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Three decades of the Brazilian Public Health System under analysis


Informe Ensp


The scientific journal The Lancet has published an article about the process of implementation and expansion of the Brazilian Public Health System (Sistema Único de Saúde [SUS]). Led by a group of researchers from Harvard University, the article Brazil's unified health system: the first 30 years and prospects for the future was also attended by the researcher of the Sergio Arouca National School of Public Health (Ensp/Fiocruz), Ligia Giovanella, who contributed to the analysis of the characterization of SUS and the organization of Primary Health Care over these years. “The article makes it clear that the SUS has contributed to improving the health and well-being of the Brazilian population, as well as reducing inequities and inequalities in health, but it brings a very clear message about the present threats,” warned the author.

The threats reported by the text refer to fiscal austerity measures introduced in 2016, which, according to the conclusions, threaten the expansion and sustainability of the SUS. “The article shows important results. For all indicators analyzed (child mortality, proportion of births in which the mother attended 7 or more prenatal consultations; Family Health Strategy (FHS) coverage; and mortality from cardiovascular diseases), it is clear that if there is no change in the current scenario – which presents a reduction and no increase in funding for the SUS, given the constraints of Constitutional Amendment 95 [an austerity law that fix the public spending in Brazil for 20 years]- there will be deterioration in all these indicators”, commented the researcher of Ensp/Fiocruz.

Despite warning about the threats to the Brazilian health system, the article shows that the SUS is an example of a successful international experience of access to health care through a public system. According to the authors, although there are limitations, having a public health system, funded by public resources, is an appropriate strategy to achieve universalization.

The publication brings important recommendations to ensure the sustainability of the SUS, prevent deterioration of results in health and the widening of health inequalities: Upholding the principles of the SUS; ensuring sufficient public funding and efficient resource allocation in the SUS; providing services through an integrated network; developing a new inter-federative governance model; expanding health sector investments and strengthening economic, technological, industrial and social policies, and regulatory milestones for the production and evaluation of health technologies and services; and to promote social dialog with different government actors, SUS workers, the academia and civil society are the paths pointed out.

Ligia Giovanella also warns that the negative impacts with worsening of health indicators may be even greater than the scenarios analyzed in the article, as the projections are conservative. “The fiscal austerity programs negatively affect the SUS and worsen inequalities - which are already important. The threats are very important and the danger of backsliding can be much greater than the data analyzed show”, she said.

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