The COVID-19 pandemic, a disease that has already accounted for more than 13 million cases and more than 350 deaths in Brazil, has made clear the importance of a public, free, and universal health system: the Unified Health System, or SUS.
"Imagine what this pandemic would be like without the SUS (Brazilian Public Health System)."Imagine the population having to pay for healthcare, or show a private health insurance card at the hospital door. Brazilians would be dying in much greater numbers, abandoned in the streets," says Suely Araújo, PhD in Political Science and professor at IDP.
The professor highlights the system's extensive reach, which offers health services organized regionally and hierarchically in levels of increasing complexity, from the municipal to the federal level. However, with the rapid increase in the number of cases, especially in this second wave, the healthcare network is facing difficulties.
“Responding to the pandemic is not easy anywhere in the world. We have had difficulty, especially regarding ICU beds. The SUS (Brazilian public healthcare system) is widespread, serving the entire country, but in many places access to more complex treatments is not available and, in the case of COVID-19, it will not always be possible to transfer patients to regional units with more sophisticated care, due to the rapid progression of the disease and the overcrowding of hospital units,” he states.
History
According to Article 196 of the 1988 ConstitutionHealth is a right of all and a duty of the State. According to the Charter, this right is "guaranteed through social and economic policies aimed at..." Reducing the risk of disease and other health problems, and ensuring universal and equal access to actions and services for their promotion, protection, and recovery.".
For Suely Araújo, the SUS (Unified Health System) is an achievement of Brazilian society, built gradually over decades. The system originated in the public health movement of the 1970s, during the military dictatorship, in which doctors and other health professionals sought to define priority areas of health and what measures could be taken to transform Brazilian public health.
A significant historical milestone in the origin of the SUS (Unified Health System) is the VIII National Health Conference, held in Brasília in 1986. With the main themes being "Health as a duty of the State and a right of the citizen," "The reformulation of the National Health System," and "Sectoral financing," the VIII Conference laid the groundwork for the creation of a decentralized and unified public system.
Organization
According to Article 198 of the ConstitutionPublic health actions and services are integrated into a regionalized and hierarchical network, forming a single system based on three guidelines: decentralization, with single management in each sphere of power; comprehensive care, prioritizing preventive actions; and community participation.
A Law 8080 / 1990 It establishes that the actions of each sphere of power are complementary to one another, from the least to the greatest complexity in health. "The system encompasses everything from the simplest actions to highly complex procedures. The law specifies the competencies of the national, state, and municipal directorates of the SUS (Unified Health System)." This is the most complex and organized inter-federative system we have in the country, considering the different public policies involved.“, comments Professor Suely Araújo.
Nationally, the health authority is the Ministry of Health. At the state and municipal levels, the health authority is represented by the Health Secretariats. It is worth noting that, in all three cases, the managers are chosen by democratically elected officials.
"This positions the health manager as part of a team that is responsible for a specific 'government project,' and they will have to report to the political leader at each level and interact with other government agencies," according to Cristiani Vieira Machado, Luciana Dias de Lima, and Tatiana Wargas de Faria Baptista, in the chapter "Organizational Principles and Management Bodies of the SUS (Brazilian Public Health System)”, Fiocruz publication.
The authors also highlight that "On the other hand, the health authority has the responsibility to conduct health policies according to the constitutional and legal provisions of the SUS (Unified Health System), which..." They constitute a given model of state health policy that is not limited to the term of a single government.".
When it comes to the direct execution of services, municipalities are primarily responsible for epidemiological and sanitary surveillance actions (for example, the fight against dengue fever by community health agents), in addition to the direct provision of healthcare services – those aimed at promoting health in order to prevent disease. They are also responsible for coordinating and planning the Unified Health System (SUS) at the municipal level, following federal regulations and state planning.
Therefore, the responsibility for executing more complex services in strategic and referral areas—such as a more complex examination like a CT scan or a transplant surgery—lies with the states. They are also responsible for meeting demands in cases of insufficient municipal services in cities or for more complex epidemiological and sanitary surveillance actions. At the planning level, they are in charge of promoting the regionalization of healthcare, as well as collaborating in the institutional development of municipal health departments.
The Ministry of Health has a more strategic and normative role, with the duty to maintain unity while respecting diversity, and to promote equity nationwide. The federal health authority performs services on an exceptional basis, in strategic areas or actions.
"It is a complex system, with a scope of free services unparalleled in the world." Even though we acknowledge all the shortcomings in the system, all Brazilians should be proud of the SUS (Unified Health System)."Suely Araújo concludes."
