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Brazil's Health System Inspires Abroad, Frustrates at Home

RIO DE JANEIRO, Nov 4, 2011 (IPS) - News that the government of South Africa was inspired by Brazil's health system in setting up its own universal coverage scheme might meet with scepticism in this South American country.

Sociologist Walkiria Dutra de Oliveira was one of the many Brazilians who had a negative opinion of the country's public healthcare system. But she was in for a surprise when she visited a public health clinic in a middle-class neighbourhood in São Paulo.

Oliveira, who had been diagnosed with diabetes eight years earlier and was facing financial problems, decided to seek free insulin from the public health system.

The "prompt, efficient" attention she was given completely changed the image she had of the Sistema Único de Saúde or Single Health System (SUS), which was shaped during the 1980s when the system was restructured to make healthcare a universal right.

Besides insulin, Oliveira was given free medication for her hypothyroidism, she told IPS.

Reports of patients dying because of a lack of hospital beds, months-long waits for surgery, serious medical errors, malpractice cases and corruption scandals gave the system a terrible reputation.

But Dr. Nivaldo Gomes, who has worked in public hospitals and clinics since the 1970s, told IPS that "although there have been some problems in implementation, the idea is excellent and legitimate."

The government is fighting a battle in parliament to create new sources of financing for the SUS, but in Gomes' view, "the problems are due to political and administrative issues, not a shortage of money."

There is a lack of political will to fully implement the principles underlying the SUS, said Gomes and his colleague, Dr. Dilene do Nascimento, a researcher at the
Oswaldo Cruz Foundation (FIOCRUZ), Brazil's leading biomedical research institute.
Despite the tragedies caused by medical mistakes and malpractice, the overcrowded hospitals, and the frequent complaints about the system, the SUS has improved health coverage in this country of 192 million people, Nascimento said.

The SUS made it possible to provide everyone with healthcare, while reducing the chaos in the health sector, which was governed in the past by piecemeal policies, she said.

The aim, said Gomes, was to coordinate three levels of public administration – municipal, state and national – that "did not communicate in the past, in the health sector. In addition, the SUS was to create a tiered health system with a broad network of primary healthcare clinics at the neighbourhood level and in poor areas on the outskirts of cities, which would refer more serious cases to hospitals and specialist clinics.

The primary health clinics were to relieve the overburdened hospitals.

The new system is based on the concept of democratising health as "a right of all and a duty of the state," which was incorporated in the 1988 constitution, Nascimento said.

Corruption, aggravated by insufficient inspections, has contributed to the poor execution of the SUS, which is, however, a "universal, tiered, decentralised system with social oversight that can be successfully replicated in any country," she added."
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