Overview of Brazil's Unified Health System (SUS)


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Brazil’s Unified Health System:
History Timeline & Public Health System Overview

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Overview of Brazil's Unified Health System (SUS)

  1. 1. Brazil’s Unified Health System PT: Sistema Único de Saúde (SUS) History Timeline & Public Health System Overview  Prepared by Brazil Pharma News April 2013
  2. 2. DisclaimerThis presentation was prepared in order to provide the general public a an updated overview onBrazil’s past and current public health system. The great majority of information contained in thispresentation was originally published by the Brazilian Ministry of Health and UNA‐SUS Universityand is of public domain. Therefore, the author of this work does not claim authorship andownership of any information originally published elsewhere. The resources listed may direct thereader to local government agencies websites which content is communicated in Portuguese. Thefree translation content is made to the best of our knowledge. Therefore, Brazil Pharma News doesnot warrant the accuracy, reliability or timeliness of any information translated in the followingslides. In addition, some items may not be fully translated into English, including graphs, photos orprint screen documents. Brazil Pharma News does not endorse the use of any web translationtools; other translation services may be used to view our site. The information reported in thispresentation does not necessarily reflect our official position on the subject, nor of any present orpast associated employers of the author. Some web links may be time‐sensitive. These links maymove or expire as the news changes throughout the time. Some sources may require registrationor fee‐based subscriptions. Any person or entities that rely on information obtained from thesystem does so at his or her own risk. The commercial use or unauthorized distribution of thecontents in this presentation without prior consent is prohibited. If you have any suggestions orcomments, please contact us by using the feedback form available at Contact Us. Brazil Pharma News
  3. 3. Federative Republic of Brazil  • Population: 205 million people (July 2012 est.) • Total land are: 3,287,597 sq. mi. • GDP: US$ 2.324 trillion (2011) • GDP Growth: 2.7% (2011) • One major official language: Portuguese  • Government: Presidential system,  Constitutional republic, Federal republic • Population concentration in major urban areas:  São Paulo, Rio de Janeiro, Belo Horizonte, Porto  Alegre, Brasilia. • Urbanization: 40% metropolitan • Life expectancy at birth : 74.08 yrs (2011 est.) • Total health expenditures (2006): US$ 87.3  billion • Health expenditure as % GDP: 9 (2009) Sources:  World Bank , World Fact Book: Central Intelligence  Agency and IBGE (Brazilian Institute of Geography and Statistics)     
  4. 4. The Unified Health SystemThe Brazilian Unified Health System was created by Law N. 8,080 (September19, 1990) and Law N. 8,142 (December 28, 1990).These laws established that “Health is a right of every citizen and a duty of the State” Source: 1988 Constitution of the Federal Republic of Brazil
  5. 5. Evolution of the Constitution and public health law • Federative Republic of Brazil (1985 to present); 1988 Constitution 1988 • Articles 196‐200: “Health is a right of every citizen, and a duty of the State”, Created  the SUS  • Federative Republic of Brazil (military government : 1964 to 1985); 1967 Constitution 1967 • Article 8 lists the responsibilities of Federal government to establish health and education standards   • Republic of the United States of Brazil (1945 to 1964); Constitution (September 18, 1946) 1946 • Article 5 lists the responsibilities of Federal government to establish fundamental  health standards • Republic of the United States of Brazil (1889 to 1937); Constitution (November 10, 1937) 1937 • Article 16 lists the responsibilities of Federal government to establish fundamental  health standards • Republic of the United States of Brazil (1889 to 1937); Constitution (July 16, 1934) 1934 • Article 10 sets forth the obligations of the Union and States in public health assistance • Republic of the United  States of Brazil (1889 to 1937); Constitution (February 24, 1891) 1891 • Legislation did not include any health provisions  • Empire of Brazil (1822 to 1889); Constitution (March 25, 1824) 1824 • Legislation did not include any health provisions   Source: Brazil Ministry of Health Online Public Health Library (2013)
