Health will have the challenge of reducing queues for surgeries and exams and reversing the drop in vaccination

Health managers will have to deal in 2023 with a scenario of a queue of dammed surgeries and exams, a drop in vaccination coverage in children, warnings about worsening health indicators and the need, among other things, to plan new measures to control and monitor Covid –under the risk of new emergencies.

The assessment is made by specialists, health secretaries and members of the transition team of the new government consulted by the Sheet. “There will be several overlapping challenges”, says Nésio Fernandes, president of Conass, a council that brings together state health managers.

One of the first tasks, according to the group, should be the restructuring of the Ministry of Health, responsible for nationally coordinating the management of the SUS with states and municipalities and the target of successive crises and management changes in the last three years.

“The main challenge for the first quarter will be to get the Ministry of Health working again, because it was paralyzed”, says Rosana Onocko, president of Abrasco (Brazilian Association of Collective Health). She questions the folder’s lack of information about planning vaccines against Covid for 2023, for example.

The current president of Fiocruz, Nísia Trindade, was announced as the new Minister of Health as of January. According to experts, she will have the challenge of recovering the folder’s technical capacity. “Without this, it is not possible to make a vaccination program work, for example”, says public health doctor and FGV professor Adriano Massuda.

Health secretaries also point out other issues. One of them is dealing with the queue of surgeries and exams that were held up due to the pandemic – a Conass survey points to a deficit of 1.6 million hospitalizations for elective surgeries and 10.4 million outpatient surgeries in the years 2020 and 2021, a liability that still needs to be be solved.

Other attendances were also dammed, says Massuda. Based on the volume of consultations in previous years, and including data from 2022, he estimates that the total number of procedures that have been held back and not related to Covid exceeds 1 billion since the beginning of the pandemic.

“There was a large volume of tests that were not carried out, causing problems that could be detected early to not be identified”, he completes. “We see cases of cancer arrive with worse prognosis. The queues for specialties have also increased.”

Covid, by the way, also remains a challenge. For specialists, there is a lack of data on the prolonged effects of the disease – the so-called long Covid. Another urgency is to reorganize means of monitoring the epidemic in the face of low testing and the drop in mortality from vaccination.

“It’s like driving a truck with a blindfold on. We don’t know what’s going on,” says Onocko.

The same warning is valid for the need to encourage people to complete the vaccination schedule against the disease. Data from the Ministry of Health indicate that 61 million people did not seek the first booster.

“We have many Brazilians with an incomplete dose, who are going for intubation”, says Mauro Junqueira, executive secretary of Conasems, a council that brings together municipal health secretaries.

He asks President-elect Luiz Inácio Lula da Silva (PT) to make some symbolic gesture in defense of immunization. “The president will have to call the press in the first few days, roll up his sleeves and get vaccinated. He needs to set an example”, he says.

The list of challenges goes on.

According to managers, 2023 should start with the need to fill vacancies generated by the end of contracts by Mais Médicos professionals, for example. In recent months, the program has been replaced by a new version, Doctors for Brazil, but still with few notices so far.

Also included in the set of emergencies are the need to reverse the drop in vaccination coverage among children –a situation that has worsened since 2015 and carries the risk of the return and advancement of diseases previously considered eliminated– and the recent worsening of some health indicators in areas miscellaneous.

The maternal mortality rate, for example, increased from 75.74 deaths per 100,000 inhabitants in 2020 to 114.62 in 2021, the year of the most recent complete data available. Until then, this rate had been at a level of stability.

In another warning sign, a Fiocruz survey showed that, in 2021, SUS recorded an average of eight hospitalizations of babies per day due to malnutrition. In all, there were 2,979 hospitalizations for this reason, the highest number in the last 13 years. A further increase was expected for 2022.

For Arthur Chioro, former Minister of Health and coordinator of the technical group in the area in the transition team, the worsening in the indicators shows a “critical” situation. According to him, mapping carried out by the group pointed out management problems at the Ministry of Health.

“It’s a situation of total chaos. There are thousands of doses of vaccines expiring, or that they don’t know how to inform stocks.”

Chioro says that a survey of urgent issues to be addressed in the coming year was carried out. “We identified important alert points, such as the potential for the suspension of hemodialysis services, lack of strategic supplies and information problems.”

The team also recommended 10 priority measures for the next administration. Among them are resuming the coordination capacity of the SUS, restructuring the National Immunization Program, strengthening the response to Covid and other emergencies and reducing service queues, with the offer of specialized networks.

The plan also provides for improving the provision of professionals in primary care and rescuing the Popular Pharmacy program, among other points.

This week, Congress approved the text of the PEC that restores BRL 22.7 billion to the health budget.

For Fernandes, from Conass, the amount helps, but does not reduce the health financing crisis. “It’s a chronic problem. The SUS has room to improve efficiency [do gasto]? There is, but where there are already services. The gaps in care are still gigantic, “she says.

The report questioned the Ministry of Health about points cited by experts, such as the lack of information about vaccination against Covid in 2023.

In a note, the folder says that the volume of vaccines purchased under current contracts meets next year’s demand, but did not report the amount still expected to be delivered. Still according to the ministry, the groups that should be included in the vaccination are still being defined.