Lula Government favors PT and allies’ management in Health – 02/19/2024 – Power

The Lula (PT) government privileged allied and PT mayors and governors with extra funds released by the Ministry of Health to finance actions in hospitals and outpatient clinics in 2023.

The municipality of Rio de Janeiro, which received R$360 million, and the states of Maranhão, Rio Grande do Norte and Pará lead the transfers made in a single installment, mainly in the last months of the year. The additional funding totaled R$1.37 billion and was distributed to more than 60 departments.

The amount was released by the department headed by Nísia Trindade. The minister is one of the main targets of the centrão bloc, which maintains constant pressure on the Lula government to obtain more health resources and still covets the command of the department.

The money came out after requests for “reinforcements” to finance medium and high complexity activities, a sector classified by the acronym MAC by SUS managers.

The ministry says it followed technical criteria. “The current administration was faced with underfunded services and health policies at risk without the guarantee of the necessary budget throughout the country”, stated the ministry.

Adding parliamentary amendments, Samu and other funds negotiated with Congress, the ministry transferred more than R$70 billion to states and municipalities to finance investments and costs in hospitals and outpatient clinics during the year.

The list of biggest beneficiaries of the extra resource also includes, among others, Araraquara, Diadema and Matão, municipalities in the interior of São Paulo controlled by the PT, in addition to Cabo Frio (RJ), which gained an additional R$55.4 million in December , more than the extra amount allocated to the state of São Paulo.

The money practically doubled the year’s transfer to the city of Rio de Janeiro. Márcio Lima Sampaio, son of minister Nísia, became municipal secretary of culture of Cabo Frio in January 2024. The Health department denies any relationship between the appointment and the reinforcement made to the municipality.

The criteria for distributing the additional MAC figure are among the questions presented to Minister Nísia by the president of the Chamber of Deputies, Arthur Lira (PP-AL), and leaders of the center.

Authorities who followed the negotiations say that the extra transfer balanced the distribution of the different types of Health funds, especially to places that are not strongholds of the centrão, the group that controls most of the parliamentary amendments.

“Resources for high and medium complexity should not be analyzed in a partial way, isolating certain types of installments and failing to understand a global analysis, as any isolated cuts do not reflect the reality of total federal funding,” said Saúde.

Mayor of Araraquara, Edinho Silva (PT) stated that the services supported by the extra funds benefit several municipalities in the region, including those owned by opposition mayors. He also said that the management of Health in the Bolsonaro government and the increase in funding from parliamentary amendments distorted the criteria for transfers for high and medium complexity.

“We did not receive the necessary resources to face the pandemic, this increased health expenditure to 45% [do orçamento municipal]which is absolutely unrealistic, no city can survive with health expenditure at this level”, said Edinho.

In a statement, Diadema City Hall said that the extra resources will be used to “complement the cost” of high-complexity, medium-sized local healthcare, estimated at R$192 million annually.

Hortolândia (SP), led by Zezé Gomes (former PT, PL and current Republicans), received an additional R$50.7 million last November. The figure exceeds the municipality’s approximately R$30 million ceiling.

The federal government finances part of the medium and high complexity health activities. The amount transferred to states and municipalities, known as the “MAC ceiling”, takes into account exams, surgeries and care provided at each location, among other factors. Local governments, in general, believe that the transfer could be greater and maintain pressure on Health to increase the ceiling.

In addition to the amount programmed by the ceiling, which is transferred in monthly installments, medium and high complexity financing can be reinforced by parliamentary amendments and by the extra funds that are usually distributed by Health when there is a surplus or contribution of resources to the ministry.

In the case of Hortolândia, the amount was sent to the city by “President Lula’s decision”, said the Minister of Institutional Relations, Alexandre Padilha (PT), in a video posted on social media.

The city hall declared that the additional resource is “technical in nature”.

The Government of Pará, led by Helder Barbalho (MDB), an ally of Lula, stated that the funds were intended for “emergency financial assistance to public units that were being financed exclusively with state resources”.

The state of São Paulo, governed by Tarcísio de Freitas (Republicans), is 10th in the ranking in the sum of single installment transfers, the best position among a management not aligned with the federal government. The state secretariat received R$50 million in this type of reinforcement.

Health states that it only releases extra resources when a request is approved by the commission that brings together municipal and state secretaries. Factors such as procedures performed on site, installed capacity of the service network, available beds and actions without federal funding are still evaluated, according to the ministry.

“It is obvious that any government will induce public policies aligned with its characteristics and objectives. This is good,” said Rio’s municipal secretary, Daniel Soranz (PSD) about the additional transfers. The city is commanded by Eduardo Paes (PSD), an ally of Lula.

The highest MAC ceiling among municipalities is in Belo Horizonte, at R$1.6 billion. The capital of Minas Gerais received around R$600 per capita in 2022 from the ministry’s own medium and high complexity budget (without adding amendments).

In the same cut, Rio had R$190 per inhabitant. SUS and city managers cite this type of example to defend compensation, for example, with increased funding in a single installment.

“These specific entries are linked to the implementation of new services, they are important, they are very worthwhile, but most of the time they are mere compensation for what these cities and states have lost [de financiamento]. When you look and calculate the per capita value of MAC for some cities, there is an absurd distortion”, stated the municipal secretary of Rio.

In some cases, the city halls benefiting from additional transfers received funds that multiplied their resources.

Matão (SP), governed by the PT, received an investment of R$16.5 million in December, an amount more than eight times higher than the annual ceiling of R$2 million. In a note, the city hall said that the figure is not directed to municipal management, but to a philanthropic hospital located in the city.

The Institutional Relations Secretariat, headed by Padilha, said that “it does not indicate beneficiaries for the execution of transfers”. Health said, in a note, that it incorporated around R$8 billion into MAC transfers, covering more than 2,900 Brazilian municipalities and 4,400 health establishments throughout Brazil.”