  6. 6. Timeline: Major Public Health Policies 1990 • Establishement of the Unified Health System (PT: Sistema Único de Saúde) • Creation of the Unified and Decentralized Health Systems (PT: Sistemas Unificados e  1987 Descentralizados de Saúde (SUDS) • VII National Health Conference enshrined the principle:  “Health is the right of every citizen  1986 and duty of State”  1982 • Integrated Health Actions Program (PT: Programa de Ações Integradas de Saúde (PAIS)  • Creation of the National System of Assistance and Social Security (PT: Sistema Nacional de Assistência e  1977 Previdência Social (SINPAS) and the National Institute of Medical Assistance and Social Security (PT: Instituto Nacional de Assistência Médica da Previdência Social (INAMPS) 1965 • Creation of the National Social Security Institute (PT: Instituto Nacional de Previdência Social  (INPS) 1932 • Creation of the retirement and pensions institute (PT: Instituto de Aposentadorias e Pensões (IAPs) 1923 • Creation of the retirement and pensions fund (PT: Caixas de Aposentadorias e Pensões (CAP) Source: UNA-SUS Políticas Públicas de Saúde: Sistema Único de Saúde (2011)
  7. 7. Current Law: Constitution and amendments Brazil: 1988 Federal Constitution (Articles 196-200) Constitution Amendment No. 29 (September 13, 2000): Modifies articles: 34, 35, 156, 160, 167 and 198 of the Federal Constitution and adds an article to the Temporary Constitutional Provisions Act, to ensure the minimum resources to finance actions and public health services. Law No. 8.080 (September 19, 1990): Provides for the protection, promotion of health, the organization and operation of health services, and other provisions. Law No. 9.836 (September 23, 1999): Adds provisions to Law No. 8.080 Law No. 11.108 (April 7, 2005): Modifies Law No.8.080 Law No 10. 424 (April 15, 2002) : Adds chapter and article to Law No. 8.080 Law No. 8.142 (December 28, 1990): Provides for the community participation in the management of the Unified Health System (SUS), and intergovernmental transfers of financial resources to health services, and other provisions. Ordinance N. 2,048 (September 3, 2009): Approves the Unified Health System (SUS) regulation, and other provisions. Ordinance N. 2,230 (September 23, 2009): Implementation of Ordinance N. 2,048/GM from September 3, 2009, and other provisions Source: Brazilian Ministry of Health Online Public Health Library (March 2013)
  8. 8. Public Health Management Health  Minister  (Dr. Alexandre Padilha) Related entities: Collegiate Bodies:  ANVISA, ANS, FUNASA,  FIOCRUZ, HEMOBRAS.  National Health Council (CNS) and  Hospitals: Our Lady of Supplemental Health Council (ANS) Conceição, Fêminaa and  Health Minister Executive Secretariat Christ Redeemer Office of  Office of  Office of  Office of  Office of  Science,  Office of  Labor and  Strategic and  Native  Health  Technology and  Health  Health  Participative  Indians  Services Strategic  Surveillance Education Management  Health Supplies Source: Brazil Ministry of Health Organizational Structure per Decree N. 7,336 (October 19, 2010)
  9. 9. Unified Health System Users Letter of Rights The “Letter of the Rights for the Unified Health System Users" provides information for the citizens to know their rights when it comes to seeking health care services. It brings together the six basic principles of citizenship which ensure every Brazilian the right of health, whether public or private. The Letter is an important tool for citizens to know their rights and thus help Brazil have an even more effective health system.The principles of the Letter of Rights are:1st.  Every citizen has the right to access an orderly and organized health systems2nd. Every citizen has the right to an appropriate and effective health treatment 3rd. Every citizen has the right to humane, free from any discrimination treatment 4th. Every ci zen has the right to care that respects their person, their values   nd their rights   a5th. Every citizen also has responsibilities to assure their treatment is managed properly6th. Every citizen is entitled to health authorities commitment to the principles above are met“Letter of the Rights for Users of the Unified Health System" (Click here for the 2011 version) Source: Brazil’s Ministry of Health website (March 2013)
