Os desafios do financiamento do enfrentamento à COVID-19 no SUS dentro do pacto federativo

Fernandes, Gustavo Andrey de Almeida Lopes; Pereira, Blenda Leite Saturnino

doi:10.1590/0034-761220200290

Cited by 23 publications

(15 citation statements)

References 29 publications

(39 reference statements)

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“…Furthermore, the public health capacity in different municipalities varied greatly. A considerable number of Brazilian regions were receiving less funding from the federal government due to political tension with the leadership [76]. As the country struggled with PPE shortages, unprotected frontline health workers visiting rural areas of Brazil might have unintentionally exposed the vulnerable Indigenous populations they intended to care for with the virus [25].…”

Section: Public Health Capacity and Responsementioning

confidence: 99%

The heterogeneity of the COVID-19 pandemic and national responses: an explanatory mixed-methods study

Chen

Assefa

2021

BMC Public Health

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Background The coronavirus disease of 2019 (COVID-19) has quickly spread to all corners of the world since its emergence in Wuhan, China in December of 2019. The disease burden has been heterogeneous across regions of the world, with Americas leading in cumulative cases and deaths, followed by Europe, Southeast Asia, Eastern Mediterranean, Africa and Western Pacific. Initial responses to COVID-19 also varied between governments, ranging from proactive containment to delayed intervention. Understanding these variabilities allow high burden countries to learn from low burden countries on ways to create more sustainable response plans in the future. Methods This study used a mixed-methods approach to perform cross-country comparisons of pandemic responses in the United States (US), Brazil, Germany, Australia, South Korea, Thailand, New Zealand, Italy and China. These countries were selected based on their income level, relative COVID-19 burden and geographic location. To rationalize the epidemiological variability, a list of 14 indicators was established to assess the countries’ preparedness, actual response, and socioeconomic and demographic profile in the context of COVID-19. Results As of 1 April 2021, the US had the highest cases per million out of the nine countries, followed by Brazil, Italy, Germany, South Korea, Australia, New Zealand, Thailand and China. Meanwhile, Italy ranked first out of the nine countries’ total deaths per million, followed by the US, Brazil, Germany, Australia, South Korea, New Zealand, China and Thailand. The epidemiological differences between these countries could be explained by nine indicators, and they were 1) leadership, governance and coordination of response, 2) communication, 3) community engagement, 4) multisectoral actions, 5) public health capacity, 6) universal health coverage, 7) medical services and hospital capacity, 8) demography and 9) burden of non-communicable diseases. Conclusion The COVID-19 pandemic manifests varied outcomes due to differences in countries’ vulnerability, preparedness and response. Our study rationalizes why South Korea, New Zealand, Thailand, Australia and China performed better than the US, Italy and Brazil. By identifying the strengths of low burden countries and weaknesses of hotspot countries, we elucidate factors constituting an effective pandemic response that can be adopted by leaders in preparation for re-emerging public health threats.

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Section: Public Health Capacity and Responsementioning

confidence: 99%

The heterogeneity of the COVID-19 pandemic and national responses: an explanatory mixed-methods study

Chen

Assefa

2021

BMC Public Health

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“…Unfortunately, not all Brazilian cities that have received Warao immigrants are as satisfactorily structured and organized through a strategic and relevant Plan as in Manaus, which should be recognized in the study. Despite numerous difficulties with underfunding of the Unified Health System, since Brazil is experiencing a serious political and economic crisis, with progressive reduction of financial resources for the SUS in recent years [ 34 ], the study revealed major strides in the universal system from the perspective of ethical, humanitarian, and social inclusion and equity for IVWEG.…”

Section: Discussionmentioning

confidence: 99%

Local action plan to promote access to the health system by indigenous Venezuelans from the Warao ethnic group in Manaus, Brazil: Analysis of the plan´s development, experiences, and impact through a mixed-methods study (2020)

