoting health. It can be provided by the Unified Health System (SUS), directly by the body or entity to which the public servant is linked, or through agreements, contracts, or aid to partially reimburse expenses with private health plans or insurance, in accordance with regulations¹⁶.

The medical expertise, an administrative act, is responsible for technically evaluating issues related to the health and working capacity of public servants, with the aim of helping the federal public administration to justify its decisions. It also generates epidemiological information on absences related to illnesses and diseases²³.

In 2009, the first official document dealing with PASS, Decree 6^.833, revoked SISOSP and created the Management Committee for Servant Health Care, which went on to approve the guidelines for implementing this policy and deliberate proposals for the creation, jurisdiction, and operation of SIASS²⁴.

This change, in conceptual terms, represented a major advance, since for SISOSP the worker was a passive recipient of health actions, with a restricted concept of occupational health. For SIASS, on the other hand, the worker is the active subject of work processes, and their values, ideas, and beliefs are considered when constructing social representations relating to occupational health.

In the chronological sequence, following on from the actions underpinning the PASS, in May 2009, Decree 6.856 was published to regulate Article 206-A of Law 8.112 and provide for the periodic medical examinations of public servants. Aimed at “preserving the health of public servants, due to the risks existing in the work environment and occupational or professional diseases”, the decree established the frequency of periodic medical examinations (biennial, for public servants aged between 18 and 45; annual, for public servants aged over 45; and annual, or at shorter intervals, for public servants exposed to risks that could lead to the onset or worsening of occupational or professional illnesses and for those with chronic illnesses); and also established the terms and conditions for clinical assessment and laboratory tests to be carried out by public servants in the direct, autarchic, and foundational federal public administration²⁵. In September of the same year, Normative Ordinance No. 4 of the SRH/MPOG established guidelines for the application of this decree²⁶.

In 2010, with the publication of Normative Ordinance No. 2, of March 22²⁷(revoked), the minimum procedures for the implementation of “technical cooperation agreements” for the creation of SIASS units were established and, in this document, Item III of Article 12 states that the SIASS unit is responsible for:

carrying out surveillance actions to assess the work environments and organization, with the issue of an environmental report containing measures to change working conditions, with a view to promoting health, within the scope of the bodies and entities that are participants in the technical cooperation agreement.

Also in 2010, the first edition of the Official Health Expertise of the Federal Public Servant Guideline was released, which has become a reference in health expert procedures in the federal public administration and is currently in its third edition, dated 2017²⁸. In the expert area, the actions of PASS “aim to standardize procedures, transparency of technical criteria, administrative efficiency, humanization in service, rationality of resources, as well as multidisciplinary support and relations with the areas of assistance and health promotion”.

In 2010, the Operational Standard for Employee Health (NOSS) was also instituted with the aim of “defining general guidelines for the implementation of actions to monitor work environments and processes and promote the health of federal public servants”, within the scope of SIASS, integrating the set of PASS actions²⁹.

According to NOSS, the concepts of health surveillance, work processes, and health promotion for public servants are, respectively:

the set of continuous and systematic actions, which makes it possible to detect, know, research, analyze, and monitor the determining and conditioning factors of health related to work environments and processes, and aims to plan, implement, and evaluate interventions that reduce risks or harm to health;

the performance of activities carried out individually or as part of a team, constituting a set of organized and interrelated resources and activities that transform inputs and produce services, which can interfere with the physical and psychological health of the public servant.

the set of actions aimed at the health of public servants, by expanding knowledge of the relationship between health and illness and work. It aims to develop management practices, attitudes, and behaviors that contribute to health protection at an individual and collective level²⁹.

Considering that the guidelines of the standard are universality, equity, comprehensive actions, access to information, the participation of public servants, regionalization and decentralization, transversality, intra- and intersectorality, co-management, epidemiological basis, training and qualification, transdisciplinarity, and research-intervention²⁹, the concern with the particularities of each region in which the SIASS units are located and with the active participation of all the actors involved in this context with a view to prioritizing and meeting the health needs of public servants is evident.

Also noteworthy among the group of documents that make up the PASS regulations is Normative Ordinance No. 3, of March 25, 2013, issued by the SGP/MPOG, which “establishes the general guidelines for promoting the health of federal public servants to be adopted as a reference in the health promotion actions of the bodies and entities that make up the Federal Administration System of Civilian Personnel”³⁰, whose function is to:

subsidize policies and projects to promote health and quality of life at work, to be implemented in a decentralized and transversal manner, through the areas of people management, health, and safety at work, and which include participatory management.

