On August 26, the city of Asunción witnessed a key event for Latin American trade unionism and, in particular, for those who defend health as a fundamental human right. During the International Health Forum "For the right to public health: decent work and quality public services", Paraguayan nurses made it clear that they no longer accept the historical invisibility and structural precariousness that have marked them for decades.

The forum, organized by the Paraguayan Nursing Association (APE) in conjunction with Public Services International (PSI), within the framework of the Union to Union project, took place in a convulsed regional political context, where the advance of neoliberal policies and the growing influence of private capital in the health sector are jeopardizing the universal and solidarity-based nature of public systems.

The initial panel was dedicated to analyzing how private capital has captured health systems in Latin America, weakening the role of the State and generating profound inequities. Mirna Gallardo, president of the APE, opened the forum together with the president of the Central Unitaria de Trabajadores (CUT) of Paraguay, Mirtha Arias and representatives of the PSI, and then intervened in the panel dedicated to working conditions in the health sector, where she forcefully exposed the problems faced by nursing professionals: chronic work overload, outsourcing that degrades rights and the persistent lack of professional recognition. Her intervention was not limited to denouncing the problems, but she proposed a horizon of dignity, convinced that the union organization of nursing personnel is strategic for the defense of the public health system.

The former Paraguayan minister, Edgard Giménez, emphasized the need to strengthen primary and family care, as well as to implement fiscal reforms to ensure sustainable financing.

Pedro Villardi, PSI regional health officer, warned that "multinationals have extended their tentacles in our countries, generating dependence on market logic and weakening the capacity of the States to guarantee equity. The pattern is repeated in Brazil, Mexico, Chile, Paraguay, Colombia and Peru: defunding of public health, job insecurity and mechanisms to capture the public sector. The result is that health becomes a consumer good accessible only to those who can pay, leaving behind the idea of a universal right."

From Chile, former minister María Fernanda Villegas added a complementary view, pointing out that privatization not only limits access to services, but also erodes working conditions: "Each privatization process translates into fragmentation of care, loss of job stability and a silent stripping of rights that have been won. This affects both users and health workers, who see their quality of life deteriorate while they support increasingly fragile systems" .

Nayareth Quevedo, PSI Cono Sur sub-regional secretary, in her opening remarks, said: "We are at a historic and challenging moment for our peoples. Wherever the privatization agenda is imposed, what is going backwards is not only the capacity of the States to guarantee health, education or social security, but also the hope of millions of people who need a present State and solid public systems".

The voice of nursing and the trade union agenda

In a country where the healthcare model has historically been built on the basis of emergency care and with insufficient funding -as recalled by former minister Edgard Giménez-, Gallardo's voice projects an urgent call to transform the structure of the system. Betting on a model of primary and family care, in which nursing plays an irreplaceable role, is one of the keys to advance towards the universality of the right to health.

The second panel, moderated by Germán González, expanded on this view. Miguel Mejía, president of the Union of Medical, Hospital and Similar Workers of Honduras (SITRAMEDHYS), told how the precariousness of labor in his country impacts not only on the lives of health personnel, but also on the quality of the services provided, and how union action has made it possible to carry out collective bargaining processes to improve the working conditions of its members. In turn, María Fernanda Boriotti, president of the Argentinean Federation of Health Professionals Trade Union (FESPROSA), denounced the defunding of public services by Javier Milei's government and its direct correlate in the deterioration of working conditions and the delivery of health care to the population with the closure of emblematic hospitals such as the pediatric center "Dr. Juan P. Garrahan".

These interventions consolidated a shared union vision: without decent work, it is not possible to guarantee quality health services. The defense of the public system necessarily involves dignifying the work of those who support it on a daily basis and the investment of the State in robust health systems.

Challenges ahead

The forum concluded with the certainty that the region faces common challenges that require collective responses. For the Paraguayan Nursing Association, the main challenge will be to consolidate its role as a union and political actor, gaining space in public discussion and gaining professional recognition for nursing. This task intersects with the need to advance gender equality, given the feminized nature of the sector.

For the health union movement as a whole, the challenges are equally clear: to stop the advance of private capital, regulate the power of corporations, and build a shared narrative that places health as a universal right and not as a consumer good. This also implies building alliances with social movements, deepening trade union action at the international level and proposing fiscal reforms to ensure sufficient resources to sustain quality public systems.