New Secretary of Health promises single and transparent queue of surgeries in SP

Appointed to occupy the Health portfolio in the government of Tarcísio in São Paulo, the doctor and former federal deputy for the PSD Eleuses Paiva intends to organize the queue of elective surgeries in the SUS (Sistema Único de Saúde) and also seek points of lack of transparency between the public and private systems, mainly in the management of hospitals by social organizations.

“The queue itself is a service orderer. The current issue depends on the management, transparency and predictability of the queue, that is, the queue needs to move”, said the new secretary in an interview with Sheet.

Regarding the management of public hospitals by private entities, Paiva states that even in models where there is excellence in execution, such as public-private partnerships and support from foundations, it is necessary to make a diagnosis to know the role of each partnership and the adequate control .

“The provision of health services is extremely complex, and its planning demands intelligence and creativity on the part of the state, mainly with the increase in demand and current cost reduction.”

A doctor specializing in nuclear medicine (radiology) at the USP Faculty of Medicine, Paiva defended preventive measures against Covid, such as the use of masks and vaccination, contrary to the speech adopted by President Jair Bolsonaro (PL) and his candidate in SP, Tarcísio de Freitas (Republicans), elected governor.

Questioned about this, he said that the disease prevention policy will be a priority for his administration. “The National Immunization Program [PNI] has always been a world reference, but we see a drop in coverage since 2015. We will act to reinforce the vaccination coverage of the population in SP”, he said.

One of the bottlenecks in the state health network is the queue for high and medium complexity procedures, which worsened in the post-pandemic period. Mr. Do you intend to make partnerships with the private sector on a one-off basis or will it be a permanent policy?

Queues for surgeries, procedures and exams are notorious. The queue itself is a service orderer, which offers a sequence of people based on defined criteria with the aim of guaranteeing one service after another. The current issue depends on queue management, transparency and predictability, that is, the queue needs to move. The solution is to establish single queues, regionalized, published and updated on a transparent website, in addition to increasing and improving the quality of the service offered.

In the last decade, there was a reduction in SUS beds in SP and an increase in private beds. How to fix it?

In the last five years, we had around 7,000 SUS beds inactivated in the state, due to financial or operational reasons. There are still several units under construction, but without funding provided for in the budget. Therefore, before starting to open new beds, it is necessary to make a precise diagnosis of the reason for closing these beds, how to reopen them and which regions are most in need.

Social health organizations (OSS) currently consume about a quarter of the area’s budget in the state and, although there are studies indicating improved management, there is no evidence of better clinical outcomes. The Court of Auditors also investigates some OSS for irregularities and lack of transparency in hospitals. What measures do you intend to take in relation to them?

All our management will be guided by transparency. The OSS are an excellent model to enable the delivery of the health service by the state, as well as foundations, PPPs (public-private partnerships), philanthropic entities and directly administered hospitals. However, they need to be clear about their role and have due and adequate control. The provision of health services is extremely complex, and its planning demands intelligence and creativity on the part of the state, mainly with the increase in demand and current cost reduction.

Primary care, although the responsibility of the municipalities, is essential to improve health indicators, but it has suffered a historic loss of physicians, leaving many family health teams shorthanded. How do you intend to work with municipalities to strengthen primary care?

The government will show solidarity with the municipalities in the challenge of improving primary care, which should solve around 85% of health problems. In practice, there is no resolution and effectiveness at this level of care, which overloads the entire network, especially emergencies and hospitals. I intend to strengthen primary care and invest in digital technologies to improve its effectiveness and resolution.

The Chamber of Deputies recently voted on the project that regulates telehealth, which was undoubtedly expanded during the pandemic period, but has a series of difficulties to be faced, starting with the lack of internet access by the population. If adopted, how will telemedicine be implemented?

Our goal is to transform São Paulo into a reference in the use of digital health to improve the efficiency of the health system. To do this, we are going to take advantage of models that have already been tested and have had positive results in the pandemic, integrating the different systems, and also establishing partnerships with universities to promote the training of health professionals in digital technologies.

Health surveillance today is very fragmented, with the three instances (municipal, state and national) with different systems that do not communicate with each other, not to mention the different types of surveillance within the secretariat itself. How do you intend to do this integration?

Currently, the existing processes in the state are bureaucratic and divided into departments, which is why the importance of investments in digital health and the work that will be done in the government from the creation of a folder totally dedicated to this.

Mr. will assume the health portfolio in the government of Tarcísio, who was an ally of President Bolsonaro, whose stance in the pandemic was contrary to vaccines, the use of masks and scientifically proven preventive measures. How do you see the challenge of running a portfolio under Tarcísio’s tutelage?

The disease prevention policy will be a priority for our government and we will work hard to reinforce vaccination coverage in SP, mainly through campaigns. The National Immunization Program [PNI] it has always been a world reference, but we have seen a drop in numbers since 2015. It is essential to show that diseases still exist and that vaccination is essential.

Recently, the largest hospital in the country to care for women victims of sexual violence, Pérola Byington, went to the private sector and closed the service for women in the SUS for legal abortion. Mr. Do you think this choice was right? What structure exists today in the state to support women victims of sexual violence?

The comprehensive health of women is an absolute priority for our government. In addition to ensuring full support for women victims of violence, we will work on family planning and prenatal care.

One of the main problems of the 21st century is future epidemics and pandemics. How do you want to strengthen the surveillance system in SP?

One of the projects is to create a State Center for Disease Control and Quality of Care, which aims to implement an epidemiological intelligence system, forming platforms and databases that contribute to the tracking and evaluation of health threats and to decision-making based on evidence, making it possible to follow the trajectories of population health systematically.

Still related to the last question, how do you intend to encourage health research in the state, linked to public institutes and state universities?

By encouraging and bringing health services closer to Fapesp (São Paulo State Research Support Foundation) to support scientific production.

Eleuses Vieira de Paiva, 69

Born in Santos (SP), he graduated in medicine from the Faculty of Medicine of Itajubá, specializing in nuclear medicine from the Faculty of Medicine of USP. He was president of the Associação Paulista de Medicina (from 1995 to 1999), of the Associação Médica Brasileira (from 1999 to 2005) and federal deputy in three terms, one for the PFL (2005 to 2007), one for the DEM (2007 to 2011) and the last by PSD (2011 to 2022).