Adriano Masuda, sanitary doctor, professor of the School of Business Administration of Fundaco Getulio Vargas (FGV EAESP) and member of FGV-Saúde. He was a visiting researcher within the Department of Global Health and Population on the Harvard TH Chan School of Public Health.
On the eve of the primary spherical of elections in 2022, issues are rising concerning the future of the unified health system. Although there was unprecedented consensus within the recognition of the significance of SUS within the applications of presidential candidates, the electoral debate didn’t focus on in depth how the candidates supposed to cope with their structural issues.
First, you will need to acknowledge the complexity of Brazil’s health crisis. In addition to approaching 700 thousand deaths from Covid-19 (11% of deaths on the earth), the nation has been registering a deterioration in a number of health indicators since 2016. Most notable is the stabilization within the downward trajectory of toddler mortality and the rise in maternal mortality, which rose from 54.8 to 107.2 per 100,000 stay births between 2019 and 2021.
The fast deterioration of Brazil’s health situations will worsen until speedy motion is taken to appropriate the structural issues within the SUS, exacerbated by the hurricanes which have engulfed the nation since 2015.
Health methods are advanced organizations, with interdependent features and are strongly influenced by context. Changes in funding and coordination have speedy impacts on service supply and health outcomes.
The mixture of the political crisis culminating within the impeachment of Dilma Rousseff, with the adoption of long-term fiscal austerity measures within the authorities of Michel Temer, culminating in a lethal pandemic underneath the administration of Jair Bolsonaro, has severely undermined authorities efficiency. SUS.
At the identical time that fiscal austerity measures worsened the continual underfunding of the SUS, the Ministry of Health’s function as nationwide coordinator of the system was fully distorted.
In the final six years, the nation has counted six ministers on this portfolio. Some of whom didn’t conceal their lack of information of what SUS was. Others insisted on displaying that his goal on the head of the MS was to scale back the dimensions of the SUS in order that it will match into the “austere” finances, whereas opening up the health coffers for spending by means of parliamentary reforms, together with increasing physiology. sources
A significant manifestation of the deterioration of SUS effectivity is the weakening of Primary Health Care (PHC). Although household health protection has remained at 63% of the inhabitants since 2016, the most recent National Health Survey (PNS, 2019) confirmed a pointy decline within the price of the inhabitants that reported utilizing PHC providers as a daily supply of entry to the system. 53.7% to 35.9% from 2013 to 2019).
The largest decline in SUS operations through the pandemic occurred in PHCs, the world of the system with the slowest restoration. Worse, since 2016, there was a progressive decline in vaccination protection – a primary indicator that measures the energy of PHC – reaching the bottom degree in SUS historical past in 2021, placing the nation at imminent threat of resurgence of ailments. reminiscent of polio.
However, if on the one hand the electoral debate didn’t permit an in-depth dialogue on how you can cope with the structural issues of the SUS, the proposals despatched to the presidential candidates by numerous organizations and associations, reminiscent of Frente pela Vida, are maturing. CONASS, IEPS, ANAHP, Sindhosp and CNI.
Despite vital variations between the historic positions of these establishments, necessary areas of convergence are recognized. In addition to recognizing the relevance of the SUS within the response to Covid-19, the paperwork point out that it’s essential to get better federal cooperation to face the speedy challenges of the Brazilian health system.
The proposals additionally converge on key points to strengthen SUS:
i) There is a consensus that strengthening PHC is probably the most applicable technique to handle health issues, but it surely requires extra funding, well-trained professionals and know-how together with info to combine PHC into the health service community;
ii) It is a normal recognition that SUS funding is an issue that must be addressed. However, whereas the general public sector proposes to extend public sources for health (4% to six% or 7% of GDP), the non-public sector suggests better effectivity in spending;
iii) It is acknowledged that state governments must play a better function within the regionalization of SUS to scale back disparities and cut back the burden on municipalities with totally different monetary, technical and administrative capacities;
iv) There is coordination that must be reviewed in public-private relations. While public actors suggest reforming the regulation of the non-public sector to guard the general public curiosity, non-public ones counsel public-private partnerships to broaden the providing of providers;
v) There is consensus on the urgency of aligning the coaching, allocation and provision of health professionals, in addition to the event and inclusion of health applied sciences to satisfy the wants of SUS;
vi) Public and non-public actors emphasize the necessity for higher use of obtainable knowledge within the administration of the system, in addition to accelerating the digital transformation of the SUS.
The above factors are removed from protecting the range of challenges going through the SUS, which has established itself as an area for battle to beat inequalities in a rustic stricken by slavery as a colonial legacy. However, they’ll function a discussion board for a nationwide settlement, which brings collectively a variety of alliances between political, financial, judiciary and health sector actors for the financing of SUS, across the environment friendly allocation of sources and the supply of high quality. providers. , with out which the precise to health isn’t realized.
As half of what former presidents Luiz Inacio Lula da Silva and Geraldo Alcamin did in traditionally totally different political spheres, who got here collectively to defend democracy within the 2022 elections, it’s essential to mobilize the nation’s greatest forces to defend the SUS. A civilizing venture for Brazil.