  10. 10. The SUS since 1988The Brazilian Unified Health System has greatly evolved since 1988. “TheUnified Health System is a unique social project whose principles ofuniversality, comprehensiveness and fairness are established in theConstitution of 1988. Based on this perspective, in order to understand theactions promoting, and preventing health care, the Brazilian Ministry of Healthorganizes and develops plans and policies that meet the constitutionalrequirements.”Several new major health policies and programs have been put in place in theareas of:- Pharmaceutical assistance- Health assistance- Science and Technology- Health education- SUS work management- SUS participatory management- Health surveillance Source: Brazil’s Ministry of Health Online Public Health Library (2013)
  11. 11. Guiding Principles of SUS • Universal acess to health services at all levels of health assistance.• Completeness of health assistance through either individual or collective actions and services set to prevent and cure, required in each case at all levels of the health sytem.• Preservation of the autonomy in defense of physical and moral integrity.• Equal rights to healthcare without prejudice of any privileges.• The right of health information to disabled people.• Disclosure of to health services information.• Use of epidemiology data to establish priorities, resources allocation and programmatic guidances.• Community participation.• Political and administrative decentralization.• Resolution capability for services in all levels of health assistance.• Organization of public health services in order to avoid duplication of work. Source: www.unasus.unifiesp.com.br
  12. 12. The Brazilian Health System Public Health Care: free, universal access Private Health Care:  Supplemental Health  access by direct  Care:  private access to  payment of services to  beneficiaries of  the health care provider supplemental health  plans  Source: Brazil’s Ministry of Health: Desafios do SUS e Propostas de Superação (2008)
  13. 13. SUS: Financial ResourcesThe Unified Health System (SUS) is funded by the three levels ofgovernment: federal, state and municipal, as determined by the1988 Federal Constitution, which establishes the minimum taxrevenues resources to cover the costs associated with public healthservices.SIOPS: Information system which collects, retrieves, process,stores, organizes data and information regarding total revenuesand public health services expenses in order to monitor theutilization of resources by health authorities. Source: Brazil Ministry of Health website (March 2013)
  14. 14. SUS: Financial Resources, cont’d Federal  States District Federal  Municipalities Government Social  SUS  Other Security Financing Source: Prof. Romulo Passos study guide (2013)
  15. 15. SUS: Financial Resources, cont’dMinimum Financial Resources in Health (Constitution Amendment N. 29/2000) Federal  • Value utilized in the previous year,  at minimum,  Government plus nominal GDP variation States • 12% of tax revenues from each state jurisdiction • 15% of tax revenues from each municipality  Municipalities jurisdiction • 12% and 15% of tax revenues from the state and  Federal District municipality jurisdiction Source: Prof. Romulo Passos study guide (2013)
  16. 16. Federal Health Budget (BRL) Sources: Brazil’s MoH #susmaisforte presentation. Dr Padilha (Sep 2011)
  17. 17. SUS systems and applications• SIA: Outpatient Information System / Credit report to health  providers.• SIGTAP: Unified Health System List of Procedures,  Pharmaceutical drugs, Orthotics, Prosthetics and Special SUS  Materials.• SIPAR: Integrated Protocol System and the Ministry of Health  File.• SIS‐Fronteira: Borders Health.• SOMASUS:  Development  Support System for Investment   Projects in Health• TABNET: Ministry of Health Tabulation Program. 
