Desafios políticos e organizacionais do SUS: vinte anos de política pública

Abstract

According to opinion polls published in the mainstream press, health care has overtaken violence and unemployment as the principal problem in Brazilian society. In the last Congress of the Brazilian Association of Public Health (ABRASCO), I contended that there is more than a "rock in the path" of the Unified National Health System (SUS) -there is an entire quarry. And I insist on the impasse: despite the growth of the SUS, there are clear indications that we are failing to meet a major share of the people's health needs. The first challenge is that the system has not become a priority for the Brazilian government (with a few counties and States as exceptions). These exceptions serve to demonstrate that it would be possible to build a real public health system in the country. But the system's current backseat status has prevented Brazil from tackling the political and organizational changes and issues with the healthcare model needed to consolidate it. No one can safely predict today whether we will have a single, unified health system in the future, or a limited public network for treating low-income populations with targeted programs.We failed to realize that we opted for a system aligned with the European tradition of socialization of health. According to the dominant discourse in Brazil, the main social policy is economic growth, whereby the majority will gain access to goods and (with time) private health insurance. The first challenge is thus to reaffirm the construction of a public system for all.A second challenge is to acknowledge that there is a crisis of legitimacy in the state and public health organizations, due to their low efficacy and efficiency. Private interests have hijacked the health budget: entrepreneurs, professional corporations, bureaucracy, and politicians. Michel Foucault recognized that there is no "art of government from socialism". I have worked for years with the concept of "reforming the reform": reinventing state systems based on shared management and clear negotiation of health responsibility on the part of professionals, teams, services, regional networks, and States and counties. In short, organizational reform of the SUS -funds, councils, and collegiate bodies, cost criteria -has proven insufficient to construct governance for the system. The history of patrimonialism in managing the public good in Brazil has aggravated this situation. How else can one explain the gross negligence with Federal, State, and municipal hospitals and services? Administrations come and go, and misgovernment remains (skeptics are advised to visit a SUS hospital in their home towns, for a firsthand look). And we have failed to honor the health tradition of public systems: although there is a "system" in the name, the SUS does not function as a population-based territorial network. The hospitals and specialized centers were not integrated into the system. Hence the long lines, hence the cancers that reach the system in advanced stages. The family health strategy is a false priority, a discourse with l...

Dialectics of a medical provision policy in priority areas in Brazil

“…A recent example of the policy of expansion and for qualification of the assistance network is the construction of UPAs, which is disastrous both for the unfinished works and for those that have been closed due to lack of personnel, equipment and supplies. 1 Medical training in Brazil, medical courses and medical residency The Ministry of Health feels it is through this axis that it will be possible to solve, permanently, the problem of the lack of professionals. Thus, the program includes an expansion plan for undergraduate and medical residency courses and important changes in the way doctors and specialists are trained.…”

“…Brazil's condition of being a continental country, in addition to the historical background of its colonization and its public policies for Development, Infrastructure, Education and Health, 1 as well as other areas, contributed significantly, especially in the case of the Unified Health System (SUS, in the Portuguese acronym), to the difficulties it has today to guarantee the population's access to health services and actions 2 in a universal, integral, resolutive and hierarchical way, divided according to levels of complexity and decentralized. These constitute the organizational and philosophical principles of the public health system, which have been regulated by Laws 8.080/90 3 and 8.142/90.…”

“…Cumulatively, this makes the broad and complex sociocultural, environmental and climatic diversity -a characteristic of the great terrestrial extensions -less stimulating and inviting for physicians to live in these places. 2 In this scenario, the constitutional guarantee of health as a fundamental right 7 has encountered several barriers for the citizens to be supported by the social medicine developed by the SUS -weakened by insufficient financing 1,8 and by unprofessional management -, as it does not guarantee quality and resolution for health actions and services. In the words of Gastão Wagner de Souza Campos, governments that, following the populist trend of several municipalities, invented degraded primary care for the poor: Ready Care Units (UPAs), one of the social spaces that we will embarrass ourselves in the future, a sign of human perversity.…”

“…In the words of Gastão Wagner de Souza Campos, governments that, following the populist trend of several municipalities, invented degraded primary care for the poor: Ready Care Units (UPAs), one of the social spaces that we will embarrass ourselves in the future, a sign of human perversity. 1 Without neglect, it is important to draw attention to the reality of medical demography in Brazil, which reflects the poor distribution of physicians between rural and urban areas, and between capital and the interior. 9 The concentration and dispersion of physicians in the different regions of the country respond directly to the conditions and the quality of life in these places.…”

A política de atenção primária à saúde no Brasil: notas sobre a regulação e o financiamento federal

“…ibge.gov.br). para a superação de problemas estruturais e predomínio de estratégias de planejamento normativo, em consonância com o apontado por outros autores 2,6,14 .…”