Precarização dos vínculos de trabalho na estratégia saúde da família: revisão de literatura

Abstract

The Reform of the State, with its reduction in the 90s, impelled the adoption of precarious labor arrangements at the same moment that the decentralization of SUS occurred. The enormous increase of public health jobs at the municipal level, followed by legal restrictions, such as the Law of Fiscal Responsibility, stimulated the adoption of diverse hiring practices. The Family Health Strategy (Estratégia Saúde da Família-ESF) was created concomitant with this process, and its considered, currently, as the prime strategy in the reorganization of the health system in the nation. With instable labor contracts, professionals were susceptible to the instability of politics and predatory dispute among the municipalities, leading to the rotation of health professionals and health care gaps. The break of the professional link with the assisted population compromises one of the principals of the ESF. In 2003, the Secretariat of Labor and Education Management for Health in the Ministry of Health was created, with the purpose of formulating policies that guide the management, education, qualification and regulation of health workers in Brazil, considered critical for the sustainability of ESF and of SUS. To formulate policies and guidelines that search solutions to face precarious work contracts across the country, the National Interinstitutional Committee for the Elimination of Precarious Employment Agreements in SUS was created. This study reflects a narrative literature review on this precarious labor arrangements in the ESF, the historical context of its creation and the implementation of the Labor Management in SUS, as well as researches which authors analyzed the types of contracts in member of the ESF teams. This review allowed identifying that, although the precarious contractual agreements are still present among ESF teams, their numbers have gone down. Therefore the need to formulate solutions to face this challenge persists.