  18. 18. Political Science: Participation and Management in SUSUnified Health System (SUS) - Set of health actions and services rendered by federal public, state andmunicipal agencies and institutions and by the private sector and non-governmental organizations throughcontracts and health plans. It is organized in regionalized and under a hierarchy of networks with singlemanagement in each governmental area.Ministry of Health (MS) - National management of SUS, formulates, standardizes, inspects, monitors andassess policies and actions, in combination with CNS. Acts in the scope of CIT to make an agreement withthe National Health Plan. The following make up its structure: Fiocruz, Funasa, Anvisa, ANS, Hemobras,Inca, Into and eight federal hospitals.State Health Offices (SES) - Participates in the formulation of health policies and actions, render support tothe municipalities in conjunction with the state council and participates in CIB to approve and implement thestate health plan.Municipal Health Offices (SMS) - Plans, organizes, controls, alleviates and executes the health actionsand services in conjunction with the municipal council and the state area to approve and implement themunicipal health council.Health Councils (municipal and state) - There are 26 state councils, one in the Federal District and 5,562municipal councils that operate as court of social participation and health policy and plan control. NationalHealth Council (CNS) - CNS proposes, deliberates, monitors and assesses the health policies and plansadopted in the three government areas. It is made up of 48 institutions, half representing entitiesof users and social movements. Source: 20 years of SUS (Brazilian Ministry of Health website)
  19. 19. Participation and Management in SUS, cont’dNational Council of Health Secretaries (Conass) - Representing entity of state and Federal Districthealth secretaries, part of CIT and operates in health actions and services.Municipal Council of Health Secretaries (Conasems) - Representing entity of municipal health offices,part of CIT and operates in health actions and services.Council of Municipal Health Secretaries (Cosems) - State representation of Conasems, part of CIB,articulates and mobilizes the municipal secretaries to exchange experiences and consolidate the healthpolicies.Tripartite Intermanagers Commission (CIT) - Deliberative court that comprises municipal, state andfederal managers to plan, implement and assess the health policies and plans.Bipartite Intermanagers Commission (CIB) - Deliberative court that comprises state and municipalmanagers to plan, implement and assess the health policies and plansNational Table of Permanent Negotiation of SUS (MNNP-SUS) - Created in 2003, MNNP-SUS unitesmangers and workers to negotiate and improve the work relationships in the Health Sector Source: 20 years of SUS (Brazilian Ministry of Health website)
  20. 20. Major Public Health Policies• National Policy for Pharmaceutical Assistance• National Policy for Medicinal Plants and Herbal Medicines• National Policy for Pharmaceutical Drugs• National Policy for Mental Health of Children and Teenagers• National Policy for Integral Attention to Users of Drugs and Alcohol• National Cancer Policy• National Policy for Comprehensive Health Care for Women• National Policy for Assisted Human Reproduction Comprehensive Care• National Policy for Kidney Disease Patients• National Policy for Hearing Health Care• National Policy for Trauma and High Complexity Orthopedics• National Policy for Health Emergencies Source: Brazil Ministry of Health Online Public Health Library (2013)
  21. 21. Major Public Health Policies cont’d• National Policy for Small Hospitals• National Humanization Policy: HumanizaSUS• National Policy for Natural Medicine and Complementary Practices• National Policy on Integrative and Complementary Practices (PNPIC) SUS• National Policy for Elective Surgical Procedures• National Policy for Elective Average Complexity Surgical Procedures for Outpatients and Inpatients• National Policy on Health Promotion• National Health Policy for the Afro-Brazilian Population• Monitoring System Incentive Policy in the Framework of the National STD and AIDS• National Policy for Health Information Systems• National Policy on Science, Technology and Innovation in Health Source: Brazil Ministry of Health Online Public Health Library (2013)
