INTERVIEW OF THE MONTH – Rudi RochaOn the economic front, “income reaching those who need it most, the most vulnerable ones, is what will make a difference in the fight against coronavirus”
Agility and coordination are essential to minimize the impacts of the coronavirus pandemic. For Rudi Rocha, PhD in economics, member of the Scientific Council of “Escolhas” and research coordinator of the Institute for Health Policy Studies (IEPS), it is necessary to maintain isolation and social distancing to save time for the preparation of the health system and social protection networks.
In Brazil, part of the population is extremely vulnerable, which requires rapid action. The government, the Executive, the Legislative powers must mobilize quickly to make the funds reach the tip as soon as possible so that people will suffer the consequences of this recession that is coming. For him, “What will make a difference really is the street bureaucracy, is income reaching those who need it most, it is a more coordinated and informative attitude, of the three levels of Power sending the message that these people will be supported, that money is coming, to find out how to access such funds.”
“Buy time. Time has never been so precious.” In the Podcast “Escolhas no Ar”, Rudi Rocha explains how to use this time to our advantage. Click here.
Instituto Escolhas: You are one of the authors of the recent work by the Institute for Health Policy Studies (IEPS), “How to contain the curve in Brazil? Where epidemiology and economics meet“, also signed by Beatriz Rache, Letícia Nunes, Miguel Lago and Arminio Fraga. You address the challenge of designing public policies and distributing funds to protect the most vulnerable ones. What would you highlight in this study?
Rudi Rocha: The study draws attention to the fact that a large part of the Brazilian population is extremely vulnerable, both in terms of the labor market and as concerns health. And there is an important overlap of such vulnerabilities. There is a relatively large group of people who are simultaneously vulnerable from the point of view of this insertion in the labor market and vulnerable also as being carriers of chronic diseases etc. The first message draws attention to exactly that: an important part of Brazil has to be taken care of.
It serves as a response, in the first place, to initial reactions from the Federal Government itself, which, in the first measures, aimed mainly at the formal labor market. So it was a first warning that the informal market and the most vulnerable were also, not only considered, but quickly considered, because the probability of a part of this population falling into poverty or extreme poverty is very high.
The second message is that, considering that the curve of the epidemic has to be suppressed in the most disruptive way possible, and for this to be possible, once again, we have to look exactly at the economic impacts of the health crisis and, again, at the most vulnerable people. So, we cannot ask these workers to simply stay at home waiting for the crisis to pass. People work on their own and are informal out of necessity, and by necessity they need an income flow and continuous earnings. This is another reason for which the government, the Executive, the Legislative powers must mobilize quickly to make the funds reach the tip as soon as possible.
Escolhas – In the study, you talk about the difficulty of knowing who these workers are, that there is a registry that deals with a part of this population, but not necessarily with this whole set of informal workers. How do you analyze the situation where you will quickly have to supply a set of data and know how that money will reach people?
Rudi Rocha: We have platforms and mechanisms for income transfer that really work in the country and cover an important part of the population. Single registration, is an example, it covers tens of millions of people. Very vulnerable people and the poorest people who receive a “Bolsa Família” (family allowance) are actually on the registry, for example, and have access to other programs. The risk, however, is that a part of the population should be on the registry but is not. What worries me most is a part of the population that would not be eligible for social assistance programs, for example, in a typical year, even more so in a year of more recession. But, that would not be eligible because they manage to have the monthly income flow that would allow them to stay above the poverty line or eligibility for assistance programs, but that by the severity of the recession may be entering.
And due to the inability to resort to formal and safe mechanisms, this part of the population will quickly fall into poverty because the recession will be very severe and very fast. We will have to quickly identify, register and make such funds reach these people. For those who are included in the “Bolsa Família” is trivial, the funds already reach this person. It is a matter of increasing income. Every protocol is set up, these people already have a “Caixa”card in hand. The difficulty is to operationalize quick access to a part of the population that will need and is not yet in the registry.
The first challenge is to identify, a priori, who those people are, not necessarily informal workers, but who are these people who will probably quickly suffer the consequences of this recession that is coming. For me this is the most complicated challenge, in logistical terms and one that requires a great speed.
Escolhas: And as regards the measures already disclosed by the Government, some of them are already consistent with what you recommend in the study. What do you need to do besides that?
Rudi Rocha: The challenge of getting it now, quickly, is not trivial at all. And when I speak quickly, I am referring to cases in one week, two weeks. It is one thing for us to want, it is another thing to be able to identify, it is another thing to be able to approve a budget, it is another one to design the eligibility criteria and another thing is to finally make these instruments operational. I would say that the challenge is now, to a large extent, logistical, operational. And another thing that worries me, a priori, is to identify groups that in the combination of all these eligibility criteria, even then, eventually, they can be left out.
