As inflexões da contrarreforma na política de Atenção Primária à Saúde no Governo Bolsonaro: implicações sobre a Estratégia Saúde da Família

Abstract

The current dissertation analysis the inflections of the Brazilian counter reform in the Primary Health Care (PHC) policy in the Bolsonaro government, with emphasis on the Family health strategy (FHS). The research is based on the perspective of dialectical-historical materialism, in which the investigation process was structured from a documental research followed by a bibliographic review. We analyzed the main regulations published in the two first years of Bolsonaro Government (2019-2020) related to PHC and which focus directly on FHS. We sought to identify how the health counter reform is materialized in the actions of the said government, concerning PHC and FHS. The ongoing process of counter reform is intensified with the growth of the capitalist structural crisis, mainly after 2008. The permanent fiscal adjustment and the dispute for the public are directly related to the exploration of the workforce and expropriation of rights in the context of the capitalist sociability. In Bolsonaro Government, the PHC has been target of many regulations that inflect on its direction, ideopolitical conception, organization of services and, most importantly, its basic principles. This been said, the FHS, given its importance in primary care has been reconfigured in several aspects. The new funding of PHC from Previne Brasil, the agency for development of PHC (ADPHC) and the portfolio of services for managers, professionals and users at primary level of care are regulations that characterize the ultra-neoliberal direction of the current government. The concept of Universal Health Coverage (UHC) to the detriment of a state-owned and quality Universal Health System for all has led the counter-reformist measures that guide the direction of this government in the health sector. This makes clear the adhesion, reaffirmation and defense of the multilateral organizations, as well as the ideopolitical conceptions, which guide it. The object analysis allowed us to identify setbacks that deepen in the PHC policy, especially in the FHS, given the counter reform undertaken to meet the interests of big business.

Keywords: Brazilian state counter reform. Social policy. Primary health care. Family health strategy.