A Gestão de Recursos do SUS e sua Complexidade

ABSTRACT: The Unified Health System – SUS was developed from the need to organize the Brazilian health in order to optimize access to public health. The beneficiaries tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado are mainly individuals of a low socioeconomic class and have no financial position to take advantage of private hospital care. The Brazilian SUS guarantees a quality service based on their principles are: universality, comprehensiveness and equity, in a simplistic way mean that health is everyone’s right and these rights are guaranteed by the SUS. The reflection of these principles is used in all services provided by the SUS ranging from vaccines to organ transplantation. Indeed, the public health services offered to the population of Brazil, far from being a model of excellence, but with the creation of SUS in 1980 there was a significant improvement in services tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado.

Key-words: Health, Public, SUS, Benefits.

INTRODUCTION

The Unified Health System – SUS was created in 1988 in order to improve the quality of the public service offered in Brazil. The objective of SUS is to prevent the occurrence of infectious and contagious diseases , to eradicate immunopreventable diseases, to humanize cancer treatment, to improve women’s health care, assistance to pregnant women and newborns, vaccination for the elderly, treatment for drug addicts, to optimize procedures therapeutics, train health teams so that they can have a scientific basis and act ethically and effectively. However, it is necessary to constantly analyze Brazilian health in order to detect flaws that may cause harm to its users, so that there is a reliable analysis, the participation of the population is essential ( TRAVASSOS, 1997 ).

From the beginning, SUS is based on three points: universalization, integration and equity, so that a quality public health service is ensured (MARINHO 2001) tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado.

The implementation of SUS significantly reduced the mortality rate of diseases that are classified as preventable, reducible and totally or partially preventable. Prevention is one of the focuses of SUS, making the population aware of disease prevention is extremely important so that there is no increase in the rate of infectious diseases, for example ( MALTA, 2007) tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado.

Brazil is a theoretical example of its model of organization of the health system, with the implementation of SUS, an advance in the treatment of basic health care is expected, implying improvements in the quality of life of individuals who seek the public health service ( CEBES) , 2004 ).

One of the priorities of SUS is the humanization of patient care, especially for those individuals who are in palliative care. This patient whose clinical condition is closed, that is, there is no possibility of cure regardless of the applied therapy, but ensuring the pain elimination of these patients respecting the individual’s rights and duties is part of the Humaniza SUS program, which ensures quality treatment respecting the patient terminal and providing the family and tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado/ or caregiver with the necessary psychological support to minimize the trauma caused by exposure to this situation (SANTANA, 2009).

1.1. objective

The objective of the research was to evaluate the quality of the Unified Health System and its contribution to the quality of public health in Brazil.

1.2 . Specific objective

When deepening the research objectives, it became possible to define some specific specific criteria for the development of the work tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado:

  1. Check the effectiveness of the Unified Health System.
  2. Discuss the different principles of SUS.
  3. Analyze the quality of treatment offered in Brazil by SUS.

1.3 . Research Problem

The improvements in health services are notable, but it should be noted that it is still not ideal due to the demand presented in Brazil , for this reason a considerable percentage of mortality is generated and due to poor medical assistance or lack of care .

          When was SUS created ?
          What is the expectation of improving the quality of life of patients using the services ?                          
          What is being done to improve the service offered by SUS ? 

1.4 . Justification

The development of this tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado research is justified by the careful analysis of the public health benefits that occurred after the creation of the Unified Health System , which aims to offer free and quality hospital care to all Brazilians.

1.5. Methodology

To carry out this work, the author uses a methodology based on qualitative exploratory research, carried out through a bibliographic survey based on a guiding hypothesis tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado. Thus, data collection was carried out with the literature related to the theme, books, articles published in specialized magazines. The information obtained in the development of the aforementioned research procedures consolidates the teachings that contribute to the understanding of the topic at hand and, consequently, the text was generated, contemplating the ideas necessary for the construction of the reasoning and conclusion of the work.