Escolhas: Do you have an estimate of what is this contingent that will have to be identified, at a time when people cannot go out on the street or have serious limitations to do so? I imagine the logistical difficulty goes through that.
Rudi Rocha: Right. Brazil has a very large capillarity of social assistance and primary care. It has a contingent of social workers and community health agents that is really important in the country and works. Now, especially in big cities, it is hard. In medium and small cities, all this already works very well. The social worker, the community health agent, knows the territory and can act quickly, integrate and quickly include a family in the registry. Now, it’s not like that in every corner of the country. And even then, once the family is identified, included in the registry, until the money reaches that family … It is not a matter of days because the logistics and operation are complicated and we are talking about actions that need to be taken very quickly.
Escolhas: And in this discussion that you are having between saving lives and saving the economy, in the matter of maintaining social isolation. How to follow these recommendations from the World Health Organization (WHO) and, at the same time, avoid contagion and manage to minimize the economic recession?
Rudi Rocha: It’s a million-dollar question. I think the whole world has been thinking about it for the past few weeks. The epicenter of the pandemic has not yet arrived in developing countries, it is now coming. So, reflections on how to deal with this question in an environment of high social vulnerability, we are still developing this answer.
Notwithstanding that, the magnitude of this first wave that is coming and the impact are not yet clear. But among the likely scenarios, some are extremely worrying. The first thing we need now, and what I have been defending, is to buy time. Time has never been so precious before. Regardless of the dynamics of these curves, what we need now is isolation, social distancing so that we can save time in the preparation of the system, in the preparation of social protection networks. We need to prepare. It is as if a tsunami is coming, we have to prepare. And it is part of this preparation, to try right now to minimize the size of this wave, because in some scenarios it can be so large that it would be impossible to fit in our system. At this initial moment, the priority is to minimize the first wave that will hit.
In parallel, we have instruments. The Ministry of Economics, the Federal Government, the Legislative Power are already mobilizing to, with measures, mitigate the impacts of this second wave, which will be in parallel, of the economic recession. We are observing very conflicting signs from the Federal Government. But, I have a very worried view, but with some optimism, about the speed with which our society has been able to mobilize, react and propose new things. From the first reaction of the Federal Government, for example, to the most recent ones, there really was a great mobilization and it started on the formal ones and quickly went towards the informal ones, the Legislative Power mobilized quickly, we are talking about a few days and a lot of things happened. I would love that the speed had been even greater and that the posture had been much more coordinated and agile. But there is some mobilization even in an environment of very stressed and fragile political institutions.
Escolhas: And do you believe that this mobilization, for example, is what will help contain the pandemic in the slums? Because in the absence of governmental measures, institutions and residents who are taking steps to leave people at home and try to provide the minimum conditions to prevent dissemination.
Rudi Rocha: It helps, but it is far from enough. Nowadays nothing can be discarded, but what will make a difference really is the street bureaucracy, the public administration, the social workers, the community agents, the income reaching those who need it most, it is a more coordinated and informative attitude, of the three levels of Power and jointly with the Legislative sending the message that these people will be supported, that money is coming, for them to find out how to access such funds. But, in fact, we still do not know how the disease will spread in environments with extremely high population density and super precarious urban infrastructure. The scenarios are not good. But, I would say that more than ever we need a coordinated response from the Government and voluntary aid is super important, but we need scale.
Escolhas: In this issue of the discussion of coordinated action, there is a point about what Government will be when all this is over, there will be a more integrated Government, a federalism, and all this is very connected to the SUS. Although it is called the Unified Health System, it is structured because it has defined visions of each one’s role. What is the analysis of the Institute in relation to this public policy design, which already exists and may undergo a remodelling?
Rudi Rocha: The more macro answer is that tensions between Governmental entities will be extremely stressed now to the limit. In particular, it is already very clear what is happening between the Federal Government and the states. In the municipalities, more than ever, we will need this coordinated action. In fact, the tip is in the hands of the cities. A week ago, I, Miguel (Lago) and Armínio (Fraga) wrote the article “Coronavirus crisis: municipalities can turn the tables” and it is in this direction. Especially when we look at social assistance policies, primary care policy, that is, prevention at the tip, information, registration and, at some point, testing, those professionals that are directly connected to the municipalities can make a difference. But remembering that the SUS is a Single System and all that we would need to have at this time, but that is very fragile, particularly in the SUS, is exactly the coordination of the flow of care at the levels of care.