Desafios para a gestão do trabalho em saúde no setor público

Abstract

The discussion concerning the management of health work has increasingly occupied the agenda of health managers and researchers and has become a critical point for implementation of the Brazilian Unified National Health System (SUS) in Brazil.A major challenge for the management of health work has been to adjust the workforce to the health system's new demands for training, professional qualification, and employment.The growth of the Third Sector (or nongovernment public sector) has gained force in Brazil since the country's re-democratization in the 1980s, leading to a considerable increase in the outsourcing of public services, especially in health, through management contracts with Social Organizations ("OS" in the Portuguese-language acronym).The Master Plan for Administrative State Reform (PDRAE), passed in 1995, proposed a management-based configuration for public administration, introducing new legal and administrative modalities. These included the "OS" model, created under Law n. 9,637 of May, 15, 1998, to enable public-private partnerships for the implementation of public policies through management contracts that define and establish mutual commitments between government and outsourced entities, based on the justification of ensuring efficiency and guaranteeing results through such contacts 1 .With regard to labor regulation, the changes resulting from the establishment of outsourced relations (through contracting-out to private institutions) has placed health workers in a vulnerable position, since work contracts are negotiated without workers' participation and few contracts are regulated or establish timeframes for the employment relationship. In addition, since the standards and rules for job admissions, laying-off/firing, contracting, and qualification are determined from outside, they can violate the basic principles of labor relations in the public sector, such as job stability and career advancement. The new model directly impacts the employment structure and work process.How to maintain quality as measured by the acquisition of indispensable skills for proper professional performance? How to guarantee decent working conditions and job stability, essential for retaining health professionals and guaranteeing continuity and bonds "with" and "in" health services? What is the nature of, and control over, these so-called nonprofit organizations?These are some of the questions that have been raised towards this new model of public-private relations in health services provision. The model has not only been criticized by workers and legislators, but is now also the object of inquiry by oversight agencies, especially in the State of Rio de Janeiro.