CHAPTER II . RATIONALE

The Unified Health System SUS tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado, was established in 1988 and approved by the Federal Constitution, which recognizes and ensures this s rights to Brazilian citizens . Since its implementation, SUS modified the health layout in Brazil, the changes were and are notable ( MINISTÉRIO DA SAÚDE, 2003 ).

Approval by the Federal Constitution of 1988 that ensures universal service.
Registration of the last case of polio in Brazil and creation of the Adolescent Health Program in 1989 tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado.
In 1990 regulation and organization of services provided by SUS.
Implementation of community agents and the 1st campaign against prejudice against Hansen’s disease in 1991.
The 9th National Health Conference was held in 1992.
In 1993, INAMPS – National Institute of Medical Assistance for Social Security was extinguished .
Certification provided by the Pan American Organization (PAHO / WHO), granted to Brazil for the eradication of Poliomyelitis and creation of the Family Health Program in 1994 .
TV stations were recommended to avoid transmitting characters by smoking in order not to encourage smoking in 1995.
There was the implementation of a free drug distribution program for people with HIV / AIDS and the 10th National Health Conference, which emphasized the theme “Quality of Life” in 1996.
Creation of the National Transplant System, implantation of the Health Dial and the creation of a home care group, the ADT, for people with HIV / AIDS in 1997 .
It institutes the floor for primary care to all Brazilian municipalities, improving the services in 1998.
There are two major achievements of SUS: the creation of the National Health Surveillance Agency (ANVISA), installation of generic medication in the country and the 1st vaccination campaign against influenza, tetanus and diphtheria in the elderly in 1999.
In 2000, ANS – National Supplementary Health Agency was created and the last measles outbreak in Brazil was registered.
In 2002, Brazil reached the milestone of 150 thousand community health agents, this goal was only expected to be reached in the following year, this figure demonstrates the effective participation of society in health promotion projects.
In 2003 there was an important milestone in the history of SUS, the restructuring of the Ministry of Health with new departments: surveillance, science and technology, education and health management, creation of the basic health care plan in the Brazilian Penitentiary System, implementation of SAMU- Mobile Emergency Care Service , start of treatment for smokers in health units.
In 2004, programs were created that greatly added to the health of Brazilians, such as: the creation of the Popular Pharmacy, the creation of HEMOBRAS – Brazilian Company of Blood Products and Biotechnology, the implementation of the Women’s Health Care Policy.
In 2005, the National Policy on Sexual Rights and Reproductive Rights was launched, ensuring the treatment of infertility.
Brazil stood out in 2006 in the area of ​​health, because it implanted the vaccine against children in the vaccination calendar against rotavirus, it was the first country in the world to make this vaccine available in the public health network.
In 2007, the beneficiaries were HIV / AIDS patients, as there was a compulsory licensing of the antiretroviral Efavirenz , which helps to reduce the TCD4 + count , an agent that characterizes the individual’s degree of virulence.
In 2008, the government encourages structural changes in health units in order to encourage normal and humanized childbirth, and to control complications during childbirth by decreasing the maternal mortality rate due to complications in childbirth.
In 2009, Ordinance No. 3,008, of December 1, determined the schedule of Health Surveillance actions.
In 2010, some beds were made available in the wards of large hospitals for the care of drug users.
In 2011 the most relevant act was the implementation of the NAT platform in all blood centers in the country, thus increasing the specificity in the early diagnosis of HIV ( MERHY, 2011 ) .
Public health experts have called the epidemiological transition the gradual evolution of health problems characterized by the high prevalence of mortality from non – infectious (or also chronic – degenerative) diseases; as they are long-term illnesses, they accumulate in the population, with a paradoxical combination of declining mortality and increased morbidity (VIANA, 1998, p. 04).