  22. 22. Major Public Health Policies cont’d• Nation Policy on Education SUS Development• National Policy on Permanent Education for the Ministry of Health Workers• SUS Training and Development Policies• National Policy for Strategic and Participative Management in the SUS: ParticipaSUS• National Policy for the Health of Indigenous People• National Policy for Reduction of Morbidity and Mortality from Accidents and Violence Source: Brazil Ministry of Health Online Public Health Library (2013)
  23. 23. Major Public Health Programs• Better at home: People in need of motor rehabilitation, elderly, chronically ill or post-surgical patients, for example, will have multidisciplinary health care provided in their own homes free of charge with comfort of being closer to family.• S.O.S Emergency: Gradual and strategic action to qualify SUS emergency services. The initiative shall include 40 largest Brazilian emergency rooms, covering all 26 states and the Federal District by 2014.• Health academy: Encourages the creation of public spaces suitable for physical activities and recreation with the goal to help promote population health.• Family health: Seeks to maintain health and prevent diseases, thereby altering the health model centered hospitals.• Dengue disease control: MoH actions to control the disease Source: Brazil Ministry of Health Web Portal (2013)
  24. 24. Major Public Health Programs cont’d• Farmácia Popular (People’s Pharmacy): program created by the MoH to increase the populations access to essential medicines, sold at prices lower than those prevailing in the market.• PNAN: The National Food and Nutrition Policy seeks to ensure the quality of food available for consumption in the country, as well as promoting healthy eating habits and prevent and control nutritional disorders.• UPA24h: The UPAs are 24 structures of intermediate health complexity services.• Organ donation: Campaign seeking to raise awareness about the importance of organs donation.• SAMU 192: Mobile Emergency Service. In case of emergency call # 192.• Olhar Brasil project: The goal of this program is to identify vision problems in students enrolled in public elementary schools and in people over the age of 60. Source: Brazil Ministry of Health Web Portal (2013)
  25. 25. Major Public Health Programs cont’d• Humaniza SUS: National Policy with strategies built by managers, workers and users of SUS who qualify the public health management.• Customized drug package: Medicinal drugs are manufactured in special sizes packaging and sold in the exact amounts recommended by the medical doctor.• Mortality rate reduction: The Pact for the Reduction of Child Mortality in the Northeast-Amazon region is part of a commitment to accelerate the reduction of regional inequalities.• Human Milk Bank Network: Seeks to promote a quantitative and qualitative expansion of human milk banks in Brazil, through integration and partnerships between federal agencies, private sector and society.• National Cancer Control Program: Provides subsidies to help advance cancer diseases control plans.• Back home: proposes the social reintegration of people affected by mental disorders and discharged from long hospitalizations. Source: Brazil Ministry of Health Web Portal (2013)
  26. 26. Major Public Health Programs cont’d• Project ‘Expansion’: Launched in 2001 by the National Cancer Institute (Inca) and the Ministry of Health, this project has the main objective of structuring the integration of cancer care in Brazil in order to obtain a high quality standard in population health care coverage.• Tobacco Control: The National Cancer Institute (INCA) is the agency of the Ministry of Health responsible for coordinating and implementing the Tobacco Control Program in Brazil. The goal is to prevent disease and reduce the incidence of cancer and other smoking-related diseases, through actions that encourage the adoption of healthier behaviors and lifestyles.• QualiSUS-Network: Established as a strategy to support the organization of health care management and technologic development networks within SUS.• National Health Card: Tool that enables the linking procedures implemented under SUS to the user, the professional who performed them, and also to the health facility where health services were provided. Source: Brazil Ministry of Health Web Portal (2013)
