New health secretary promises single transparent queue for surgeries in SP

Appointed to occupy the portfolio of Health in the government of Tarcísio in São Paulo, the doctor and former federal deputy of the PSD Eleuses Paiva intends to organize the queue of elective surgeries in the SUS (Sistema Único de Saúde) and also look for points of lack of transparency between public and private system, especially in the management of hospitals by social organizations.

“The queue itself is an orderer of services. The current issue depends on the management, transparency and predictability of the queue, i.e. the queue must move,” the new secretary said in an interview with Sheet.

Regarding the management of public hospitals by private entities, Paiva says that even in models where there is excellence in execution, such as public-private partnerships and the support of foundations, it is necessary to make a diagnosis to know the role of each partnership and appropriate monitoring.

“The delivery of health services is extremely complex and its planning requires intelligence and creativity on the part of the State, especially with the increase in demand and the current reduction in costs.”

Doctor specializing in nuclear medicine (radiology) at the USP Faculty of Medicine, Paiva defended preventive measures against Covid, such as the wearing of masks and vaccination, contrary to the speech adopted by President Jair Bolsonaro (PL) and the his candidate in SP, Tarcísio de Freitas (Republicans), governor-elect.

When asked about this, he said disease prevention policy will be a priority for his administration. “The National Immunization Program [PNI] it has always been a worldwide reference, but since 2015 we have been witnessing a decline in coverage. We will act to strengthen the vaccination coverage of the population in SP,” she said.

One of the bottlenecks of the state health network is the queue for procedures of high and medium complexity, which has worsened in the post-pandemic period. Mr. Do you intend to partner with the private sector on a one off basis or will it be a permanent policy?

The queues for surgeries, procedures and exams are known. The queue itself is an orderer of services, offering a sequence of people based on defined criteria with the aim of guaranteeing one service after another. The current problem comes down to queue management, transparency and predictability, i.e. the queue has to move. The solution is to establish unique, regionalized, published and updated queues on a transparent website, as well as increase and improve the quality of the service offered.

In the last decade there has been a reduction in SUS beds in SP and an increase in private beds. How to fix it?

Over the past five years, we’ve had approximately 7,000 SUS beds deactivated in the state, whether for financial or operational reasons. There are still several units under construction, but without budget funding. Therefore, before starting to open new beds, it is necessary to make a precise diagnosis of the reason for the closure of these beds, how to reopen them and which regions need them most.

Health and social care organizations (OSS) currently consume about one-quarter of the area budget in the state, and while there are studies that indicate better management, there is no evidence of better clinical outcomes. The Court of Auditors also investigates some OSS for irregularities and lack of transparency in hospitals. What measures do you intend to take against them?

All of our management will be guided by transparency. The SDGs are an excellent model to enable the provision of the health service by the State, but also by foundations, PPPs (public-private partnerships), philanthropic bodies and directly managed hospitals. However, they must be clear about their role and have due and adequate supervision. The delivery of health services is extremely complex and its planning requires intelligence and creativity on the part of the state, especially with the increase in demand and the current reduction in costs.

Primary care, although the responsibility of municipalities, is essential for improving health indicators, but has suffered a historic loss of doctors, leaving many family health teams understaffed. How will you work with municipalities to strengthen primary care?

The government will show solidarity with municipalities in the challenge of improving primary care, which is expected to solve around 85% of health problems. In practice, there is no resolution and effectiveness at this level of care, which overloads the entire network, especially emergencies and hospitals. I intend to strengthen primary care and invest in digital technologies to improve its effectiveness and resolution.

The Chamber of Deputies recently voted on the project that regulates telemedicine, which has undoubtedly been expanded during the pandemic period, but has a number of difficulties to face, starting with the lack of internet access by the population. If adopted, how will telehealth be implemented?

Our goal is to transform São Paulo into a reference in the use of digital health to improve the efficiency of the healthcare system. To do this, we will exploit models that have already been tested and have had positive results in the pandemic, integrating the different systems and also establishing partnerships with universities to promote the training of healthcare professionals in digital technologies.

Health surveillance today is very fragmented, with the three bodies (municipal, state and national) having different systems that do not communicate with each other, not to mention the different types of surveillance within the same secretariat. How does it intend to achieve this integration?

Currently the existing processes in the state are bureaucratic and divided into departments, which is why the importance of investments in digital health and the work that will be done in government by the creation of a folder totally dedicated to this.

Mr. will take over the health portfolio in the government of Tarcísio, who was an ally of President Bolsonaro, whose position in the pandemic was against vaccines, the use of masks and scientifically proven preventive measures. How do you see the challenge of managing a portfolio under Tarcísio’s tutelage?

Disease prevention policy will be a priority for our government and we will work hard to strengthen immunization coverage in SP, mainly through campaigns. The national immunization program [PNI] it has always been a worldwide reference, but since 2015 we have seen a decline in numbers. It is crucial to demonstrate that the diseases still exist and that vaccination is essential.

Recently, the largest hospital in the country for the treatment of women victims of sexual violence, Pérola Byington, has been transferred to the private sector and there has been a temporary interruption of assistance to women in the SUS for legal abortion. What structure exists in the state today to support women victims of sexual violence?

Global women’s health is a top priority for our government. In addition to guaranteeing full support to women victims of violence, we will work on family planning and antenatal care.

One of the major problems of the 21st century is future epidemics and pandemics. How do you want to strengthen the surveillance system in SP?

One of the projects is the creation of a State Center for Disease Control and Quality of Care, which aims to implement an epidemiological intelligence system, forming platforms and databases that contribute to the monitoring and assessment of health threats and the process evidence-based decision-making, making it possible to systematically track population health trajectories.

Still in relation to the last question, how do you intend to encourage health research in the state, linked to public institutes and state universities?

Encouraging and bringing health services closer to Fapesp (State Foundation for Research Support of São Paulo) to support scientific production.

Eleus Vieira de Paiva, 69 years old

Born in Santos (SP), he graduated in medicine at the Itajubá Faculty of Medicine, specializing in nuclear medicine at the USP Faculty of Medicine. He was president of the Associação Paulista de Medicina (from 1995 to 1999), of the Associação Médica Brasileira (from 1999 to 2005) and federal deputy in three terms, one for the PFL (2005-2007), one for the DEM (2007 to 2011) and the latest from the PSD (from 2011 to 2022).

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