SUS’s evolution since its creation is remarkable. However, it is necessary to emphasize that due to the demand in Brazil, the Unified Health System is far from being a model of excellence in public health, it is of utmost importance that there is more investment and citizen participation to improve more and more the programs offered in the Brazilian health (NUNES, 2000).

2.1. The R Management esources of the NHS and its complexity

There is a deliberate government policy to contain the hiring of public servants. The claim is that they are excessive and generate excessive pressure on the payroll. In order to reduce them, the Voluntary Resignation Programs were created in the Fernando Henrique Cardoso Government, which, although postponed to have a higher level of adhesion, did not advance, as the civil servants did not adhere to the plan as the government imagined. It was a fiasco for the Government. The high level of unemployment, the recession of the economy and the guarantee of stability in public employment are credited, the main causes of the small adherence to the plans.

Other trends observed in the market are:

  • Outsourcing of job hiring, going beyond the general cleaning, surveillance, food, maintenance services, already traditional, now reaching professional and technical health services;
  • Formation of work cooperatives that sell professional services to establishments and health services; initially restricted to certain medical specialties, these cooperatives are widespread and, nowadays, they also organize services of other professionals, such as nurses;
  • Introduction of new forms of personnel management implemented in the sector of public health services, which include some experiences of participatory management, the implementation of collective bargaining tables in hospitals and services, and the adoption of mechanisms to relax the relations of work in some institutions;
  • Innovative experiences in relation to the implementation of incentive systems and new forms of remuneration for health work (Carvalho et alii , 1998)

According to Guedes (1994), in an approximate calculation, in Brazil, in 1993, there were 7 million jobs in the direct and indirect public service, including also state-owned companies at the municipal, state and federal levels. This total corresponds to just over 10% of the PEA.

After 17 years, with Brazil increasing its population to more than 160 million inhabitants, the proportion of civil servants in relation to the PEA dropped to 9.3% (Vieira, 2000). Research carried out by the Brazilian School of Public Administration (EBAP) reveals that the proportion of civil servants is one of the lowest in the world. While in Brazil the number of servers represents 9.3% of the PEA, the average in Latin America is 12%, in Mexico it is 16.8%, in Canada it is 15%, in the United States it is 14.7% and in Sweden it is 36%. The EBAP study concludes that Administrative Reform may be going in the wrong direction, as in some sectors and regions, instead of being left over, there are missing servers (security / education / judiciary). This reveals that the neoliberal and minimum-state policy has harmed millions of Brazilians.

A disconcerting fact is that Brazilian poverty is not residual, as is the case in most developed countries, but a mass phenomenon (Guedes, 1994). Therefore, this fact points to a greater responsibility of the government in the implementation of social policies, especially in the area of ​​health, because with a high level of unemployment, the demand for services increases and the unemployed and low-income population has no way of meeting their needs. basic needs.

One way to alleviate this situation would be for the government to strengthen the SUS, transferring a greater volume of financial resources to the municipalities and states, so that they better remunerate their employees and hire more health professionals to meet a repressed health demand, as shown by the insufficiency in outpatient care and the needs for vaccination and hospitalization, evidenced by the long waits, and in the comings and goings to different care units, without an adequate solution, as we often find, affecting mainly the poorest.

The economic adjustment and the fiscal crisis of the State caused a series of changes in the configuration and dynamics of labor markets in the health sector.

Data from the Annual List of Social Information (RAIS), between 1986/95, shows that there was a small change in the contingent of servers, going from 5, 3 million to 5.4 million.

With the Constitutional Reform, the Single Legal Regime (RJU) was approved, with a significant increase in the number of civil servants in this type of contract. It was recently passed in the National Congress, a law that divides employees into those belonging to typical and non-typical careers in the State. Only the first will be statutory (with more rights), the rest will be hired within the CLT rules

In municipalities and federal public foundations, they increased from 16.04% of total employment in 1998, to 61.34 in 1992, and to 79.09 in 1994. By order of magnitude, 84% are federal employees, 75% are state employees, 45 % municipal, with “celetistas” in this instance making up more than half of the total number of civil servants.

