Opinion – Saúde em Público: How can budget cuts affect Brazil’s Digital Health Strategy?

Digital health is a heated agenda in the academic, care and economic environment. At the global level, the sector raised US$ 10.3 billion in the first half of 2022 and there are currently 1,023 healthtechs on the market in Brazil alone. This emphasis is due to the needs driven by the COVID-19 pandemic, accompanied, at the local level, by the new General Data Protection Law (LGPD), by the negotiations for the expansion and regulation of telehealth and by the perspective of the arrival of 5G.

The promise that new technologies will promote the integration of information, reduce waste and improve people’s care experience, is an objective that, to be achieved, depends on a series of previous agreements that need to be supported by a robust strategy and financially sustainable. The Digital Health Strategy for Brazil (ESD28), published by the Ministry of Health in 2020, systematizes what we can expect in terms of digital health for the next eight years, having as priorities, among others, the guarantee of computerization and the exchange of information. information between health facilities.

Although there are efforts to advance the debate from a normative point of view – since the ESD28 represents a set of intentions based on national experience and aligned with what the cases of countries that managed to achieve successful results propose -, the materialization of the Strategy still lacks the definition of pragmatic goals and financial contributions for its execution.

In the Health Budget Monitoring Bulletin nº 01, we reported that in the Budget Law Project for 2023, the actions oriented to the costing of the Department of Informatics of the Unified Health System (DATASUS) and to the promotion of digital health and telehealth in the SUS are forecast to drop by R$206 million (-60%) and R$26 million (-63%), respectively. Budget cuts put at risk advances already achieved, such as the implementation of free electronic medical records in Primary Health Care, which allows the integration of health information, and the ConectSUS Cidadão application, which provides important services such as national vaccination certification. The actions of innovation, research and technological development in health, in turn, also show a forecast of a fall of R$ 297 million (-65.7%), corroborating the pessimistic expectations about advances in the area.

In addition to the volume of available resources, it is important to analyze how the budget is managed. A study dedicated to quantifying the speed of innovation diffusion compared Finland and Germany and showed that in Finland, where there was a state-coordinated process, electronic medical records were adopted more quickly than in Germany, where almost free market forces led to adoption without the encouragement of a policy. In the Brazilian context, despite the governance of the ESD28 being centered on DATASUS, being a complex scalability project, in a country of continental dimensions, an important step would be to adjust the Strategy’s action plan so that the Department is able to lead a team beyond its borders and thus reach all regions of the country.

The computerization pilot project in the state of Alagoas is a concrete example of how the receipt of funding for implementation, by itself, is not reflected in accelerated computerization. First, it is necessary to map local needs and prepare the workforce to face operationalization challenges. Thinking about ESD28 more broadly, in an ideal scenario, the budget should be directed towards the allocation of capillary teams to support states and municipalities in the implementation and use of available technologies, stimulating interoperability and agility.

However, cutting investments without a transparent and justified contingency exit points to a process of maturation and collection of ESD results28 taking longer than the eight years desired by the Ministry of Health. What we can predict as direct consequences are the delay in the qualification of health services, given that studies have already shown how much professionals and users tend to gain from interventions mediated by digital tools; and a trend towards greater fragmentation of the Health System, due to the technological mismatch that suggests that digital health will advance faster in private health than in public health.