This ordinance has the following guidelines: I - encouraging the provision of health education and health promotion actions for federal public servants, at different levels of prevention, aimed at well-being, quality of life, and reducing vulnerability to health-related risks, their determinants, and conditioning factors; II - providing public servants with healthy working environments, involving them and managers in establishing a process of continuous improvement of conditions and relationships at work and health, providing well-being for people in the work context; III - a better understanding of the determinants of the health and illness process in public servants and the development of intervention alternatives that lead to the transformation of reality, towards the appropriation by public servants of the human dimension of work; IV - intervention in the determinants of the health and illness process and the process of becoming ill in its individual aspects and in the collective relations of the work environment; V - a contribution to improving the quality of life of public servants³⁰.

In relation to programmatic actions, the importance of monitoring indicators to assess the repercussions of the relationship between health, illness, and work and the work of multi-professional teams made up of public servants from different areas of knowledge³⁰ is highlighted.

As of 2013, an analysis of the set of regulated legal provisions³¹shows the predominant focus on the expert axis of the PASS, to the detriment of a more comprehensive approach aimed at surveillance, health promotion, prevention of damage and illness, and assistance, which appear to have less normative and operational weight. This approach reflects a culture that is reactive and very much focused on granting social security benefits to the detriment of promoting well-being, quality of life, and reducing the risks of illness.

This means that, despite the conceptual advances in recognizing the importance of the integral health of federal public servants, there are still significant shortcomings in strengthening preventive actions, expanding health surveillance in work environments, and promoting healthier working conditions, which will be presented below, highlighting the need for a better balance between these aspects in public policies aimed at federal public servants.

Challenges in implementing PASS and SIASS: gaps and tensions

PASS and SIASS face significant challenges in the equitable implementation of their actions, and these are evidenced by gaps and tensions between theory and daily practice. This dissociation is nothing more than a reflection of the fragility of the culture of occupational health in the federal public administration, which, despite its potential and transformative capacity, is predominantly guided by economic interests and compliance with social security issues. In this sense, the operationalization of SIASS activities is strongly geared towards carrying out medical examinations and evaluations of work capacity, with little attention paid to preventive actions, through periodic medical examinations, and health promotion programs¹¹,³²-³⁴.

Although medical examinations are fundamental for regulating administrative acts, such as approving leave and disability pensions, their predominance limits the emphasis on mental health programs, health education campaigns, and ergonomics, which could generate significant benefits for the health of public servants in the long term. Studies show that mental disorders, for example, account for a significant percentage of absences from work. The SIASS IF Goiano/Goiás identified that 20% of absences between 2016 and 2017 were due to mental and behavioral disorders (ICD F), with a predominance of depressive syndromes (32%), followed by anxiety, adaptation, and stress disorders³⁵. SIASS IFCE identified that 23% of all sick leaves was also due to ICD F, corresponding to more than 5,000 days away from work in one year³⁶and, in another study, there was an increase between 2010 and 2018 in sick leave, days away from work, and the incidence of public servants on sick leave due to mental and behavioral disorders, with predominance of mood disorders, which generated high financial effects for the institution³⁷. At SIASS Governador Valadares, this problem accounted for 33.53% of absences between 2017 and 2021, corresponding to 11,480 days away from work³⁸.

This reactive approach, demonstrated by diagnostic studies, results in late interventions, when the employee’s state of health is already compromised, instead of implementing strategies that could reduce or prevent occupational illness, reinforcing an outdated view of occupational health and a concern with controlling the workforce, to the detriment of broader guidelines that address workers’ health proactively¹¹,³²-³⁴.

Another critical point to consider is that government guidelines do not always keep pace with technological advances, changes in working conditions, and the health of public servants. A concrete manifestation of this problem is the lack of regulations for monitoring the health of those who work remotely or in hybrid work, supported by the establishment of the Management and Performance Program³⁹, creating gaps in the health protection of this group. An additional and emblematic example of this is the lack of critical and systematic reviews of the Official Health Expertise of the Federal Public Servant Guideline²⁸, which shows divergences between its technical criteria and the real needs of workers. While the manual establishes rigid parameters, anchored in traditional biomedical perspectives, professionals on the front-line face complex cases that require flexibility and contextualization¹⁴.

