The COVID-19 pandemic, a disease that already accounts for more than 13 million cases and more than 350,000 deaths in Brazil, has made clear the importance of a public, free and universal healthcare system: the Unified Health System, the SUS.
“ Imagine what this pandemic would be like without SUS . Imagine the population having to pay for care, or showing a private health plan card at the hospital door. Brazilians would be dying in much greater numbers, left on the streets”, says Suely Araújo, PhD in Political Science and professor at IDP.
The professor highlights the capillarity of the system, which offers health services organized in a regionalized and hierarchical manner at levels of increasing complexity, from municipal to federal levels. However, with the rapid evolution of the number of cases, especially in this second wave, the assistance network is facing difficulties.
“It is not simple to respond to the pandemic anywhere in the world. We have had difficulty providing services, especially regarding ICU beds. The SUS is widespread and serves 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 to regional units with more sophisticated care, due to the rapid evolution of the disease. illness and overcrowding in hospital units”, he states.
History
According to article 196 of the 1988 Constitution , health is a right for everyone and a duty of the State. According to the Charter, the right is “guaranteed through social and economic policies that aim to reduce the risk of disease and other injuries and universal and equal access to actions and services for their promotion, protection and recovery ”.
For Suely Araújo, the SUS is an achievement of Brazilian society built little by little over decades. The system has its origins in the health movement of the 1970s, still during the military dictatorship, in which doctors and other health professionals sought to define the priority areas of health and what measures could be taken to transform Brazilian public health.
An important historical milestone in the origins of the SUS is the VIII National Health Conference, held in Brasília, in 1986. The main themes were “Health as the duty of the State and the right of the citizen”, “The reformulation of the National Health System” and “Sectoral financing”, the VIII Conference laid the foundations for the creation of a decentralized and single public system.
Organization
According to article 198 of the Constitution , public health actions and services are part of a regionalized and hierarchical network and constitute a single system, based on three guidelines: decentralization, with a single direction in each sphere of power; comprehensive care, with priority given to preventive actions; and community participation.
Law 8080/1990 establishes that the actions of each sphere of power must be complementary to each other, from the smallest to the greatest complexity in health. “The system ranges from the simplest actions to highly complex procedures. The law explains the powers of the national directorate, state directorates and municipal directorates of the SUS. This is the most complex and organized Interfederative system we have in the country, considering the different public policies ”, comments professor Suely Araújo.
At a national level, the health authority is the Ministry of Health. At state and municipal levels, the health authority is represented by the Health Departments. It is worth noting that, in all three cases, the managers are chosen by democratically elected officials.
“This places the health manager as a member of a team that has responsibility for a certain “government project”, which will have to respond to the political head in each sphere and interact with other government bodies”, according to Cristiani Vieira Machado, Luciana Dias de Lima and Tatiana Wargas de Faria Baptista, in the chapter “ Organizational Principles and management instances of the SUS ”, published by Fiocruz.
The authors also highlight that “On the other hand, the health authority has the responsibility to conduct health policies in accordance with the constitutional and legal determinations of the SUS, which constitute a given model of State health policy that does not end in period of a government ”.
When it comes to the direct execution of services, municipalities are mainly responsible for epidemiological and health surveillance actions (for example, the fight against dengue by community health agents), in addition to the direct provision of assistance services - those aimed at promoting health, in order to prevent diseases. In addition to coordinating and planning the SUS at the municipal level, following federal standardization and state planning.
Therefore, it is the States' responsibility to carry out more complex services, in strategic and reference areas - a more complex exam, such as a tomography, or transplant surgery, for example. It is also responsible for meeting demands in cases of lack of municipal services in cities or in more complex epidemiological and health surveillance actions. At the planning level, it is responsible for promoting the regionalization of health, in addition to collaborating with the institutional development of municipal health departments.
The Ministry of Health has a more strategic and normative role, with the duty to maintain unity, respecting diversity, and promoting equity at the national level. 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 service that is unparalleled in the world. Even if we recognize all the deficiencies in the system, all Brazilians should be proud of the SUS ”, concludes Suely Araújo.
