In 100 days, Lula’s administration repackages Health programs – 04/11/2023 – Health

After taking over with an agenda of priority measures, the tenure of Luiz Inácio Lula da Silva (PT) at the Ministry of Health reaches the 100-day mark with part of the actions in progress, such as the resumption of the More Doctors program, while runs to remove others from the paper, such as the expansion of Farmácia Popular.

The portfolio is headed by Nísia Trindade, former president of Fiocruz and the first woman to assume the position. In the first few days, she announced changes in the organization of the folder, such as the creation of a digital health secretariat and an immunizations department and the resumption of a similar structure in the area of ​​HIV/AIDS.

It also began to adopt measures that represent a direct counterpoint to the management of former President Jair Bolsonaro (PL), such as the revocation of ordinances in the area of ​​women’s health that brought obstacles to legal abortion and an informative note that suggested the use of chloroquine in the Covid treatment.

The first days were also marked by the declaration of emergency due to deaths due to malnutrition among the Yanomami and the sending of the National Force of the SUS to Roraima, by the announcement of resources to reduce the queue of elective surgeries and by the launch of a new version of Mais Médicos, a program that aims to take doctors to the interior and that had been left in the background.

Within the folder, actions are defined as “reconstruction” in the face of what the transition team called “chaos” and “scorched earth”. The reason was the lack of coordination with states and municipalities, lack of information on test and vaccine stocks and a greater drop in vaccine coverage in recent years, among other problems.

At the same time, the transition listed ten priority measures as a suggestion for the first hundred days —reinforced in large part by the minister in her inauguration speech and interviews.

Of this list, at least eight have already had some initial announcement. Most, however, still require greater detail or must include new actions. This is the case of the strengthening of the health industrial complex, whose executive group was recreated in recent days, and of Mais Médicos itself, which is awaiting new public notices.

Experts and managers consulted by the Sheet point to advances in the last three months, but reinforce the need to address other urgent challenges and measures aimed at addressing structural issues of the SUS in the medium and long term.

“We need a strategic agenda so that we are not just dealing with emergency issues”, says Cipriano Maia, secretary of health for Rio Grande do Norte and president of Conass (state managers).

In general, the assessment is that the government saw the new version of Mais Médicos as one of the main milestones of the period. The idea of ​​the program, repackaged with new financial incentives to try to retain professionals, is to offer 15,000 new vacancies this year, reaching around 28,000.

The announcement, however, brought a new chapter of clashes with medical organizations over the possibility of admitting professionals without having their diplomas revalidated. Now, the forecast is that the discussion will go to Congress in the analysis of the provisional measure that brought the changes.

“There is a need to look for an effective and resolutive solution for the provision of physicians. We want to collaborate, but we cannot accept that doctors who are not trained in Brazil, even Brazilians, are taken without their competences having actually been proven”, says César Fernandes, from AMB (Brazilian Medical Association).

For him, there are other models to be tested. “One of them is having itinerant teams to inhospitable places”, points out Fernandes, for whom the lack of structure weighs on the difficulty of fixing.

Rosana Onocko, from Abrasco (Brazilian Association of Collective Health), says that the resumption of Mais Médicos “is not the panacea, but it was necessary”.

She defends, however, that there is also discussion about a state career in the health network. “More Doctors is important, but it is a palliative measure. The career issue is structural for the SUS itself.”

The need for new measures is also pointed out by specialists in other goals considered as priorities, such as reducing queues for elective surgeries. In January, the folder announced R$ 600 million until June to be distributed to states that send plans for this reduction in queues.

For Gonzalo Vecina Neto, professor of Public Health at USP, although strategies such as joint efforts and night care serve in an emergency, it is necessary to discuss other actions, such as improving regulation. “As long as there isn’t a single queue, like that for transplants, I’ll never know what I’m failing to do.”

Onocko agrees. “Money for mutirões is important, but it is not the solution for SUS”, she says. “It needs another regulation from the health regions. We can’t even know how many people are in line and for what.”

Specialists and managers also suggest attention to other topics, such as the computerization of the health network and new strategies to encourage vaccination.

In February, the government launched a National Vaccination Movement and campaign with doses of the bivalent vaccine against Covid for vulnerable groups. On the occasion, Lula was vaccinated by his deputy, Geraldo Alckmin, in a pro-immunization gesture and a new counterpoint to Bolsonaro.

Since then, Health has also said to study extra actions to curb the fall in coverage, such as the return of partnerships with schools, but nothing has yet been released.

The list of priority measures has other pending actions, such as the resumption of Farmácia Popular, a program that aims to expand access to free or low-cost medicines.

In a recent meeting with state and municipal health secretaries, Minister Nísia Trindade said that the portfolio “managed to fulfill almost all the planned actions” for the 100 days and that it is preparing to relaunch the program.

