quarta-feira, 10 de junho de 2015

Brazil’s Public Health: Utopia and the hard truth

In the NEJM’s first edition of June 2015, a very optimistic perspective was published about the Unified Health System of Brazil ( http://www.nejm.org/doi/pdf/10.1056/NEJMp1501140 ).

It is truth that the government “has invested substantially in expanding access to health care for all citizens” in absolute numbers. However, after the whole picture is seen, including the fact that we are talking of the “world’s fifth-largest population and seventh-largest economy”, a progressive lack of investment is the norm. There is a prevision of a more than 10 billion (R$) reduction in Healthcare funds for the year of 2015 and a 20 billion (R$) reduction considering all the four years of the actual Worker’s Party presidential mandate.

Even if the reach of the Family Health Strategy increased, the structural problems remain. The buildings dedicated to Healthcare assistance are, in most parts of Brazil, in a calamitous situation. At some places, the most basic materials – like gloves, masks, protection glasses, bandages, soap and even drinkable water - are not available. The decentralized administration proved mostly to be disastrous, and the central government is falling apart amidst scandals and corruption as never seen before.

Patients in need of a more complex treatment, a more elaborated diagnostic, or even in the need of a basic consultation of a specialist like an ophthalmologist, are waiting for months. The system just do not flow in most places, and the overcharged situation of secondary and tertiary Healthcare remains.

Moreover, the program Mais Médicos (More Doctors) proved to be an excuse to spend public money in Cuba for ideological reasons while the actual president of Brazil made her marketing using it in the 2014 presidential election. The allegedly good that it would provide, proved also to be false. Local mayors from the small cities from Brazil dismissed Brazilian physicians to save the money keeping in mind the fact that Cubans would arrive with Federal funds, which resulted in the decrease of the medical assistance in 49% of the municipalities reached by the Program Mais Médicos1.

If there is a lesson that “the world can learn (…) from the Brazilian experience” is that the most well planned Healthcare System can fall apart in a context of ludicrous ideological priorities and endemic corruption.


1 – Jornal do CREMESP. Desafios dos Sistemas público e privado são debatidos no 2º fórum A Saúde do Brasil. Dados citados pelo Presidente da Associação Paulista de Medicina, Florisval Meinão, com base em informações do Tribunal de Contas da União.