  27. 27. National Health Card “The National Health Card meets a historical demand of public health in Brazil. The goal is to identify each SUS key user and monitor the health care provided by the health system, wherever they occur, through the access of the national citizens health database.”“It is a modern information system instrument needed for the organization of thenetwork of health care and SUS management.” Ordinance MS / GM # 940 of April 28, 2011 Regulates the National Health Card System Source: Cartão Nacional de Saúde – Normas e Procedimentos de Uso (2011)
  28. 28. People’s Pharmacies programThe Federal government People’s Pharmacies program"Farmácia Popular do Brasil“ was established by the Decree N.5.090, dated May 20, 2004.Ordinance N. 971 (May 15, 2012) updated the Peoples Pharmaciesregulation including the updated description of definitions, operation norms andcriteria for the registration of pharmacies and drugstores in the program which iscomprised of a network of public and private pharmacies/drugstores accreditedby the Ministry of Health.The large number of accredited pharmacies and drugstores in this program havegreatly improved the access to medications for common diseases. Somemedications are distributed “free of charge” while others are offered with adiscount of up to 90% Official list of medicines available through the People’s Pharmacies program Source: Brazil Ministry of Health Web Portal (2013) Ministério da Saúde e Municipios. 2ed. (2013)
  29. 29. SUS in numbers: capacity 39,526 basic health units** 8,502 public hospitals 17,000+ emergency facilities 17,202 intensive care facilities: 10,986 adult; 2,217 pediatric; and 3,999 neonatal 1,287 intensive care care units beds 504,270 hospital beds 63,000 outpatient units 26,000 family health teams 215,000 community health agents 13,000 dental health teams Health assistance in 5,000+ Brazilian municipalities Source: Relatório de Gestão – Secretaria de Atenção à Saúde. (2011) **Ministério da Saúde e Municipios. 2ed. (2013)
  30. 30. CNES: National Register of Health Centers STATE  Total % ACRE (AC) 695 0,27% ALAGOAS (AL) 2715 1,04% AMAPA (AP) 452 0,17% AMAZONAS (AM) 1901 0,73% BAHIA (BA) 14028 5,35% CEARA (CE) 9025 3,44% DISTRITO FEDERAL (DF) 5504 2,1% ESPIRITO SANTO (ES) 5425 2,07% GOIAS (GO) 7592 2,9% MARANHAO (MA) 4337 1,65% MATO GROSSO (MT) 4486 1,71% MATO GROSSO DO SUL (MS) 3763 1,44% MINAS GERAIS (MG) 32227 12,3% PARA (PA) 5262 2,01% PARAIBA (PB) 4830 1,84% PARANA (PR) 20070 7,66% PERNAMBUC O (PE) 7407 2,83% PIAUI (PI) 3026 1,15% RIO DE JANEIRO (RJ) 16094 6,14% RIO GRANDE DO NORTE (RN) 3613 1,38% RIO GRANDE DO SUL (RS) 20001 7,63% RONDONIA (RO) 1828 0,7% RORAIMA (RR) 476 0,18% SANTA CATARINA (SC) 12887 4,92% SAO PAULO (SP) 60595 23,12 Total in Brazil: 252,620 SERGIPE (SE) 3047 1,16% TOCANTINS (TO) 1334 0,51% Source: CNES (National Register of Health Establishments) April 2013
  31. 31. SUS in numbers: assistance 11,117.634 hospitalizations, 2011 annual cost of BRL 11,1 billion:  52.76% supplemental health assistance  47.23% public health assistance 3,523,910.480 procedures, 2011 annual cost of BRL 15,1 billion:  1,682,010.649 basic outpatient procedures  1,841,899.831 specialized procedures in the areas of clinical pathology, radiology, ultrasound, CT scans, hemodialysis, cytopathology, cataract surgery and oncology 150 million medical visits** 2 million child births** 300 million laboratory tests** 1 million CT scans** 10.5 million oncology treatment* 282 heart surgeries * 98,000 oncology surgeries * 9 million ultra-sound scans** 140 million immunization doses** 21,000 human organ transplants * A total of 145 million Brazilian citizens rely exclusively on the SUS Sources: *Relatório de Gestão – Secretaria de Atenção à Saúde. (2011) **SUS, conquistas e desafios by Luiz Odorico Monteiro de Andrade (Nov. 2012)
  32. 32. SUS Public Health Access Index Source: Índice de desempenho do sistema único de saúde IDSUS (April 2013)
  33. 33. SUS Performance Index  Source: Índice de desempenho do sistema único de saúde IDSUS (April 2013)
  34. 34. SUS Medium and High Complexity  Performance Index  Source: Índice de desempenho do sistema único de saúde IDSUS (April 2013)
