Wednesday, February 1, 2023

Lula’s return and defense of the integrated health system

In his inaugural address, Luiz Inácio Lula da Silva raised as his first social commitment the defense and strengthening of the Brazilian Integrated Health System, known as SUS, which was born from the new 1988 constitution, which for years Democracy returned to Brazil after. A bloody military dictatorship. The constitutional principle on health is that it is a right of a citizen that it is the duty of the state to guarantee it. Unlike the Mexican public system, the SUS is decentralized to municipalities, a principle that reveals the deep popular dysfunction of years of hyper-centralization and vertical dictatorship. There are two reasons that explain the priority of SUS on the agenda of the new government. One is that the previous president, Jair Bolsonaro, severely discredited SUS and tried to privatize health. This led to the fact that the number of deaths during the epidemic in Brazil was very high, especially among the poorest people who were denied the vaccine despite its proven protection against the virus. The result to date is 690,000 direct deaths from Covid.

From the beginning, SUS was based on the concept of social determinants of the health-disease process and was promoted by the Brazilian University of Health. There was also the idea of ​​building a system from the bottom up, first of all guaranteeing basic care for the entire population. For this purpose, family medical centers were created throughout the region and this care was achieved even in the most remote places. Due to the difficulty of medical personnel in the most remote rural areas, the Mas Medicos program was created in collaboration with Cuba. While prioritizing first level care, SUS guarantees access to essential services in each individual case through a variety of agreements with the university and charitable sectors, and even the private sector.

It was also gradually strengthened into what is now the Fiocruz (Osvaldo Cruz Foundation), which is a combination of the School of Public Health and the Institute of Public Health in Mexico. However, the Foundation is much more, as it trains all kinds of human resources for the Ministry of Health, in addition to its master’s and doctoral postgraduate courses. It also has technical laboratory areas, for example, the World Health Organization (WHO)’s COVID Reference Laboratory. It produces immunogens and focuses on the development of cutting-edge technologies in vaccines, drugs and medical devices. Its importance is reflected in the fact that it has branches all over the country. The appointee, Nicia Trindade Lima, Minister of Health, was the director of Fiocruz until his appointment. He is a sociologist, who holds a master’s degree in political science and a doctorate in sociology.

The Ministry of Health has five secretariats, of which Science, Technology, Innovation and Strategic Inputs and Strategic and Partnership Management are particularly notable. The new owner of the first, Carlos Gadela, also comes from the Foundation. He has wide experience in health economics. However, unlike health economists trained in the Anglo-Saxon world, he is a promoter of national self-sufficiency in health supplies, equipment, including drugs and vaccines, with his technological innovation scheme. His appointment as Secretary marks the beginning of a rapid and intensive development of the Brazilian medical-industrial complex, which has been beneficial not only for Brazil but also for the rest of Latin America. It represents a kind of “evolutionism” in health, which is also promoted by Sepel and Celac.

Another secretariat that will surely see a new surge is the Strategic and Participatory Management, which was abandoned during the previous government. This will make it possible to resume the democratic structure of the National Health Council (CNS) and its corresponding structures in the states and municipalities. By law, the CNS is the highest decision-making body of the SUS and is composed of 50 percent members from popular organizations (unions, neighborhoods, farmers), 25 health professionals of all categories, and 25 percent appointed members. Government. The members of the CNS are elected in a process that begins in the municipalities, continues in the states to finally integrate the council by vote. It works on priority issues in various groups where votes are cast to make decisions.

As can be seen, there are different ways of organizing public health systems where objectives, structure, different professions and popular participation are conceived in different ways or even absent.

Nation World News Desk
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