2.1 .1. SUS Management: Organizational Principles

In order to guarantee free, universal, effective and efficient health services, SUS management should be:

P articipative – allow the control and intervention of workers and all citizens of organized civil society, on the way health services are being provided to the community in general;

D emocratic – Attending in the first and last instance, the interests of users, regarding their real needs for health services;

D escentralização – Provide materials, physical, financial, human and political resources, to enable the management and control in each governmental sphere (municipalities, states, Union), autonomously and P oder to D ECISION L ocal .

In addition to the necessary obedience to the above principles, it is essential that civil servants in the provision of health services, whatever their role, do so with commitment, ethics and competence, in order to guarantee the maximum quality of these services, respected the rights of the Brazilian citizen. They must also be guaranteed as a fundamental condition.

The Organic Health Law. 8080/90, in its eighth and ninth articles, establishes principles for the SUS Direction and Management Organization. The organizational principles of SUS are:

a) R egionalisation and Hierarchisation – Health services are classified into levels of increasing complexity. There are services that require a special structure and conditions for their execution, while others do not. The organization of the health network in a regionalized and hierarchical way will favor a broader knowledge of the health problems of each locality and, consequently, a better programming of the actions of epidemiological surveillance, health, vector control, health education, in addition to outpatient and outpatient actions. hospital at all levels of complexity.

b) R esolutivity – It is the guarantee of solving the problems of both the individual and the community, who seek the necessary service. The network, in turn, must be able to answer and solve problems up to the level of its competence.

c) D decentralization – understood as a redistribution of responsibilities at the three levels of government. It implies that the closer to the problem, the more chance of a correct decision. Thus, what is within the scope of a Municipality should be the responsibility of the municipal government, in the scope of the State the responsibility falls on the state government and the national will be the federal responsibility.

d) P articipation Citizens – Guaranteed by the Federal Constitution, means that the population will participate in the process of formulation of health policy and control of its implementation, the municipal, state, federal, through the health councils and conferences.

e) C Private Sector OMPLEMENTARITY – The unified health system can use the services of private enterprise, since proven the inadequacy of its network in healthcare coverage to the population of a given area of Law 8080/90, in its articles 25 and 26, the conditions under which these services will be contracted are foreseen.

SUDS was created in July 1987, through Decree nº 94.657, with the objective of consolidating and qualitatively developing the AIS and had as its great merits, the state deconcentration of health and the municipalization of services. The 1988 Federal Constitution incorporated a set of concepts, principles and guidelines extracted from current and hegemonic practice, reorganizing them in the new logic referred to by the principles of health reform.

SUS was constitutionally created, which came to be regulated by Laws No. 8080 of 9/19/90 and 8,140 of 12/28/90. With the decentralization process agreed between the three spheres of government, and with the edition of the Basic Operational Standard – SUS / 1993, it was established that there would be three types of management: incipient, partial and semi-full; therefore, different degrees of responsibilities and autonomy.

The semi-full management provides for broader actions and a greater level of autonomy, with the Municipal Health Secretariats having full responsibility for the administration of health service provision; therefore, there is no intergovernmental purchase and sale of services, due to the receipt by the states and municipalities of financial resources from the Ministry of Health, according to the financial ceilings, previously establishments for outpatient and hospital assistance.

The Ministry of Health’s initiative to develop and put into practice the Basic Operational Standard (NOB) of SUS / 1996 was of utmost importance; aiming to promote and consolidate the full exercise, by the municipal public power and the Federal District, of the role of health care manager in my municipalities, as well as the redefinition of the responsibilities of the States, the Federal District and the Union.

It constitutes an effort to perfect all the actions implemented, to increasingly give power, autonomy and resources to the Municipal Power, to assume responsibility for all health issues within its territorial limits, although the formation of Municipal consortia is also encouraged. for solving local problems.

