World Bank Health Sector Reforms in Brazil: 1990s Analysis

World Bank and Brazilian Health Reform in the 1990s

Abstract: We analyze the World Bank's proposals for reforming the Brazilian health sector, explaining aspects assimilated by the Brazilian government in implementing the Unified Health System (SUS) during the 1990s. We assume that projects and programs funded by the World Bank aimed to contribute to economic and social development. However, through loan agreements and conditionalities, the Bank sought to influence national policies, provoking an unannounced counter-reform to restrict or annul constitutional rights.

Social rights, including the right to health expressed in the 1988 Federal Constitution, resulted from a multifaceted process reflecting contradictions within Brazilian society, which had been experiencing an economic and political crisis since the early 1980s. During and after the constitution's preparation, national and international voices expressed discontent. It seemed clear to the economic elite and part of the political class that implementing constitutional rights would hinder capital's interests. The World Bank's displeasure with the progress of constitutional rights in Brazil was evident in two documents: Brazil: New Challenge of Adult Health (1991) and The Organization, Financing, and Provision of Health in Brazil: An Agenda for the 1990s. Generally, the World Bank's proposals for peripheral countries like Brazil went beyond assisting in political and economic stabilization. They served as a tool for the Bank's 'humanization,' articulated with 'strategic issues' concerning internal and external security and central to the organization of the capitalist world. Under World Bank President Wolfensohn, alleviating poverty and maintaining it at bearable levels was deemed necessary for future growth. There was a strong emphasis on basic human needs, such as funding for poverty reduction programs, basic education, and primary healthcare.

World Bank Proposals for Brazil's Health Sector

The World Bank focused on fighting poverty. Key loans in the last decade included:

• Design of surveillance and disease control
• Prevention and control of STDs/AIDS
• Strengthening and reorganization of the National Health System