Doubles the share of the budget for basic health care defined by Congress

The share of the federal budget for basic health care defined by parliamentarians doubled during the government of Jair Bolsonaro (PL) and is now almost a fifth of the total. Experts point out that this has led to inefficiency in health spending, ignoring technical criteria, and the creation of clientelistic ties between mayors and congressmen.

The percentage of expenditure classified as primary health care in 2019, coming from parliamentary amendments, was 9.4% in 2019. In 2022, it reached 18.1%.

The growth took place in the wake of the explosion of the so-called rapporteur’s amendments, which in 2022 have health as their main destination.

In this year’s Budget, there were R$ 9.8 billion in parliamentary amendments of all kinds for basic health care, of which R$ 5 billion with the rapporteur’s stamp. In 2019, this type of amendment did not exist.

There are four types of amendments: individual amendments (to which every deputy and senator are entitled), bench amendments (congressmen from each state define priorities for the region), committee amendments (defined by members of the collegiate bodies of Congress) and rapporteur (which are criticized for lack of transparency for being controlled by the top of the House and Senate).

“This is one of the biggest distortions that the federal government together with the center has made with the funding of the SUS (Unified Health System)”, says Aparecida Pimenta, advisor to Cosems-SP (Council of Municipal Health Secretaries of São Paulo) .

Before her current position, she was health secretary in four cities in the interior of São Paulo.

“Many times the Ministry of Health says how much the resource for primary care has increased, but a large part has increased by the amendment – and the [execução da] amendment has a beginning, middle and end. The big health problem is the permanent funding, mainly from the personnel sheet”, he pointed out.

Due to their temporary nature, the amendments cannot be used to hire doctors, nurses or other health professionals. As a result, they end up buying supplies or renovating or building health facilities.

Primary health care, or primary care, is the gateway to the SUS. The objective is to prevent diseases, solve some cases and direct those who need additional attention to medium or high complexity care. An important action in primary care, for example, is the Family Health Program.

Federal deputy and former Minister of Health Alexandre Padilha (PT-SP) follows the same line. The excess of amendments, he argues, causes the budget for primary health care to be “captured by the political interests of its base.”

This “takes away the technical criteria for allocating resources, transforming primary care into a one-stop shop”.

When contacted, the Ministry of Health did not comment on the increase in the share of parliamentary amendments in this type of expenditure.

Congressional technicians believe that this process harms primary care policies, as the political criterion does not necessarily meet the main demands of municipalities across the country.

Conasems (National Council of Municipal Health Secretaries) welcomes the resources arising from amendments. “The problem is that the distribution of these resources follows the political logic established by parliamentarians, which is not always the same logic of the public health care network.”

For the group, it is necessary to “enable the application of resources according to the care network of the health regions that are established according to the health needs of the population”.

Of the BRL 9.8 billion of amendments destined for primary care in 2022, BRL 5 billion are from the rapporteur’s amendments and BRL 3.5 billion from individual amendments.

In 2020, the first year with the rapporteur’s amendments, there were BRL 862 million in this type of application and BRL 2.7 billion in individual amendments.

In both cases, the amendment is intended for a municipality under the sponsorship of a specific parliamentarian. The difference is that, in the rapporteur’s amendments, the senator or deputy who made the appointment are hidden.