Budget for indigenous health is the lowest since 2023 – 02/17/2023 – Health

The 2023 budget for health care for indigenous peoples in the country is the lowest in the last ten years. Compared to 2014, the value fell by 24%.

The information is contained in a new bulletin from the Institute of Studies for Health Policies (Ieps) produced in partnership with Umane. The work is based on data from the Integrated System of Financial Administration of the Federal Government (Siafi).

“The retraction in the budget can exacerbate problems in the provision of health services that already exist in indigenous communities”, says Victor Nobre, public policy assistant at Ieps.

The Ministry of Health told the Sheet “the 2023 budget proposal, sent by the previous management to Congress, was insufficient to meet indigenous health expenses”. Then, the transition of government, negotiated to recompose the budget and reach the current values.

He also stated that “the portfolio is attentive to budget needs and maintains a permanent dialogue with the economic area and with the National Congress”.

The values ​​compiled by the bulletin refer to the Annual Budget Laws (LOAs) and were corrected according to the IPCA (National Index of Extended Consumer Prices) of December 2022.

The budget law regulates federal government expenditures. It is developed in the year prior to which it refers: for example, the 2023 law was designed last year. Initially, a plan is drawn up, called the Ploa (Annual Budget Law Project), designed by the Executive and sent to the National Congress.

Before being enacted, the project may undergo changes. One case is the assistance for the promotion of indigenous health in 2023. This amount is used to cover most of the costs involved in health in indigenous villages, such as supplying medicines and paying salaries to employees.

Initially, approximately R$ 609 million were earmarked. But, in the final version of the text, which when sanctioned becomes the LOA, the budget for assistance to the indigenous health promotion program rose to approximately R$ 1.5 billion.

Between 2014 and 2017, the amount exceeded BRL 2 billion each year. As of 2018, the amount was below this total and, with the exception of 2022, it continued to fall over the years.

Another budget item related to health is basic sanitation, which includes measures such as carrying out works to supply drinking water. This reached a record in 2023: BRL 145 million, almost triple compared to the previous year.

Together, sanitation and health care reach R$ 1.7 billion. Even so, this figure is the second lowest in the last ten years. It only loses to 2021, with approximately R$ 1.6 billion.

Investment in indigenous health came back to the fore with the crisis in the Yanomami land, in Roraima. Severe malnutrition, malaria and pneumonia were some of the conditions seen in the community. In the territory, there is a lack of basic supplies and health units are in a poor state of conservation.

Paulo Abati, an infectious disease specialist in indigenous health and assistant professor at the Faculty of Medical Sciences at Unicamp, says that the reduction in the budget affects the health of indigenous peoples in different ways. One of them is the downsizing of health surveillance action.

“Part of this catastrophe [dos yanomamis] it is due to a lack of epidemiological surveillance, which is directly related to a lack of funding for us to map what was happening in that territory in recent years”, he says.

Without a mapping of the main health problems, the design of an adapted health strategy, such as for the supply of medicines whose need is greater in those communities, is hampered.

The funding shortfall also makes it more difficult to provide supplies to treat illnesses in general.

“The reduction in funds deepens existing problems and makes this population even more vulnerable”, summarizes Nobre, from Ieps.

In the current crisis of the Yanomami, for example, there is a lack of basic supplies such as medicine and syringes.

Abati recently visited the community. “I was with the Yanomami last year […] and we took all the medicines, because there were no medicines at the base pole. They are basic medicines for worms. Very simple things.”

Another point that enters this equation is the way indigenous health is structured.

The responsibility for financing this portion of health rests with the Federal Government by making funding available directly to the DSEIs (Special Indigenous Health Districts). In other areas of public health, this obligation is shared with states and municipalities – in the case of indigenous people, these spheres can only be complementary actors.

As it is a responsibility of the federal government, the reduction of investments in indigenous health is even more critical, says Abati. “If we have fluctuations in the financing of indigenous health, we have the repercussions at the end as a result of a decrease [no orçamento].”

A Sheet sought out the former Ministers of Health who took over the portfolio from 2018, the year in which the sharpest drop in the budget for assistance to indigenous peoples for health promotion began.

Ricardo Barros, holder of the portfolio between 2016 and March 2018, said that he increased budget execution during his term. He also stated that he strengthened the indigenous health districts, expanding services to this population, and that he had the collaboration of indigenous leaders in decision-making.

Gilberto Ochhi, who took over the portfolio in April 2018 and remained until the end of the Temer government, said that the 2018 budget had already been defined when he took office. Even so, he reiterated that he had no problem with the financial resources allocated to Sesai (Special Secretariat for Indigenous Health).

Henrique Mandetta, who headed the ministry from January 2019 to April 2020, said he had already entered the ministry with the 2019 budget ready to be executed. As for 2020, he stated that the budget was in line with the needs of indigenous districts.

Nelson Teich, Mandetta’s replacement who appeared for less than a month as minister in 2020, said he did not have access to the LOA budget project. Teich added that, during his tenure, the main focus was Covid-19, considering the seriousness of the health crisis.

Eduardo Pazuello, who took over the ministry after four months as an interim and held the position until March 2021, and Marcelo Queiroga, who succeeded him and remained in the post until the end of the Bolsonaro government, did not respond to the report.