  35. 35. SUS: Total Number of Outpatient Procedures of Medium  Complexity per region (2008‐2011) Data analysis: Brazil Pharma News (March 2013) North 3,523,910,480 3,363,761,138 Northeast 3,246,439,600 Midwest 2,914,162,162 Southeast 1,652,671,478 South 1,573,297,609 1,524,714,510 1,389,157,195 Total 852,589,286 834,415,967 804,108,538 730,220,151 508,963,125 465,360,273 434,228,857 384,863,345 263,536,586 262,668,090 252,288,362 247,018,501 231,099,333 226,958,202210,381,308 199,520,716 Quantity Quantity Quantity Quantity 2008 2009 2010 2011 Data source: Relatório de Gestão 2011 – Secretaria de Atenção à Saúde
  36. 36. SUS: Total Number of hospital admissions by region (2008‐2011) Data analysis: Brazil Pharma News (March 2013) North Northeast 11,128,809 11,357,965 11,117,634 Midwest 10,743,603 Southeast South Total 4,358,294 4,342,659 4,226,450 4,094,612 3,211,310 3,134,816 3,078,840 3,016,562 1,891,360 1,887,681 1,850,041 1,812,052 1,011,174 992,653 969,039945,632 901,462 887,209 874,745 861,420 2008 2009 2010 2011 Data source: Relatório de Gestão 2011 – Secretaria de Atenção à Saúde
  37. 37. Department of Science, Technology  and Strategic Supplies (SCTIE)It is responsible for implementing the policies of pharmaceutical evaluation andincorporation of technologies in health, and to encourage the development ofthe industrial and scientific sectors.In the context of science and technology, the Secretariat is responsiblefor encouraging the development of health research in the country, so as todirect the investments made by the Federal Government to the needs of publichealth.The SCTIE directs the industrial health complex policy for the public sector injoint action with other ministries and state agencies, encouraging thedevelopment of pharmaceuticals, medical equipment and health technologies.The goal of the Federal Government is, thus, to make Brazil independent fromthe external market. Source: Ministry of Health (SCTIE) website (April 2013)
  38. 38. SCTIE Management SCTIE (Mr. Carlos Augusto Grabois Gadelha Chief of staff Budget and  Planning Office  Office of  Office of  Management  Office of  Office of  Industrial  and Pharmaceutical  Science and  Complex and  Incorporation of  Assistance Technology Innovation in  Health  Health Technology Source: Ministry of Health (SCTIE) website (April 2013)
  39. 39. Essential Medicines RENAME 2012The Ministry of Health issued the Ordinance MS / GM No. 533 of 28 March 2012 with the list of medications and health supplies from the National List of Essential Medicines ‐ RENAME. The RENAME/2012 was compiled from the definitions of Decree No. 7508 of 28 June 2008 and structured in accordance with Resolution No. 1/CIT of January 17, 2012. The RENAME/2012 includes medicines and supplies available through SUS in the Basic Component of Pharmaceutical Care, Strategic Components  of the Pharmaceutical Assistance, Specialized Components for Pharmaceutical Services, and certain medicines for hospital use. RENAME 2012
  40. 40. Actions and Health Services RENASES 2012The Ministry of Health issued the Ordinance MS / GM No. 841, of May 2, 2012, establishing the National List of Actions and Health Services (RENASES) in the SUS. The actions and services described in RENASES include, in aggregate, the entire Table of Procedures, Orthotics, Prosthetics and Drug Administration in SUS. The RENASES 2012 was compiled from the definitions of Decree No. 7508 of 28 June 2008 and structured in accordance with Resolution No. 2/CIT of January 17, 2012.The additions, deletions and changes IN RENASES actions and services will be conducted by the National Incorporation of Technologies in SUS (CONITEC). States and Municipalities must submit requests for amendment and incorporation of health technologies to CONITEC , in order to complement RENASES for the state or municipalities. RENASES 2012
