As políticas de gestão do trabalho e educação na saúde de 2003 a 2023: continuidades e descontinuidades no contexto do Estado brasileiro dependente

Abstract

Brazil’s Unified Health System (SUS, acronym in Portuguese) was created after the redemocratization, representing a national heritage for the population and ensuring social rights. However, its management faces contradictions, as the 1988 Constitution establishes principles for public administration and workers' rights, while market-oriented reforms have led to changes affecting work in health. The creation of the Secretariat for Work Management and Education in Health (SGTES, acronym in Portuguese) in 2003 aimed to address the valorization of work within the SUS. Still, the structure of Brazil's dependent State negatively impacts these policies, leading to labor precarization and the super-exploitation of the workforce. This research aims to analyze the policies of work management and education in the Brazilian Health Care System implemented from 2003 to 2023, to understand the continuities and discontinuities of these policies during the 20 years of the SGTES in Health in Brazil. The research demonstrated that although the Ministry of Health, through the SGTES, has made progress in constructing policies to fight precarization and value workers, many policies are discontinued due to power correlations in a dependent state, where regulations tend to reinforce dependency through the super-exploitation of the workforce. In particular, work management policies focused on regulation and betterment of work in the SUS go through periods of strengthening followed by ruptures. Decentralization also brings challenges, as policies do not always reflect in municipalities, facing regional inequalities and market pressures. In 2023, with the reconstruction of the SGTES, the scenario is even more challenging due to the accumulated loss of labor rights over the years, highlighting the urgency of developing a National Policy for Work Management and Education in Health that defines state-interest careers for SUS workers, preventing each municipality from making isolated decisions regarding hiring and remuneration. This work reaffirms that social health research must align with political economy to identify the barriers affecting the SUS, aiming for more structured and consistent actions.