Distributed in 507 of the 645 municipalities in São Paulo, 1,172 primary care teams work without federal funding, according to a report by Cosems/SP (Council of Municipal Health Secretaries of the State of São Paulo) in November of this year.
The survey, obtained by Sheet, points out that the problem affects 392 of the 6,734 family health teams in the state. 780 of the 2,430 primary care teams are in the same situation. These teams work in around 5,000 UBS (Basic Health Units), according to the entity.
In the area of oral health, 1,489 of the 4,297 teams in São Paulo are without federal funding, in addition to 7 of 59 from the Street Clinic and 5,014 of the 34,051 community health agents.
Questioned, the Ministry of Health stated that the payment of primary care teams and services is linked to compliance with criteria for the transfer of federal resources, such as accreditation, homologation and other rules presented by ordinances nº 6/2017 and nº 1/2021.
“Services that do not receive federal funding may have some type of suspension for failure to send production, professional duplicity or for not being properly accredited and homologated. In addition to the physical composition of the team at the establishment, the municipal management must register in the system of the CNES”, said the folder, in a note.
The ministry did not respond to the report which criteria are not being met by the municipalities and which imply a cut in the transfer.
The council’s survey is based on the CNES (National Register of Health Establishments) and the E-gester AB, from September, based on the municipal transfers of financial competence in November.
For Adriana Martins, vice-president of Cosems/SP, the lack of federal funding burdens municipal coffers.
“What happens in practice? The municipality’s initial budget planning is outdated when paying the team without federal funding. The manager has to reduce in other areas, or make choices, because the budget is unique. The cost of the service continues even without the transfer. When the citizen goes to the UBS, he doesn’t feel the absence of the team, but the impaired health care”, he explains.
According to the National Primary Care Policy, health funding is tripartite and must be guaranteed at the national, state and municipal levels of management of the SUS (Unified Health System).
Federal funding reaches municipalities through Previne Brasil, from the Ministry of Health.
To calculate the resource, four components are considered: weighted intake (number of people registered by the health teams); pay for performance; financial incentive based on population criteria and incentives for strategic actions (include the implementation of programs, strategies and actions that reflect on the improvement of care, such as oral health, street consultation, health on the spot and others).
“Previne brings a new methodology for transferring resources. If I can’t register the population and link them to a team, I start to have losses. In the division by municipality profile, the state of São Paulo, which has been accumulating a series of deficits , was the one that lost the most”, says Martins. “One of the losses is that of doctors not replaced.”
The Doctors for Brazil program, replacing Mais Médicos, has not been able to send professionals to compose the teams. As a result, the municipality loses funding and does not provide adequate assistance to patients.
According to Cosems/SP, the lack of a federal policy that supports municipalities in retaining physicians causes municipal managers to increase remuneration in order to be able to hire, further burdening cities that already invest more than 25% of their budgets in health .
In 2022 (September data), the Doctors for Brazil program provided 801 vacancies for the state of São Paulo. Of these, 222 were occupied.
Maria Inez Padula Anderson, director of scientific and continuous professional development at the Brazilian Society of Family and Community Medicine, says the lack of federal funding is hampering patient care.
“The lack of co-financing can affect the remuneration of health professionals, the quality of care provided, reduce inputs, which creates a situation of exhaustion for the professional. It is complex to maintain longitudinality, which is fundamental in primary care, or that is, the guarantee that when I get there I will have a team that knows me, has established a bond with me and knows my story”, she says.
According to the Municipal Secretary of Health of São Paulo, in October, the Ministry of Health carried out the financial transfer referring to 1,503 teams of the Previne Brasil program.
The State Department of Health of São Paulo told the report that, due to the discrepancy in the SUS table and to expand assistance to the population, it fulfills, in addition to its responsibilities, the extra allocation for the Basic Care Floor —in 2022, R $289.4 million to municipalities.
There are also investments through programs, such as Dose Certa, and transfers from the State Health Fund.
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