Furthermore, both the guideline and Siape-Saúde^e have made no progress in the inclusive approach to people with disabilities. The lack of a specific protocol for the expert characterization of disabilities acquired during working life and mechanisms for granting transport aid when the public service does not meet the needs of the disabled public servant⁴⁰, are some of the many situations that reinforce a narrative of merely formal inclusion, which does not materialize in practice. This omission corroborates the maintenance of barriers and a false visibility of public servants with disabilities in the workplace, significantly impacting on the achievement of the SDGs.

Unfortunately, the challenges don’t stop there: while some agencies and entities in the federal public administration have complete structures and large teams, others lack the appropriate infrastructure and qualified professionals to meet the demand from public servants, whether in quantitative or qualitative terms³². This imbalance creates a substantial barrier to the universalization of health promotion, quality of life at work, and worker safety projects. Structural diversity combined with different realities in terms of size, location, and operational complexity makes it difficult to apply policies uniformly, highlighting the complexity of the issue.

Moreover, the lack of human and financial resources⁴¹, together with SIASS’s lack of budgetary autonomy, greatly compromises the execution of occupational health and safety actions, restricting its ability to act proactively¹¹,³². Consequently, this limitation reduces the efficiency and effectiveness of PASS, hindering the cross-cutting nature of its actions and directly impacting its results.

To overcome these challenges, there is an urgent need to strengthen the culture of workers’ health in the federal public service by adopting more flexible and decentralized management models, coupled with adequate and predictable funding, as well as by encouraging the collective participation of the public servants themselves, regardless of whether they are in management positions or not³³. Valuing collective debate and empowering workers are fundamental to consolidating a public policy that truly promotes health and well-being in the federal public service⁴².

Currently, this participation is limited and compromises the engagement and performance of health actions, as public servants do not seem to understand their importance in ensuring that PASS and SIASS fulfill their role as a functional public policy for public servant health⁴³.

In addition to all of the above, there is a lack of unified parameters, such as national protocols, standardized indicators, and common technical guidelines to guide the SIASS units. In the current work context, this gap means that actions are guided by outdated models that favor precarious working conditions¹³. Each SIASS unit adopts its own practices, often depending on the resources available locally, without centralized guidance³². This prevents the implementation of integrated actions and the adoption of strategies that consider the specificities of work in the public sector.

In addition to this internal fragmentation, there is a profound lack of coordination between PASS, SIASS, and the National Network for Comprehensive Workers’ Health Care (RENASTT), which operate in parallel, without interoperability of systems or conceptual alignment. This disconnection has a direct impact on the health of public servants, who experience fragmented care, and on the fulfillment of goals related to health and well-being (SDG 3), decent work (SDG 8), the reduction of inequalities (SDG 10), and peace, justice and effective institutions (SDG 16). The creation of joint protocols between SIASS and RENASTT would represent a major step forward not only in guaranteeing holistic care for public servants, but also in aligning policies with sustainable development agendas. Integrated governance would make it possible to optimize resources and, above all, to build a system capable of responding preventively to occupational risks specific to the public service.

In this context, another obstacle is the lack of robust information systems, which represents one of the greatest difficulties in managing occupational health. Despite the publication of the DW SIASS manual⁴⁴, a tool for extracting aggregate and comprehensive health information, there is still an urgent need to consolidate a national indicator tool with a national database, since the systematic collection and analysis of occupational health and safety data is still insufficient, making it difficult to build a reliable epidemiological profile of public servants and formulate evidence-based policies. The fragmentation of information between SIASS and RENASTT, as well as between different bodies, and the lack of interoperability between existing systems, results in duplication of effort which compromises the ability to jointly monitor key indicators such as absenteeism, work-related illnesses, and accidents at work, jeopardizing transparency and the evaluation of the impact of any action that may be implemented¹¹,⁴⁵,⁴⁶

What we currently have with Siape-Saúde, as a management support tool, is a system with restricted access to management reports by SIASS units; underuse of the system as a mere data repository; low information quality in terms of completeness, clarity, and usability; and the absence of feedback mechanisms, which prevent the generation of organizational knowledge from the stored data.

These challenges highlight the urgent need to plan an integrated short-, medium-, and long-term approach to strengthening PASS and SIASS and their connection with RENASTT. Although the legislation is formally established, this does not guarantee its practical application. It is important to note that these policies often remain only on paper and, in the specific case of SIASS, their implementation is already lagging, largely due to a lack of attention and adequate investment. Proposals will therefore be put forward to ensure the effectiveness of these policies in promoting the health and safety of public workers.

