Brazil’s public healthcare system needs more funds to meet pent-up demand generated during pandemic; country also must increase vaccination coverage against diseases that are again seen as threats

10/03/2022

---

The worst phase of the pandemic was left behind last year, but whoever takes over the presidency in January will still have to face several effects of the crisis that still persist in the health area.

Experts say that Brazil’s public healthcare system, Unified Health System (SUS), will need a budget reinforcement in order to meet the pent-up demand from the most acute years of the pandemic – which have not been completely solved so far.

The agenda seen as a priority also includes the universalization of basic health care, more funds for science, technology, and innovation, and a nationwide effort to recover vaccination coverage for diseases that are once again seen as threats to Brazilians.

In relation to the SUS and the pent-up demand for care, these refer to elective surgeries, appointments with doctors, exams, and treatments that were not carried out between 2020 and 2021, when health care was congested with cases of Covid-19 patients.

Due to lack of beds and schedules, or due to many people’s fears of being exposed to the coronavirus in crowded health care units and hospitals during the worst moments of the pandemic, a substantial slice of patients across the country who would have needed to undergo these exams, appointments, and surgeries in the two critical years of the pandemic chose to postpone the procedures.

Until the beginning of this year, the number of health care visits at SUS was still at a lower level than in 2019.

“The pandemic produced an extremely delicate situation for health, an increase in demands that were not met in that period and that have not yet been treated,” said Adriano Massuda, a public health physician and a professor at the think tank Fundação Getulio Vargas.

The National Council of Health Secretaries (Conass) estimated that an additional budget of R$8 billion would be needed in the health area to meet the demand that was not met during the pandemic. And also to solve pending accreditations of ICU beds, family health teams and even ambulances of the Mobile Emergency Care Service, known as SAMU.

Increasing the salaries of doctors and nurses and also the value of the transfers to hospitals is also a point considered important to improve health services nationwide.

The secretaries say that an agenda of urgent measures must be put in place or, at least, addressed in the first 100 days of government.

Besides an emergency agenda, Conass defends the creation of a nationwide public health plan. And also a 10-year plan, as already exists in education.

“During the pandemic, SUS started to be perceived as an extremely relevant system. Both the right and the left started to defend the system. And we need an agenda to modernize the SUS,” said Nesio Fernandes, head of Conass and state health secretary of Espírito Santo.

This modernization agenda involves setting aside more public funds for the system, Mr. Fernandes said. He cites that public spending on health in Brazil is currently 3.8% of GDP. The Pan-American Health Organization (PAHO) indicates that the appropriate level of spending on public health is 6% of GDP.

The Oswaldo Cruz Foundation (Fiocruz), an agency linked to the Ministry of Health, also insists on the need to increase public funding for SUS. The institution defends spending 7% of GDP in the system.

Among the points that Fiocruz listed in a letter to the presidential candidates is the universalization of basic health care coverage, mainly through the expansion of the family health program.

This measure, according to calculations made by Fiocruz, could quickly generate 2 million jobs for health professionals. Plus, it would have a direct effect on the country’s health indicators.

Another point in the letter is the defense of increased funds for science, technology and innovation – which would open doors for reducing the country’s dependence on foreign manufacturers of medicines, inputs, and medical equipment, for example.

Brazil spent about $20 billion on importing medicines and medical equipment last year and $15 billion in 2020, according to data compiled by Fiocruz.

Carlos Gadelha — Foto: Leo Pinheiro/Valor

Carlos Gadelha, coordinator of Fiocruz’s Center for Strategic Studies, advocates a tax overhaul that includes taxing the super-rich and the reduction of inefficient tax breaks. Mr. Gadelha, a trained economist, said that the government could collect extra R$40 billion with both measures and, as a result, fatten funds for healthcare.

That would be an antidote to a practice that has been established in recent years of parliamentary amendments for several fields, including health. One risk in the healthcare field is that these amendments end up financing fragmented actions, said Mr. Gadelha.

In addition to setting aside more public funds for SUS, science, and technology and addressing the pent-up demand generated by the pandemic, the next president also has the challenge of recovering the vaccination coverage against diseases that are again seen as threats.

Carla Domingues, an epidemiologist and coordinator of the national immunization program of the federal government between 2011 and 2019, says this should be priority zero of the next administration in the health area.

If one were to do a prioritization ranking, vaccination, she said, would be the most important item for the next administration.

“The country faces the risk of reintroduction of diseases that were already eradicated,” she said, reiterating a warning that is a consensus in the medical profession and that refers to the risk of reappearance of poliomyelitis, measles, diphtheria, pertussis, and meningitis outbreaks, among other diseases.

*By Marcos de Moura e Souza — São Paulo

Source: Valor International

https://valorinternational.globo.com/