“We hope to announce the resumption soon,” he said, without giving a deadline.

Questioned, state and municipal secretaries say they see improvement in the dialogue with Health in recent months. “It’s a change from water to wine. Before we had odd and unacceptable situations”, says Maia, from Conass.

The group, however, has been concerned at meetings with other urgent demands, such as the risk of a lack of insulin starting in May. It also asks for support in the face of the damming of specialized consultations in the pandemic.

Adriano Massuda, coordinator of FGV Saúde and member of the transition’s technical group, says that the actions so far indicate an attempt to “recover what was deconstructed”. “From now on, there will need to be much more innovation to meet the challenges.”

He advocates increasing the debate on structural problems, such as funding, and the construction of new policies for urgent issues. “The health crisis is very serious. One of the main issues is maternal mortality, which has increased a lot in recent years.”

In a note, the Ministry of Health said that the current administration “has as a priority the reconstruction of fundamental public policies for the health of the Brazilian population, such as the Popular Pharmacy program, which was under threat of paralysis in the last government”.

“The initiative, created in 2004, will be strengthened and improved, ensuring access to free and affordable medication,” he declared, without detailing measures and deadlines.

The folder also says that the current management “is committed to rescuing the population’s confidence in vaccines” and that the resumption of partnerships with schools is discussed with the Ministry of Education.

Asked about proposals such as the regulation of surgery queues, the ministry says it intends to discuss the topic in the coming months, when it also plans a new stage to reduce the backlog of exams and consultations. He also says he is waiting for plans to be sent from more states to release the planned resources.

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100 FIRST DAYS OF GOVERNMENT IN HEALTH

Priority measures for the health area recommended by the transition team to the new government in the first hundred days and some of the main actions carried out in the period

SUS MANAGEMENT AND COORDINATION

• what was suggested: Strengthen SUS management, recovering the technical role of the Ministry of Health in the national coordination of the system with states and municipalities
• Example of what was done: Pasta appointed secretaries linked to health or previous administrations and created new departments focused on immunization, HIV/AIDS and mental health. Health managers say that there has been an improvement in the dialogue, but they also demand attention to new urgent demands

VACCINATION

• what was suggested: Restructure the National Immunization Program to recover high vaccination coverage
• Examples of what was done: The National Movement for Vaccination was launched, with campaigns featuring celebrities; experts point to the need for more measures, such as strategies in schools

RESPONSE TO COVID

• what was suggested: Strengthening the response to Covid and other health emergencies
• what was done: Pasta launched a vaccination campaign with doses of the bivalent for a priority group and revoked an informative note on chloroquine; minister even spoke of an “immediate” plan to deal with the consequences of Covid, still without announcements; portfolio says it hired a study to map the scenario

QUEUE REDUCTION

• what was suggested: Ensure access and reduce queues for consultations, exams, surgeries and specialized procedures
• what was done: Announced R$ 600 million for a program to reduce queues for elective surgeries, to be released with the delivery of plans by the states; created department of mental health

BASIC ATTENTION

• what was suggested: Strengthening primary care and restoring professional staff
• what was done: Mais Médicos was relaunched with the possibility of financial incentives for professionals who stay at the post and in remote areas or who have participated in Fies; Management still says to evaluate Doctors in Brazil

WOMEN’S HEALTH

• what was suggested: Strengthening the Health of Women, Children and Adolescents
• what was done: Pasta revoked an ordinance from the previous administration that was seen as an obstacle to access to legal abortion; it also revoked a measure criticized by nurses and seen as an incentive for cesarean sections and resumed the ordinance of Rede Cegonha; announced a budget of BRL 418 million per year to offer pads

INDIGENOUS HEALTH

• what was suggested: Strengthen indigenous health care
• what was done: He made an emergency decree on indigenous health due to the increase in hospitalizations and deaths of Yanomamis due to malnutrition and malaria; resumed public notice initiated in the previous management for vacancies in DSEIs by Mais Médicos

POPULAR PHARMACY AND PHARMACEUTICAL ASSISTANCE

• what was suggested: Rescuing the Popular Pharmacy program and restructuring pharmaceutical assistance in the SUS
• what was done: Program not yet relaunched; folder criticized lack of data on stocks of vaccines and tests from the previous management and says it has adopted measures, but confirms the loss of some products that were close to expiration

HEALTH INDUSTRIAL COMPLEX

• what was suggested: Resume the development of the health industrial complex, an area that encourages the development of products and medicines of interest to the SUS
• what was done: Reactivated, along with other ministries and bodies, an executive group to monitor actions

DIGITAL HEALTH

• what was suggested: Strengthening digital health (improving access to information systems and expanding telehealth services)
• what was done: created digital health secretariat, which signed an agreement with PAHO for systems analysis; portfolio says it has a telehealth expansion plan, still without a forecast