In an attempt to improve this situation, the federal government introduced changes in the decentralization process, changing the management modalities for state governments, which came to be called Advanced Management of the State System and, for municipalities, Full Management of Basic Attention and Full Management of the Health System to replace the types of Incipient, Partial and Semi-Full Management.

The figures presented by SUS show how it is of great importance for the population of the country. Its main challenges are the allocation of the volume of financial resources needed, guaranteeing access and more homogeneous quality in all regions of the country, etc.

According to the Institute for Applied Economic Research (IPEA), federal spending on health in 1996, in relation to total federal spending, (tax and social security), was 4.1%.

It is obvious that if the government does not have access to information, cost spreadsheets, databases, indicators and parameters of health procedures, in financial terms, it will not have the technical and political conditions to act firmly. The law alone is not enough, political will is needed to defend millions of people who pay their dues monthly.

It was agreed to call this crisis situation “exclusionary universalization”, that is, the process of universalization of the health system has always been accompanied by the exclusion of middle-income social segments and qualified workers (Faveret & Oliveira, 89).

After growing throughout an era of development, around 7% per year, in the 1980s, the Brazilian economy, with the exception of the Cruzado Plan period, remained in crisis.

The structural crisis was accentuated with the deterioration of the exchange rate situation, inflationary acceleration, recession and notably with the rupture of a growth pattern based on the solidarity articulation between State, multinational companies and national private companies. Therefore, the rupture of the developmentalist state, consumed by a liberal developmentalist alliance, with a conservative cut, was consummated (Mendes, 1996).

The instability of funding sources has greatly aggravated the SUS situation, contributing to worsening the quality of health service provision, due to the lack of resources for professional qualification, purchase and maintenance of equipment, hiring new professionals, medicines, food, etc.

The sum of total expenditure per capita / year (sum of federal, state and municipal expenditures), in the period from 1989/93, fell from US $ 99.26 in 1989 to US $ 65.11 in 1993.

SUS, for legal and political reasons, has come to depend more and more on the impoverished National Treasury which, in a time of economic stabilization, receives strong pressure from business and international agencies to eliminate the public deficit, due to the policy implementation of a minimum state, privatizations, low state regulation power, market-oriented economic reforms, preferential payment of interest on domestic and foreign debt.

According to Mendes (1996), who won with the creation of SUS, since its inception, were 60 million Brazilians hitherto submitted to state care of simplified medicine or philanthropy.

While recognizing that the universalization of health in Brazil was exclusive, with a drop in the average quality of medical and hospital care, it is undeniable that for millions of dispossessed people who have acquired rights and freed themselves from indigence, the gains, both from the point of view of services , as from the psychosocial perspective, are undeniable. Millions of Brazilians achieved, through SUS, citizenship in health, but remained political sub-citizens.

The financial resources of SUS are deposited in a special account, in each sphere of government and moved under the supervision of the respective Health Councils, according to Art. 33 of law nº8080 / 90. This special account is called the Health Fund.

2.1 . 2 . Failures in the Unified Health System

SUS, despite its notable achievements associated with Brazilian public health, still has deficits in some areas of activity, for example, the lack of availability of structure for the treatment of chemical and psychiatric dependents ( VIEIRA, 2008 ).

I begin the first critical node, which I consider fundamental, which is the question of the assistance model. Such a model was built, mainly, centered on the creation and functioning of reference centers, or reference units, that became almost autonomous islands, marginal to the rest of the system; several of these services faced enormous difficulties in articulating with the other levels of the system, and the other SUS instances still do not incorporate workers’ health in their conception of the health-disease process and in their practices ; that is, they do not yet consider work as a determinant of the health-disease process. This resulted in units that were more a reference for institutions outside the health sector, workers’ unions and even companies, much more than in fact referring to other SUS instances; one can even speak of the existence of ghettos, given the difficulty of intra-sectorial articulation, both with the basic levels of care, as with the specialized levels, hospital and also with the epidemiological and sanitary surveillance (CEBES, 2004 p.195) .