Final comments and proposals for strengthening public policies

This essay, by carrying out a review of regulations and specialized scientific literature, based on the authors’ professional experiences in managing the health of federal public servants in relation to the potential of PASS and SIASS to contribute significantly to alignment with SDGs 3, 8, 10, and 16, has shown that their implementation still faces challenges that limit their transformative potential.

The predominance of a reactive approach, centered on expertise, to the detriment of preventive actions and health promotion, the disarticulation between PASS, SIASS, and RENASTT, without interoperable systems, the absence of unified protocols, and the inequalities in the structuring of SIASS units, with inequities in resources, represent major challenges.

The fragmentation of policies jeopardizes the goals of decent work and the reduction of inequalities, especially in relation to the most vulnerable groups of public servants, such as those with disabilities and those working remotely. The lack of robust epidemiological data makes it difficult to monitor key indicators such as the prevalence and incidence of work-related illnesses and absenteeism and, consequently, their impact on public servants and agencies.

Therefore, to overcome these challenges, we suggest, as an expanded proposal to strengthen PASS and SIASS to achieve the SDGs, a detailed legislative and normative review; the regulation of SIASS’s budgetary autonomy, with a guarantee of stable funding; the expansion and training of SIASS teams, with an emphasis on the psychosocial determinants of work; and the inclusion and appreciation of public servants’ participation in the co-management of policies, through local committees and public consultations.

In terms of health promotion, there are proposals to implement permanent campaigns on topics such as healthy eating, physical activity, and mental health, with measurable targets; to offer workshops on stress management and burnout and burnon prevention; to certify universities as Health Promoting Universities⁴⁷, following the guidelines of the World Health Organization (WHO); and to encourage well-structured teleworking, with digital ergonomics protocols and work disconnection.

Regarding the prevention of damage or injury, it is proposed to incorporate a system for recording and analyzing sectoral risks into Siape-Saúde, with periodic updates; to offer essential courses on health and safety at work when new public servants join, as well as periodic training for managers and public servants, with certification; and to guarantee the presence of organizational psychologists and social workers in the SIASS teams for psychosocial monitoring. Regarding surveillance of public servant health, improve computerized systems, with guaranteed interoperability between PASS, SIASS, and RENASTT, with a view to compulsory and integrated notification of work-related illnesses, accidents at work, and moral harassment; making open data available, without identification, for research and formulation of public policies; and creating national indicators of health and safety at work (such as rates of absenteeism, sickness, and return to work), in line with the SDGs. In addition, the adoption of predictive analysis technologies for risk identification and early intervention.

In the field of official health expertise, it is recommended that the revision of the Official Health Expertise of the Federal Public Servant Guideline be a dynamic and continuous process, with immediate updates whenever new legal instruments are published, maintaining systematic alignment with Siape-Saúde; that experts and the multi-professional team receive continuing training, with an emphasis on fair and unbureaucratic assessments; and that adequate physical, human, material, and financial resources be guaranteed for expertise, based on the number of public servants per body.

It is also recommended to invest in intervention research that evaluates the effectiveness of preventive models and health promotion programs, in research that proposes and evaluates intersectoral governance models to guarantee comprehensive health care for public servants and that develops methodologies for evaluating the impact of public policies in line with the SDGs.

In summary, PASS and SIASS should not be deconstructed, but reinforced and strengthened as strategic public policies, since their principles of universality, comprehensiveness, and equity are compatible with the SDGs. However, they require political will, sustainable investment, and a change in culture to migrate from a bureaucratic logic to a proactive approach centered on the well-being of the federal public servant.

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• Data availability:
  All data supporting the results of this study has been published in the article itself.
• Presentation at a scientific event:
  The authors declare that the study has not been presented at a scientific event.
• d
  Sigepe Legis is a search tool for federal personnel management legislation.
• e
  Siape-Saúde is a computerized system designed and developed to automate and centralize the health information of federal public servants.
• Funding:
  The authors declare that the study was not subsidized.

Edited by

• Editor-in-Chief:
  Leila Posenato Garcia

Data availability

All data supporting the results of this study has been published in the article itself.

Publication Dates

• Publication in this collection
  26 Sept 2025
• Date of issue
  2025

History

• Received
  17 Dec 2024
• Reviewed
  23 Apr 2025
• Accepted
  28 Apr 2025