The government of President Jair Bolsonaro (PL) sent the National Congress a budget proposal for 2023 with a cut of at least 50% in funds to fund programs such as Mais Médicos, Popular Pharmacy and indigenous health.
Less than 20 days before the elections, the scissor raised an alert in Bolsonaro’s campaign team, especially regarding the Popular Pharmacy, a program for free or discounted distribution of medicines. The chief executive is running for reelection, but is in second place in polls, behind former president Luiz Inácio Lula da Silva (PT).
The measure affected central programs in serving the population, which triggered the fear of negative repercussions at the polls. Bolsonaro decided to call ministers Marcelo Queiroga (Health) and Paulo Guedes (Economy) to try to review the cut in the Popular Pharmacy.
Faced with the negative impact of the reductions, Guedes went out into the field and cited the program when signaling, this Wednesday (14), a recomposition of Health resources through a message amending the Budget.
Despite Bolsonaro’s request and Guedes’ signal, no formal communication has yet been sent to Congress. Technicians point out that this should only be done after the elections.
The significant reduction in the resources of Mais Médicos — renamed by the current government of Doctors for Brazil — has also entered the Ministry of Health’s radar as a warning point, although the two programs are not the only ones affected.
as showed the Sheet, the Health budget for funding and investments was cut by 42% in the proposal for 2023. To meet the minimum expenditure guaranteed by the Constitution, the Executive will depend on the so-called rapporteur’s amendments, an instrument used as a bargaining chip in negotiations with Congress . Sought, the folder did not comment on the cuts.
Created in 2013 by then-President Dilma Rousseff (PT), Mais Médicos established an agreement with PAHO (Pan American Health Organization) to take Cuban doctors to the interior of Brazil to reinforce basic health care. The program was one of the main targets of Bolsonaro’s campaign in 2018.
The Chief Executive promised to remodel the program, which he did only this year, under the management of Marcelo Queiroga na Saúde. In April, the government summoned the first 529 Doctors professionals across Brazil, almost three years after launching the successor to Mais Médicos.
The continuity of its implementation next year, however, is threatened. The budget for the program fell from BRL 2.96 billion this year to BRL 1.46 billion in the 2023 budget proposal, which represents a reduction of 50.7%.
The amount is also much lower than the R$ 4.06 billion originally requested by the ministry, as shown by internal documents from Saúde, to fund the actions of Mais Médicos and Médicos Pelo Brasil.
UFRJ (Federal University of Rio de Janeiro) professor Ligia Bahia, a specialist in public health, points out that the program currently supports 18,240 vacancies in 4,058 municipalities across the country —a coverage of 73% of Brazilian cities—, in addition to 34 districts. indigenous special toilets.
“With the cut of half the budget, will there be a reduction of doctors for these more distant locations or will there be complementation of resources?”, asks the specialist.
The Popular Pharmacy program, in turn, distributes basic medicines free of charge or with a discount of up to 90% for hypertension, diabetes, asthma, among other diseases, through private pharmacies. Created in 2004, it also delivers products such as geriatric diapers and contraceptives.
The reserve for the program fell from BRL 2.48 billion this year to BRL 1 billion in 2023, a 59% cut in the budget.
Under a cut of this magnitude, technicians from the Ministry of Health estimate that the money only guarantees the operation of the Popular Pharmacy for 4 months in 2023.
The industry has also warned of the risks of reducing the Popular Pharmacy, since the medicines provided are important allies in the prevention or control of serious diseases.
Without access to these medicines, the population can suffer considerable losses and still demand a greater number of visits in the SUS (Unified Health System), according to PróGenéricos (Brazilian Association of Generic and Biosimilar Medicines Industries).
The entity’s president, Telma Salles, says that the measure will end up restricting the population’s access to 13 different types of active drug ingredients, used in the treatment of diabetes, hypertension and asthma.
“Reducing funds from the Popular Pharmacy program will bring immeasurable damage to the entire Brazilian health system. We are talking about people’s lives. It will be opportune to know how the government intends to treat people who will be without these medicines,” he said.
Other actions of the Ministry of Health related to the delivery of medicines also had significant reductions in the budget proposal. The net cut in programming was R$ 665 million, led by Farmácia Popular.
The budget of Sesai (Special Secretariat for Indigenous Health) was also affected, falling from R$ 1.64 billion to R$ 664.6 million between this year’s budget proposal and that of 2023 – well below the original request of R$ 1.8 billion.
The most affected area was the “promotion, protection and recovery of indigenous health”, with a reduction from R$ 1.4 billion this year to R$ 591.3 million in the 2023 proposal. Basic sanitation in indigenous villages for prevention of diseases, in turn, had a reduction from R$ 153.9 million to R$ 54.64 million.
There is a concern within the government with social actions that were heavily compressed in the Budget.
Despite this, current tax rules limit government action at this time. It would be necessary to cut from another area to respect the spending ceiling — which limits the advance of expenses to inflation.
Even if Bolsonaro, as well as other candidates for the Palácio do Planalto, express the desire to change the spending ceiling, this is not enough to allow the accommodation of new expenses in the Budget. Only under a new fiscal rule will it be possible to recompose expenses.
For this reason, government assistants compare the proposal to a piece of fiction, as it will still be significantly modified from November onwards, when deputies and senators will look into it and possibly discuss the new fiscal rule with the elections already defined.
The electoral impasse faced by Bolsonaro due to the budget cut of Farmácia Popular is similar to the dilemma experienced around the minimum amount of the Auxílio Brasil program. Despite Bolsonaro’s promise to maintain the payment of R$ 600 for families in the program, the Budget proposal foresees an average benefit of only R$ 405.21.
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