What is SUS? – 05/22/2023 – Health in Public

Fiocruz launched in 2009 the book “What is SUS?“, authored by Professor Jairnilson Silva Paim, with the aim of clarifying a non-specialized public about what the Unified Health System (SUS) is. I consider it essential reading for anyone who wants to know our health system, its history, its problems and challenges. Even after 14 years, the structural issues listed in the book continue to challenge everyone who proposes to build a health system as envisioned by the Brazilian Sanitary Reform Movement (MRSB).

The author reminds us that the MRSB, organized by civil society about 10 years before the promulgation of the Constitution, achieved a historic victory by inscribing in our major law of 1988 the right to health as a duty of the State and creating the SUS, public and universal . For the first time in the history of our country, the constitution guaranteed this right to all Brazilian men and women.

The Constitution did not nationalize the health system, but defined the private sector as complementary to the public sector, leaving the Ministry of Health to define public health policies and coordinate the entire system to avoid duplication of efforts and waste of resources. At this point, the author notes a contradiction between what our Magna Carta says and what happened in practice: the lack of public investment did not allow for the necessary growth of the SUS infrastructure and created conditions for the expansion of the private sector in health, which, in the opinion of Jairnilson Silva Paim, it will hamper the implementation of the SUS, as highlighted by some scholars of health policies.

Jairnilson summarizes what the SUS is, as established in the Constitution, as follows: the SUS is the set of public health actions and services, composing a regionalized, hierarchical and organized network based on the guidelines of decentralization, comprehensiveness and community participation . It is, therefore, a way of organizing actions and health services in Brazil, in accordance with principles, guidelines and devices established by the constitution of the republic and subsequent laws.

SUS was an innovative initiative for its time

The proposal to create the right to health and the SUS was also an innovation in terms of formulation, organization and management of public policies, combining republican and democratic elements. Below we list 7 aspects highlighted by Jairnilson Silva Paim that made the public health system proposal an innovative initiative:

These innovations allowed Brazilian society to conquer important public health policies. The author highlights some of the results achieved up to 2009, when the book was published: the Family Health Program (PSF), the National Immunization Program (PNI), the National Medicines Policy, the Mental Health Policy, the Hospital Information (SIH/SUS), the network of blood banks (the Blood Centers) and the development of communication and health education actions, training workers and health professionals at different levels of activity.

The challenges for the full realization of the right to health are still many

The book also presents a broad diagnosis of the difficulties of the health system. According to Paim, issues related to access and the quality of actions and services in the Brazilian health system express the limits and distortions of current health care models. They are intimately related to problems related to the unequal distribution of the infrastructure of the health services system, especially the number of establishments and health workers. They also have to do with unresolved problems in the financing, organization and management of the SUS. Even if the SUS can absorb certain problems linked to the population’s way of life, it is practically impossible to be efficient and effective in a society with levels of inequality, poverty and violence like ours.

Regarding management, the author says: The SUS has suffered great vulnerability in the face of changes in governments, managers and parties, which compromises its efficiency, administrative continuity and its legitimacy in the eyes of public opinion. Improvised directors, persistent political clientelism, high turnover of teams and bureaucratic rigidity require creative alternatives to protect or shield the SUS from the interests and maneuvers of health policy. This should not mean that we should neglect control mechanisms or allow public money to be wasted. However, as relevant as the fight against corruption and waste is ensuring the rational use of health resources, to ensure greater efficiency and effectiveness. A set of bureaucratic chains, which, under the pretext of fighting corruption, stifle administration, impair the flow of vital inputs for people’s care and treat the complexity of the health system as if it were any other sector, cannot be ignored as one of the main factors responsible for the poor resolution and low quality of SUS services.

Still by way of diagnosis, the author quotes an excerpt from the document “Twenty years of the SUS, celebrating what has been achieved, repudiating the unacceptable”, prepared by the Brazilian Center for Health Studies (CEBES) and released in 2008 during the celebrations of the 20th anniversary of the SUS, which says: “Brazilian society has invested work and hope in building a SUS for all. It is unacceptable that governments and managers, State representatives responsible for the SUS, fail to comply with its elementary guidelines. We can no longer hide or justify the daily tragedies that afflict the population and that can be resolved now”. As we can see a visionary and valid document today.

The issue of the digitization of health was not addressed in the book with the importance it has today, which is perfectly understandable, not least because this topic has taken on greater relevance in recent years. But, certainly, nowadays, it is one of the most important challenges of the SUS, due to the possibility that this technology reveals to help solve problems in serving the population, particularly in expanding access to health services in the most remote regions of the country. . However, the author cites the importance of the scientific and technological sustainability of the SUS.

The author’s writing gives us the emotion with which the book was made and fully fulfills its role of mobilizing the reader for the importance of what has been achieved and the need to maintain social mobilization to achieve the full implementation of the SUS. In his understanding, the right to health is not a natural right that is achieved at birth. It is not a gift from any government. It is historically constructed and conquered through social struggles. It is very worth reading.

Ricardo de Oliveira is a production engineer and was State Secretary of Management and Human Resources of Espírito Santo between 2005 and 2010 and State Secretary of Health of ES from 2015 to 2018. He is the author of the books “Public Management: Democracy and Efficiency” (FGV/ 2012) and “Public Management and Health” (FGV/ 2020). He is Counselor of the Institute of Studies for Health Policies (IEPS) and member of the philanthropy committee of UMANE.

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