  41. 41. Current challenges in SUS• Underfinanced system: Brazil invests 3,67% of the GDP in health (2010), or only half of what  is recommended by the WHO.• Universal health care priorities: Great part of SUS resources is destined to 1/3 of the  population who utilize supplemental health systems services.• Fragmented national networks for health assistance and surveillance.• Lack of sufficient human resources: Insufficient number of health care professionals in public  health systems, and their poor distribution and availability across the country. 1.8 medical  doctors per 10,000 inhabitants • Lack of active social participation: Brazilian citizens need to be more engaged in the political  aspects of SUS and not leave it as a government only priority.• Unequal health care between population groups and regions: fragmentation of care and  empty territories in both cities (eg slums) as in less developed regions across the country.• Inefficiency: hospital and clinics patient lines, low remuneration of medical procedures. • Overload of urgent and emergency care requests• Low production capacity in the country of essential medical products such as pharmaceutical  drugs, vaccines and medical devices. Sources: Desafitos do SUS e propostas de Superação – Secretaria de Gestão Estratégica e Participativa – MS (2008) SUS, conquistas e desafios by Luiz Odorico Monteiro de Andrade (Nov. 2012) Revista Princípios aborda os desafios do SUS. Fenafar (Feb. 2013)
  42. 42. SUS Dimensions • Largest network of human milk bank in the world• Largest number of human organ transplants in the world• 90% of vaccines are funded and offered by SUS • 50% of medical equipment market is managed by SUS• 80% investments in oncology treatments in Brazil• More than 90% of the total hemodialysis  Sources: Brazil’s MoH #susmaisforte presentation. Dr Padilha (Sep 2011)
  43. 43. Major Ongoing Efforts• 2,834 emergency response units  + 54% over 2010,  covering 127,8 million people• 267 emergency care units working 24h/7 (UPA 24h)  – Seek to reduce the amt. of patients in urgency and high complexity care units• + 86 % invested in medium complexity  surgeries over 2011• + 90 dental offices opened between 2011‐2012 – For a total of 942 centers benefiting 94.5 million people in the country• + 121% invested in oncology care in 2013 compared to2011• Investment in new technologies  – 26 new medical products included in SUS  Data source: Ministério da Saúde e Municipios. 2ed. (2013)
  44. 44. Achievements in Public Health• Reduction in maternal mortality rate (50%), child mortality rate (70%)*• 70% Reduction in cardiovascular diseases*• 86% Reduction in deaths caused by influenza (2011)• Current policies increased number of medical procedures and medical  products offered• Strategic interministerial initiatives which foster collaboration, research  and education• The MoH strives to meet the World Health Organization Millennium  development goals pertaining to health and improve public health  services Ministry of Health extended BRL 7 Billion in financing to Healthcare Sector  (Foxbusiness.com April 2013)  Sources: * Brazil’s MoH International Convention “Cuba Health 2012” Minissry of Health web portal (March 2013)
  45. 45. Recent Advancements in SUS• Partnerships for Productive Development  (PDPs): comprise of several  agreements between the private sector and goverment for the technology  transfer of pharmaceutical produts for domestic production. – 55 PDPs as of November 2012!• PROVAB: Primary Health Care Professional Enhancement Program seeks  to expand public health assistance in Brazil by allocating 4,392 primary  health care doctors to several regions of the country, benefiting 1,047  municipalities in need of health services.• Plans to hire foreign health care professionals: The Federal government is  working on a new program which will offer work permits to foreign  medical doctors interested in working in the country.
  46. 46. “Despite several limitations, the SUS has managed tovastly improve access to primary and emergency care, reach universal coverage of vaccination and prenatal care, and invest heavily in the expansion of human resources and technology, including major efforts to produce the country’s most essential pharmaceutical needs”. Paim et al. The Brazilian health system: history, advances, and challenges. The Lancet, Health in Brazil . May 2011
  47. 47. Images source: Ministério da Saúde e Municipios. 2ed. (2013)
  48. 48. 25 years of SUS  1988‐2013Note: All images were extracted from the Brazilian Ministry of Health website (March 2013)
  49. 49. ResourcesBrazilian Ministry of Health website
  50. 50. ResourcesFederal Republic of Brazil 1988 Constitution
  51. 51. ResourcesCurrent health legislation database
  52. 52. ResourcesBrazil’s Public Health Online Library
  53. 53. ResourcesNational Health Fund
  54. 54. Contact UsPlease check again for more updates