et al. 2021

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Background The provision of care and monitoring of health are essential for indigenous Venezuelans from the Warao ethnic group, who are at risk of decimation. Objective Analyze a Local Action Plan (LAP) to promote access to the health system of indigenous Venezuelans from the Warao ethnic group (IVWEG) in Manaus, Brazil. Method A mixed-methods study was performed. Quantitative data were collected to assess the provision of care and monitoring of health conditions in IVWEG through a survey that was self-completed by healthcare providers. Qualitative narrative data were collected to gain insight into IVWEG that seek care. We applied descriptive statistics, grouping analysis (GA) by hierarchical levels, and multiple correspondence analysis (MCA). Content analysis was applied to qualitative data. Results 106 healthcare providers participated in the study, with the following characteristics: 94 (88.7%) females, 67 (63.2%) pardo race/color, 40 (37.7%) working in primary healthcare, and 49 (46.2%) nurses. In addition, 43 (40.6%) of the healthcare providers reported providing care to IVWEG. Among the providers, 89 (84%) had received training for assisting IVWEG. Additionally, 30 IVWEG were enrolled for interviews in the qualitative phase. The barriers to seeking care were language, distance to health units, and lack of money for transportation. The LAP proved to facilitate access to the health system by indigenous Venezuelans from the Warao ethnic group in Manaus. The study contributed to knowledge on a LAP addressed to IVWEG and helped improved their access to the health system, providing appropriate training for healthcare providers and other relevant actors by implementing a coherent and consistent public health policy at the local level.

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“…Modalidade de aplicação dos recursos da unidade orçamentária Fundo Nacional de Saúde, destinados ao enfrentamento da emergência de saúde pública -COVID19 (SUS/2019-2020). Contudo, registrou-se recorrência da postura do MS (responsável pela maior fatia do financiamento SUS) segundo a qual, mesmo frente a uma emergência internacional de saúde pública, restou mantida a cultura de execução atrelada, não somente a finalidade definida no Programa de Trabalho, mas também aos interesses das áreas finalísticas do MS, limitando a autonomia da gestão e da execução dos recursos recepcionados pelos entes subnacionais [16][17][18][19] . Consequentemente, dos R$32,30 bilhões repassados aos entes subnacionais R$11,88 bilhões (36,8%) tiveram sua execução engessada, dentre eles: R$649,83 milhões (Portaria 2516/20) destinados à aquisição de medicamentos de saúde mental; R$454,33 milhões (Portaria 1857/20) para Saúde na Escola; R$2,24 bilhões (75 Portarias) atrelados a objetos de Emendas Parlamentares.…”

Section: Discussionunclassified

Saldos dos repasses federais no SUS: o que temos e o que esperar do incremento para a COVID-19

Faleiros

Pereira

2021

Ciênc. saúde coletiva

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Resumo Analisamos os saldos provenientes dos repasses do Ministério da Saúde (MS) aos entes subnacionais, destinados ao financiamento do Sistema Único de Saúde (SUS), inclusive para COVID-19. Verificamos a representatividade destes frente aos repasses do MS destinados às ações e serviços públicos de saúde, entre 2019 e 2020. Analisamos as portarias do MS que deram origem aos repasses COVID-19, classificando-as em: quantidade, objeto, critério de rateio, quantidade de parcelas, execução vinculada a estratégias do MS, valor. Mais de 70 mil contas-correntes foram contabilizadas, alguns entes subnacionais tinham mais de cem. Em 2019, saldos atingiram R$16,29 bilhões (aumento anual de 10,2%), representando 19,9% do total repassado. Em 2020, R$23,83 bilhões (aumento de 46,3%), representando 21,1% do repassado, com tendência de crescimento. Mais de 616 portarias, com 28 diferentes objetivos, repassaram R$32,30 bilhões à COVID-19. O recurso, antes de livre utilização, teve R$11,88 bilhões (36,8%) vinculados às estratégias do MS: R$1,36 bilhão (99,9%) Bloco Estruturação e R$10,52 bilhões (34,0%) Bloco Manutenção. Várias podem ser as causas que dão origem ao acúmulo de saldos, todavia qualidade, quantidade e complexidade do arcabouço normativo do SUS contribuem fortemente para uma execução dos recursos pouco célere, efetiva, eficiente e eficaz.

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Os desafios do financiamento do enfrentamento à COVID-19 no SUS dentro do pacto federativo

Cited by 23 publications

References 29 publications

The heterogeneity of the COVID-19 pandemic and national responses: an explanatory mixed-methods study

The heterogeneity of the COVID-19 pandemic and national responses: an explanatory mixed-methods study

Local action plan to promote access to the health system by indigenous Venezuelans from the Warao ethnic group in Manaus, Brazil: Analysis of the plan´s development, experiences, and impact through a mixed-methods study (2020)

Saldos dos repasses federais no SUS: o que temos e o que esperar do incremento para a COVID-19

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