Election 2022, the health crisis and the SUS bailout

Adriano Massuda, sanitary physician, professor at the Fundação Getulio Vargas School of Business Administration (FGV EAESP) and member of FGV-Saúde. He was a visiting researcher in the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health.

On the eve of the first spherical of elections in 2022, there may be rising concern about the way forward for the Unified Health System. Although the recognition of the significance of SUS in the packages of the presidential candidates is an unprecedented consensus, the pre-election debate didn’t focus on in depth how the candidates intend to face their structural issues.

First, it’s crucial to acknowledge the complexity of Brazil’s health crisis. In addition to the approaching 700,000 deaths from covid-19 (11% of deaths in the world), since 2016 the nation has registered a deterioration in a number of health indicators. Most seen are the stagnation in the downward trajectory of toddler mortality and the improve in maternal mortality, which jumped from a price of 54.8 to 107.2 per 100,000 stay births between 2019 and 2021.

The speedy deterioration of the health state of affairs in Brazil is prone to worsen if pressing measures usually are not taken to appropriate the structural issues in the SUS, exacerbated by the good storm that engulfed the nation since 2015.

Health programs are complicated organizations with interdependent capabilities and strongly influenced by context. Changes in funding and coordination have a direct affect on service supply and health outcomes.

The mixture of the political crisis that led to the impeachment of Dilma Rousseff with the adoption of long-term fiscal austerity measures in the authorities of Michel Temer, culminating in a lethal pandemic beneath Jair Bolsonaro, critically impaired the functioning of the SUS.
At the similar time as fiscal austerity measures worsened the continual underfunding of the SUS, the Ministry of Health utterly disfigured its position as nationwide coordinator of the system.

In the final six years, the nation has had six ministers on this division. Some of whom make no secret of their lack of expertise of what SUS is. Others insisted on exhibiting that their goal at the head of the MS was to cut back the dimension of the SUS to make it match right into a “stringent” funds, whereas opening up the health coffers for spending via parliamentary amendments, increasing the physiologic use of sources.

The predominant expression of the deterioration of SUS performance is the weakening of main health care (PHC). Although Family Health protection has remained at 63% of the inhabitants since 2016, the newest National Health Survey (PNS, 2019) confirmed a pointy decline in the proportion of the inhabitants that reported utilizing PHC companies as an everyday supply of entry to the system (53.7% to 35.9% from 2013 to 2019).

The largest discount in procedures carried out by SUS throughout the pandemic occurred in PHC, the space of ​​the system with the slowest restoration. Worse, since 2016 there was a progressive decline in vaccination protection – a key indicator that measures the power of SUS – reaching the lowest ranges in SUS historical past in 2021, placing the nation at fast danger of re-introduction of ailments resembling polio.

However, if on the one hand the electoral debate doesn’t permit a deep dialogue on the right way to face the structural issues of the SUS, there’s a maturation in the proposals despatched by numerous entities and associations to the presidential candidates, resembling Frente pela Vida, CONASS, IEPS, ANAHP, Sindhosp and CNI.

Despite vital variations between the historic positions of those entities, necessary areas of convergence have been recognized. In addition to recognizing the significance of the SUS in response to covid-19, the paperwork recommend the want to revive federal cooperation to face the pressing challenges of the Brazilian health system.

The proposals additionally converge on key factors to strengthen the SUS:

i) there’s a consensus that strengthening PHC is the most acceptable technique to handle health issues, but it surely must be supplied with extra funding, well-trained professionals and applied sciences, together with data, to combine PHC into health service networks;

ii) it’s typically agreed that the financing of SUS is an issue that must be solved. However, whereas the public sector presents a rise in public sources for health care (from 4% to six% or 7% of GDP), the personal sector presents higher value effectivity;

iii) it’s acknowledged that state governments must play a higher position in the regionalization of SUS to mitigate inequalities and the burden on municipalities with totally different fiscal, technical and administrative capacities;

iv) there’s a convergence that public-private relations must be reconsidered. While public actors suggest bettering regulation of the personal sector to guard the public curiosity, personal actors suggest public-private partnerships to increase service choices;

v) there may be consensus on the pressing must align the coaching, allocation and provision of health professionals, and the improvement and incorporation of health applied sciences to satisfy the wants of SUS;

vi) public and personal actors emphasize the must make higher use of obtainable information in the administration of the system, in addition to to speed up the digital transformation of the SUS.

The factors above don’t cowl the number of challenges going through the SUS, which has established itself as an area for struggles to beat inequality in a rustic that has the scourge of slavery as a colonial legacy. However, they will function a platform for a nationwide pact that brings collectively a variety of alliances between political, financial, judicial and health actors for the financing of the SUS, round the environment friendly distribution of sources and the provision of high quality companies, with out which the proper to health doesn’t exist. materialize.

As former president Luiz Inacio Lula da Silva and Geraldo Alcmin did, traditionally in several political areas who got here collectively to defend democracy in the 2022 elections, it’s crucial to assemble the finest forces in the nation to reserve it SUS as a part of a civilized venture for Brazil.

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