Labor relations under decentralized health management and dilemmas in the relationship between work expansion and casualization in the Brazilian Unified National Health System

This article analyzes the logic behind human resources management in primary health care from the perspective of municipal health systems administrators in Brazil, rethinking the decentralization process based on mediation between Federal government guidelines and the health services' daily practice. This was a cross-sectional study using a semi-structured questionnaire applied to municipal health secretaries in the Southeastern Health Macro-Region (Minas Gerais State). The municipal health secretaries had a mean age of 39.4 years and low schooling, and a large proportion did not belong to the health field. As for the workforce in the Family Health Program, the municipal governments hired 93.3% of the health professionals, mostly on temporary contracts. The findings confirm gaps in the workers' political and social rights. Paradoxically, the government itself, through the municipal administration, is responsible for failing to comply with the prevailing labor legislation.