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Original article: Recorte del 3% del área Salud: La atención primaria debe prepararse para enfrentar un verdadero y triste desastre, no una «emergencia»

By Fabricio González Berríos, President of Confusam Region of Valparaíso

Since the end of the pandemic, primary health care has been grappling with a challenging, harsh, and disheartening environment.

The systematic budget cuts, the freeze of per capita allocations for two consecutive years, and the reduction of staffing levels that had steadily increased to cover critical areas during the COVID pandemic have led to increased workloads and a noticeable decline in service quality, especially in the most vulnerable regions of the country.

The government change, admittedly, never held high expectations. The macroeconomic strategy of the former president Boric’s team, led by Finance Minister Mario Marcel, aimed to stabilize the economy that was facing concerning indicators like inflation nearing 12%, inherited from the administration of Sebastián Piñera, which directly impacted family purchasing power.

Through a typical neoliberal approach, public spending was reduced, and fiscal discipline was strengthened, negatively impacting sensitive areas like healthcare. Since 2023, staff shortages and the difficulty in acquiring supplies and medications have been commonplace.

With the new government, which throughout its campaign portrayed public sector employees as parasitic excess, and promised to cut taxes for large national and multinational corporations, resulting in diminishing state revenues, the prospect of a larger and more comprehensive budget is nearly non-existent.

Thus, the 3% reduction in the national budget, as indicated by circular N°12 dispatched by the new Finance Minister, Mr. Jorge Quiroz (a businessman involved in the chicken collusion scandal), which amounts to approximately 517 million pesos cut from the health sector alone, comes as no surprise. This does not even include cuts to education, housing, and other areas that are social determinants of health, which, although not part of the formal health system governed by the Ministry of Health (Minsal), will nonetheless impact people’s health by altering and undermining social and economic conditions.

As the circular announces, the coming years will be marked by a permanent loss, as we have already been acknowledging, of rights and working conditions for health workers who will have to adapt to situations such as: modifications to medical leave laws, which unfortunately penalize sick workers; the lack of replacements for staff on leave, placing the burden on health teams to redistribute their tasks; gradual staffing reductions due to hiring freezes and the absence of replacements for colleagues retiring; elimination of reinforcement programs for Primary Health Care (APS) that do not meet the required ‘impact’ or productivity outcomes; prioritization of investments that leads to delays in renewing and implementing new infrastructures for health centers across the country, which health workers and the community have been waiting for years.

In light of this tragic, demoralizing, and restrictive reality: Can APS workers fulfill their obligations, responsibilities, and provide dignified care to the people of Chile?

The answer is clear. APS has demonstrated since the pandemic that it possesses a unique capacity for flexibility to adapt to complex scenarios and challenging realities, as its members are committed to public health—from working in facilities that do not meet basic habitability conditions to safeguarding lives and health during disasters, as evidenced by the recent fires in Viña del Mar and Bio-Bio.

However, dismantling APS as intended through budget cuts will inevitably spike the country’s epidemiological indicators, which have been internationally recognized for being controlled by a strong, cohesive network in South America.

This will affect the quality of life for individuals and communities, further straining the secondary health sector, with thousands of patients suffering from cardiovascular issues among other conditions that require primary care, ultimately leading to a predictable and avoidable health disaster.

Today, workers affiliated with Confusam bear a greater responsibility: to safeguard APS and our labor rights, enshrined in the primary healthcare statute, which have guaranteed a minimum standard of quality care for communities accessing health centers.

It is time to take charge of the effects of a government with such characteristics. We know that behind a process of precarization comes a wave of privatization, which we cannot afford to let inch into our sector.

Medical societies have a history of sustained pressure to infiltrate primary care, and scenarios of municipalities being financially crippled and in crisis are breeding grounds for the health business to enter the public sector.

Handing over the management of our facilities and health centers to the private sector can indeed be called an emergency, as it would dismantle the healthcare system as we know it, creating a landscape devoid of access to a right considered universal: healthcare. In other words, a true and tragic DISASTER.

(*) Fabricio González Berríos is the president of Confusam Region of Valparaíso, a Kinesiologist graduate from the University of Valparaíso, a Master’s in Public Health student at UNAB, and a worker at the Dr. Miguel Concha health center in Quillota.

La entrada 3% Cut to Health Sector: Primary Care Must Prepare for a True and Sad Disaster, Not Just an ‘Emergency’ se publicó primero en El Ciudadano.