Governors have up to 8 health secretaries in the pandemic

The high turnover of managers registered in the Ministry of Health of the Jair Bolsonaro government (PL) has been repeated in the state health departments since the beginning of the pandemic, with an impact on public policies to combat Covid-19.

That’s what a study, carried out with data from FGV, coordinated by researchers Lorena Barberia, from USP, Luciana Santana, from the Federal University of Alagoas, and Iana Alves, from FGV, points out.

The study mapped the changes of health secretaries in the states between January 2020 and March 2022. In all, governors made 30 changes of secretaries in the period, reaching seven changes in some states. At the federal level, there were four ministers of health.

“We identified a high turnover of Health Secretaries, especially at the most delicate moment of the pandemic. Some states experienced an extremely problematic situation in the forwarding and continuity of public policies”, says Luciana Santana, from the Federal University of Alagoas.

He also highlights that, if governments had a more permanent management, with less turnover, managers would be able to mobilize teams to think and implement more effective public policies to combat the pandemic.

In Roraima, Antônio Denarium (PP) had eight state health secretaries in the last two years, with an average of four months of management for each one. The governor was elected in 2018 amid the Bolsonarista wave and follows a faithful ally of the president.

During the pandemic, there was a balance between the adoption of restrictive measures to prevent the spread of the virus and alignment with Bolsonarist guidelines. In February last year, it even proposed tax exemptions for ineffective drugs for Covid-19, such as chloroquine, hydroxychloroquine and azithromycin.

In the first six months of 2020 alone, the period that marked the beginning of the pandemic, Denarium had five different Health Secretaries in his government.

The first secretary left amid accusations of mismanagement of the portfolio that resulted in complaints of crimes of improbity and administrative advocacy. The replacement left the post a month later.

The third secretary was dismissed in May after a controversy involving the price and advance payment of ventilators without bidding. The fourth left office in June after the governor’s refusal to request federal intervention in the state’s health.

In a note, the Government of Roraima said that the changes are part of the routine of public administration and that, in the case of health, the changes were aimed at adjusting the flow and response for the population due to the pandemic.

Another state with a high turnover of secretaries was Rio de Janeiro, where the then governor Wilson Witzel (PSC) lost his position in an impeachment process based on Operation Placebo, launched by the Federal Police to investigate health deviations.

In all, there were five Secretaries of Health in the last two years. The first exonerated was Edmar Santos, who left office in May 2020 after the outbreak of the PF operation that identified alleged fraud in contracts in the Health Ministry. At the time, he denied the allegations.

Other other secretaries left office for personal reasons or in the midst of political attrition in the relationship with the then governor Wilson Witzel and, later, with the current governor Cláudio Castro (PL), who took office permanently in May last year.

The state of Amazonas, which saw the health system collapse in January last year with patients dying from lack of oxygen, had four health secretaries appointed by Governor Wilson Lima (União Brasil) throughout the pandemic.

In all, 14 states registered changes in Health Secretaries between January 2020 and March 2022. Of the 30 secretaries who were dismissed in the period, half left due to political wear and tear.

Another nine were the target of complaints of mismanagement or fraud, while five left their positions for personal reasons. Only one state secretary left in 2020 to run in municipal elections.

In addition to the 30 secretaries who left their posts until March, ten more state secretaries left their posts over the last week, to contest the October elections.

Overall, they were secretaries who remained in office throughout the pandemic, gained political muscle and took advantage of the showcase to run in October for legislative terms.

This was the case, for example, of Carlos Lula, former secretary of health of Maranhão and former president Conass (National Council of Secretaries of Health). He will run for state deputy for the PSB.

Researcher Iana Alves, from FGV, highlights the atypical nature of the high turnover of health secretaries during the pandemic period. Since redemocratization, the average of governors was two or three Health Secretaries per term.

She credits the high turnover to the intensification of tensions in a period of crisis, with political attrition and differences of views between governors and secretaries in the conduct of policies to face the pandemic.

Political scientist Lorena Barberia, a professor at USP and scientific coordinator of the Research Network, says that the lack of national management of the pandemic by the federal government has made state secretaries gain prominence and assume new roles in the fight against the pandemic.

“The lack of coordination by the Ministry of Health made the strategies remain at a decentralized level”, highlights the researcher, noting that states had to, on their own, buy respirators and install field hospitals to care for serious Covid patients. -19.

The strategy distinguished itself from other moments of health crises in which Brazil faced with greater harmony, even in contexts of crisis in the relationship between the Union and the states.

The study also researched the profile of state health secretaries and identified that most were professionals with a specialization in management, experience with public health, or both.

On the other hand, the presence of women in health command positions in the states is still small. Currently, only five states have women as health secretaries: Bahia, Rio Grande do Sul, Acre, Sergipe and Roraima.

“It’s hard to understand because women make up the majority of the healthcare workforce,” says Lorena Barberia.