SUS: time to move forward – Public Health

Ricardo Oliveira

The postponement of about 1.6 billion procedures performed by the Unified Health System (SUS), according to estimates by the National Council of Municipal Health Secretaries (CONASEMS), as a result of the Covid-19 pandemic, adds to the difficulties of access already existing. Therefore, it is expected a scenario of greater restrictions for meeting the health needs of the Brazilian population in the coming years.

On the other hand, the current health crisis has created conditions to advance in the quality and efficiency of care for SUS users, due to at least the following four questions:

1- Overcoming the pandemic has become key to facing the social and economic crises and to the resumption of economic growth and jobs, raising the priority of public health policies with government officials.

2- The population’s need, interest and appreciation of the SUS led the media, government officials and political leaders to mobilize with more emphasis on the debate on health policies. This can be seen in the creation of a Parliamentary Inquiry Commission (CPI) in the Senate and in the volume of hours dedicated to coverage of the pandemic by the press.

3- The health crisis had the effect of making the population aware of the importance of self-care. Sanitizing hands with alcohol gel or soap, wearing masks and maintaining social distance were incorporated as daily habits, showing the need for each one to take care of their health and the community. Self-care is a fundamental behavior to help SUS overcome the challenge of serving its users, because it reduces the demand on the system.

4- The existence of a set of widely accepted proposals regarding the reorganization of the SUS care, management and financing model, namely: a) overcoming the fragmentation between the levels of care, integrating primary, specialized and hospital care; b) implement an adequate care model to treat chronic non-communicable diseases (NCDs); c) organize the Care Networks (RAS) from the health regions; d) consider Primary Health Care (PHC) as the coordinator of the RAS; e) increase the computerization of the management and provision of services; f) strengthen tripartite management; g) improve social control; h) provide adequate financing; i) promote self-care; j) implement management by results, with a view to increasing the quality and efficiency in the provision of services.

These proposals are quite complex and require time for effective consolidation. Therefore, concomitant with them, emergency measures must be designed to meet the demand for health services in the short term, such as consultations, exams, hospitalizations and surgeries.

The pandemic showed the need to increase scientific, technological and industrial investment in the health sector to develop knowledge and production capacity for goods and services in Brazil. External dependence on the production of basic inputs and drugs proved ineffective to meet the needs of the SUS.

To take advantage of the favorable situation for the SUS, it is necessary that the public health community mobilizes, with a view to seeking a political consensus regarding proposals that improve the provision of services, guarantee its implementation over time and contribute to the debate with the National Congress.

This mobilization must be understood as a collective work, as it depends on the leadership and commitment of the Ministry of Health (MS), as well as governors and mayors, managers and servers in the sector, public bodies that oversee and control the management and the exercise of professions in the area and, finally, the fundamental participation of society.

Only the public sector will not be able to meet the demands of services now and in the future. Therefore, it is necessary to bring together all partners who can collaborate in overcoming this challenge.

The MS, due to its role as national coordinator of health policies, should take the initiative to invite representatives of the National Council of Health Secretaries (CONSAD), the National Council of Municipal Health Secretaries (CONASEMS) and the National Council (CNS) for the debate on how to overcome the enormous challenge in the provision of SUS services. There is no time to lose!

Ricardo de Oliveira he is a production engineer, was State Secretary for Management and Human Resources of Espírito Santo from 2005 to 2010 and State Secretary of Health of ES from 2015 to 2018. Author of the books: Public Management: Democracy and Efficiency, FGV / 2012 e Public Management and Health, FGV 2020. Advisor to the Institute for Health Policy Studies (IEPS).