Despite the problems, the SUS is still considered one of the best public health systems in the world, says former minster Alexandre Padilha

We have 30 years of improvements, although we still have not met our quality and access standards for a National Public Health System


SUS represents one of the most important and most daring policies ever installed in Brazil

In a newspaper article published on Folha de São Paulo (05/08), the World Bank affirms an efficiency improvement in Brazils Unified Health System could represent a 16.5% economy in health expenditures for the next 12 years and this will be key to ensure the systems sustainability in a scenario marked by underfunding and population aging. Former Minister of Health, Alexandre Padilha estimates the resources waste could be even greater. To him, combatting wastage is a responsibility and fundamental mission to improve the systems operational effectiveness, but there are some challenges: The first refers to the systems management and governance in order to permanently combat any irregularity situation or private interest influence. The second is to overcome the biomedical model, the centered physician, and centered at the hospital, that still exists in the Brazilian public health system. The strengthening of a technical and care model based on primary attention, outside the hospitals, with a multi-professional team, increasingly closer to the community, is decisive to reduce wastage and prepare the SUS for epidemiological, demographic and aging changes in the Country and to continuously increase the need for care on non-infectious chronic diseases, he says. The third challenge is to invest more in integrated networks. In 2011 when we implemented the first attention network policies we begun to finance the service in an integrated way and not isolated, per individual procedure or health equipment. One of the main challenges to consolidate the integrated networks in the SUS was to overcome cities fragmentation and specialty fragmentation, says Padilha.

According to the ex-minister, since its creation, SUS is a completely underfunded health system and this challenge was not faced by Brazilians. To him, this is evidenced when we compare to other international public systems. Simply comparing what is spent and what is invested in the family supplementary health economy and what is spent in public health clearly shows how the SUS is underfunded, he argues.

The SUS 30-year trajectory mark one of the most important and daring policies ever put in practice in Brazil, created to ensure universal and free health, a peoples right and an obligation to the State. However, Padilha acknowledges these in these three decades the SUS has suffered two massive defeats: In 2007, when health lost R$ 42 billion under the excuse that taxes over financial operations should be removed in order to lower prices. The second defeat of its funding was the Constitutional Amendment 241/2016 that froze federal government spending for the next 20 years. This proposition tears the Brazilian constitutional commitment to have health as a right, and this right being ensured by a public system, he says. During this time the pre-salt resources were also removed – one of the resources destined to health and education – what would mean about R$ 200 billion for health, in estimates under a decade. This exploration model change had a very strong impact leading SUS to underfunding in our Country.

Regarding the SUS main legacy, the former minister calls attention for the assistance service that proved it is possible for a middle-income country, with over 200 million inhabitants, three government levels to have a national immunization program that even lead to diseases eradication. It also proved to be possible to host one of the most daring national AIDS programs, that over 90% of the cancer treatments are performed by the national public system; reaching the millennium goals earlier, in 2012, when the goal was 2015 (reducing child mortality, reducing the incidence of tuberculosis and malaria); proved it was possible for a country as Brazil to have the largest national public transplant system; to have a public network of blood centers. Besides this, the SUS has important technical-assistance and political legacies, when through these 30 years, it helped to construct new citizens, as wells as movements and organizations that raised having the SUS as their main assistance platform, he adds.

Asked if Brazil should get healthier, Padilha stresses the need to develop other policies rather than health, but that promote health. To him, it is not possible to end arboviral diseases cyclic epidemics without a permanent commitment to confront the basic sanitation issue. Still as an example of health promotion policy, Padilha says that in São Paulo, traffic speed control, signage and pedestrian protection have decreased by 14% the number of hospitalizations in the SUS. So, the first step towards a healthier Brazil is to build a set of policies not specific to health, but that have outstanding impacts over Brazilian health. The second is a permanent commitment by the three government levels to ensure a strong public national system based on basic health attention, he says.

Finally, the former health Minister says the SUS represents 30 years of advances, although not yet reached the intended levels, it is a quality, universal national public system available to all Brazilians. What concerns me is the current risk of 20 years of setback with the Constitutional amendment 241 that froze public investments in our Country, he regrets.