During the COVID-19 pandemic, the hashtag #VivaoSUS has taken over social media. Featured in posts from users who recognized the importance of a unified health system in both treating patients and vaccinating the population.
However, in order not to become just another empty wave, the defense of SUS needs to get off the Internet and win over the community. Thus, it is necessary to understand how it works, what its problems and qualities are, where it is necessary to invest and when to ask the authorities for fundamental improvements to work properly.
It’s also important for people to realize that SUS goes beyond health care: it’s a national heritage, the nation’s largest social program, capable of helping reduce the many inequalities that plague it.
Among the country’s many priorities in this time of economic, social and political crisis, health cannot be left aside.
However, to minimize these issues, it is essential to understand the issues behind the problems reported by users.
The topic is complex, and impossible to deal with in a single column, but I’ve tried to pick out issues that public health experts usually point out as necessary to understand beyond the problems users notice, such as queues, and difficulty in decision making. Appointments, delays in surgeries and treatments, among others. Come on:
specialists Edessa (Institute of Applied Health Law) has launched the “Health Agenda 2023”, drawing attention to the problems and solutions of SUS. The issue of financing deserves attention.
Brazil invests 9.5% of its GDP in health, which is slightly less than the amount it spends United kingdom (10.1%) for example. However, when we analyze how much of this total is directed at public and private health, countries go in the opposite direction.
Brazil spends 3.8% of its GDP on public health to serve 71.5% of the population (more than 150 million people) who, according to IBGE, rely exclusively on SUS, and 5.8% on private health. The UK spends 8.1% of GDP on public health and only 2.1% on the private sector.
The United States, which does not have a single health system, spends 8.5% of GDP on public health, more than twice what Brazil invests. This illustrates the need to increase funding for the system, which, according to public health experts, is insufficient both from a quantitative point of view and in terms of an equitable distribution of resources.
It is also important to better define the public and private role in health, “clearly regarding their relationships in SUS, and to define the boundaries of integration, partnerships and promotion,” the Idisa document notes.
Increasing funding and discussing how it can be used and distributed effectively is, therefore, one of the needs of SUS.
According to Idisa specialists, public administration based on heredity slows down the administrative processes of the SUS, which still allows for political interference and lacks long-term strategic planning, which is fundamental to health.
The difficulty of integrating services in a regional way was also cited as a problem to be solved.
There is also a need for a health policy that better defines which services can or should be the goal of partnership and integration. The lack of clarity and legal certainty regarding the ways in which public health services operate is also an ordeal that must be overcome.
In addition, we must look for projects that value health professionals, who must have well-designed career plans and decent salaries so that they can secure their jobs.
Primary health care
The SUS model of care provides integration of curative and disease prevention practices, constituting a holistic health model that should be based on primary health care (PHC).
However, despite being able to meet up to 80% of the population’s needs through its teams of family health professionals and community agents, primary health care still lacks adequate funding and retention of professionals.
According to the World Health Organization (WHO), 74% of deaths in the world are caused by chronic non-communicable diseases, such as diabeticCardiovascular disease and cancer. In addition, Brazil’s population is aging: in 1988, only 8% of Brazilians were over 60, a figure that has risen to 14% today. By 2060, it is expected that there will be 25% of the elderly population in Brazil.
A model that focuses more on hospital care, and focuses on specialized diagnostic medicine as a gateway to the health system, as we have done so far, will not address future challenges. Thus, strengthening primary health care is essential for the country to face the health problems that will increase in frequency in the coming years.
The field of mental health is one of the problems of SUS. The World Health Organization estimates that more than 11 million people suffer from depression in Brazil. Research shows that the number of people suffering from psychological disorders such as anxiety and depression is increasing.
Therefore, it is necessary to improve the RAPS network and train professionals and services to receive and treat people with mental suffering.
According to public health professionals, it is essential for a country to have a single national and independent body to conduct analyzes on integrating technologies into both SUS and health plans.
For this, it is necessary to expand the role of Conitec (the National Committee for the Integration of Technologies in the Unified Health System), which is currently doing this work, but has often suffered from political interference and needs improvements so that responses to incorporation from new technologies are faster and more evidence-based. According to EDSA, the commission also needs more technical and administrative autonomy to perform its function.
All of this can help reduce the legalization of health, which has led to higher costs in the region and reduced equitable access to health care.
Several candidates, in this year’s elections, pointed to the need to digitize data to improve health care efficiency. However, although experts in the field agree that digitization can be beneficial for SUS, they stress the importance of establishing strict regulation and strict data control.
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