Under the leadership of the World Bank: challenges in, and perspectives of, the SUS counter-reform

Abstract

This study aims to reflect about the current situation in the Brazilian Unified Health System (SUS -Sistema Único de Saúde), mainly in view of international determinations set by the World Bank (WB). To this end, it should be noted that the neoliberal direction taken by Brazilian politicians has gained momentum, mainly in the 1990s, due to a series of measures focused on opening the country's borders to the international capital by offering tax exemptions to multinationals, as well as on privatizing state companies, on encouraging the indiscriminate use of imports as price control mechanism and on giving priority to the economic sphere at the expense of social policies. This process was named "counter-reform" by Behring (2003), and it went against the philosophy guiding the 1988 Brazilian Federal Constitution (FC).The 1989 Washington Consensus was the formal starting point for the Brazilian insertion in the neoliberal dynamics, which linked Brazil's international relationships to guidelines of financial organizations such as the WB and the International Monetary Fund (IMF). According to Correia (2005), these guidelines significantly affected SUS, since they ruled the health systems of backward capitalist countries according to protocols set by the neoliberal order. Two documents have significantly marked the beginning of this process in Brazil: Brasil, novo desafio à saúde do adulto/Brazil, a new challenge for adult health (BANCO MUNDIAL,

Prevalence of errors in the preparation and administration of intravenous drugs in adults: Meta-analysis with meta-regression

“…On the one hand, health systems in developed countries are emerging with structural investments and the incorporation of modern technologies, which, if properly implemented, can mitigate health problems. On the other hand, health systems in developing countries have shortcomings that are mainly related to structural limitations and the inadequate distribution of resources (Silva da & Elias, 2019;Souza, 2020).…”

“…The underfunding of public health services is recognized as the main obstacle to safe care, as it limits managers in implementing a culture of patient safety, including adjustments to the systems, structure, work process and management of health services (Souza, 2020). The literature shows that the cost of errors is still unknown by health institutions, involving increased hospitalization time and use of inputs, compensation, as well as affecting the prestige of the service in the eyes of clients (Couto et al, 2018;Paulino et al, 2021).…”

“…In this study, heterogeneity was present and the meta-regression analysis indicated that none of the selected variables (year of study, hospitalization sector, sample size and methodological quality) contributed as a source of heterogeneity to the analyses. However, it may be associated with differences between the studies, such as the health systems and institutions of the countries, given the peculiarities of health systems around the world, the characteristics of the institutions, the level of technology (Silva da & Elias, 2019;Souza, 2020) the establishment of clinical protocols for the preparation and administration of medicines, the sizing of nursing staff, working conditions, the dynamics of the services, among others (ASHP, 2018;WHO, 2017).…”