Reports point to failures in the inspection of social health organizations in SP

The inspection of social organizations that manage public health in São Paulo has records of failures, weaknesses and lack of procedures by the Municipal Health Department.

The notes are in reports from the TCM (Court of Accounts of the Municipality) that had excerpts included in an order signed by prosecutor Arthur Pinto Filho, from the Public Health Prosecutor’s Office.

The 18-page document was a call for representatives of the municipal secretariat, the TCM and the Municipal Health Council to participate in a meeting at the Public Ministry of São Paulo on August 8th. The outcome of the meeting was not reported.

The reports were sent by the Court of Auditors to a public civil inquiry by the Prosecutor’s Office, which was split off from another, in 2006, which investigated the lack of inspection of agreements signed at the time for the management of AMAs (Medical Assistance Outpatient Clinics).

In the convening document for the meeting, the prosecutor mentions that there was a need for investigations into items such as the structuring of the inspection area of ​​management contracts and agreements, evolution of the rendering of accounts of terminated agreements and whether amounts were returned in cases of accountability made spontaneously.

One of the TCM reports that helped to guide the call, which analyzed the period between January 1 and November 30, 2019, pointed out, among other points, that the functional structure of the CPCSS (Coordination of Partnership and Contracting of Health Services) was insufficient to carry out its purposes.

In a note this Friday (19), the city hall said that the coordinator, responsible for the financial and accounting verification of the accountability of partner social organizations, will be expanded from 28 to 43 professionals. “The expansion is the result of an order published on the 12th in the Official Gazette of the Municipality,” he said in a note.

The text also said that Mayor Ricardo Nunes (MDB) determined that the municipal secretariats of Management and Finance provide technical-operational support for the designation of 15 servers for the Municipal Health Secretariat, in order to strengthen and improve control. accountability of partner organizations.

In the 2019 report made available by the TCM to the Public Ministry, it was also pointed out that between 2014 and that year there was a 503.77% increase in transfers to management contracts and that at least two contract renewals did not comply with the decree on the qualification of non-profit entities as social organizations.

Another item mentioned that the system for rendering accounts of social organizations is fragile and allows these entities to change data at any time.

The city government informed the court that the contracting of a new system was in the price research phase. To the report, this Thursday, the municipal administration stated that on the 12th, a public tender was published for the development of Sicap (Integrated System of Control and Evaluation of Partnerships), to modernize the control of accountability of social organizations.

“The objective is to replace the current system with a more modern, efficient and with better data processing capacity.”

The report delivered to the prosecution informed that the CAF (Administration and Finance Coordination) had not been established and that no meetings were held in 2019.

The court pointed out that there was no effective control to assess whether social organizations carried out purchases and contracts in accordance with regulations.

In its responses, the municipal health ministry said, according to the summons from the Public Ministry, that it was taking steps to correct faults and listed improvement procedures.

THE Sheet, the Municipal Health Department stated that there are several control mechanisms. The inspection of care assistance, for example, says in a note, is carried out in all regions of the city by professionals from the CRSs (Regional Health Coordinations) and STSs (Technical Health Supervisions).

“The secretariat constantly controls and inspects the services performed and the accountability of social organizations and applies penalties for non-compliance with goals, such as those related to the stipulated number of professionals to serve the population. On average, this year, the penalties reach R $20 million monthly,” the folder said.

Asked this Thursday about how many contracts the city has with social health organizations and how much they cost per month, the Nunes administration did not respond.

The city government argues that the model of partnerships with social organizations makes it possible to make better use of financial and human resources.

“Were it not for the OSSs model, hospitals in Brasilândia [zona norte] and Bela Vista [centro] would not have been anticipated”, he said, about the opening of the units during the Covid-19 pandemic.

This Thursday, there was a protest in front of the city hall because of the dismissal of about 1,300 employees of the Hospital da Brasilândia, after the change of the social organization that manages the place. Workers complain about the difficulty of obtaining the termination of contracts to apply for unemployment insurance and FGTS (Fundo de Garantia por Tempo de Serviço).

The hospital in the north, which in the pandemic came to work with 400 beds, now has 206, and recently started to serve as an open-door emergency room. The number of employees is expected to drop to 800 people.