It is necessary to make the population aware of the importance of participating in SUS-related activities in order to be able to qualify data on care development and provide data analysis on users’ satisfaction and dissatisfaction, as this is how the State Health Secretariat , in partnership with the municipal secretariats, has been working to map the difficulties of SUS in order to correct them ( SILVA, 2003 ) .

Created 20 years ago with the objective of universalizing public health in the country, the Unified Health System (SUS) has only partially fulfilled its mission: if today its doors are open to 190 million Brazilians, it is not always able to meet the demand or attract good part of the population to their dependencies. Despite indisputable advances, providing services of excellence and high complexity, as in the case of transplants, SUS still has terrible failures, which lead 39.9 million people (21% of the population) to contract health plans. In 1988, these plans had only 23 million customers – that is, the sector grew 73.47% (MARINHO, 2010 , p. 05).

Other problems related to the creation of SUS are: insufficient financing, irrational spending, minimal participation of states in financing, deficiency in human resource management , precarious work relationships and low resolution of access to services (MINISTÉRIO DA SAÚDE, 2003)
According to Graf. 1 it is possible to note the main problems presented by the Unified Health System.

2.2 . Brazilian Health before SUS Implementation

The period before the creation of SUS, Brazilian public health was in a chaotic scenario. The precariousness of care reflected in failures in diagnoses, lack of hospital beds, lack of doctors and a multidisciplinary team to meet the demand of patients, lack of vaccines and medication, poor hospital structures, lack of assistance to pregnant women, lack of intensive care units for newborns, lack of drug support offered to people with infectious and contagious diseases, lack of care for drug addicts . As a result of the chaos from the 80s onwards, Brazil started at a slow pace to organize the public service routine (AMARAL, 2002) .

With regard to the macro-functioning of health systems, formulas were predominantly adopted to obtain cost containment and to define a transfer policy from the central level of government to decentralized or subnational instances, as the case may be, that favored this process. This type of decision stems from examining the functioning and performance of the three basic forms to which the different financing mechanisms of health care systems converge: public financing based on taxes; public financing based on compulsory social security contributions; finally, private financing based on specific health care insurance (Maxwell, 1988). In this sense, international experience has shown greater deficiencies in the performance of voluntary-based financing systems controlled by typically market rules (uncertainty and risk of this type of insurance; existence of “moral risk” affecting both the behavior of users and service providers – on use associated with improper use of equipment and therapies; incentives for adverse patient selection; greater difficulties in obtaining universal coverage and equitable access; high administrative costs). On the other hand, systems financed by taxes or compulsory contributions, although relatively successful in the cost containment process – through the use of global budgets with a prospective basis for hospitals; central controls for the construction of facilities and acquisition of equipment; limitations in the remuneration of medical teams and their standardization; standardized remuneration tables for procedures; restrictions in the professional training process, etc. -, faced problems in the field of quality of services, in the productivity obtained and in the excessive bureaucratization and centralization of procedures and controls, causing administrative costs that are also quite high (SILVA, 2003 p. 04).

In fact, the changes brought about by the creation of SUS were relevant, however, even after 20 years of its implementation, the service provided is still not ideal, news is often broadcast about the lack of structure to provide humanized and quality care, so that there are effective improvements the population must participate, for example, providing services as community agents, facilitating the detection of failures to be remedied . SUS work is uninterrupted in order to improve the Brazilian health model that has already offered more benefits to the population since the creation of the single health system ( NUNES, 2000 ).

This situation gives rise to reflection on what is meant by social justice and the right to health. It also highlights the need to recover the ideas of universality, equality and integrality, defended by the Sanitary Reform Movement and made concrete in the form of SUS principles, in the Federal Constitution and in the Organic Health Law (VIEIRA, 2008).

In order to minimize the occurrence of shortages in care and basic support to the Brazilian population, the 3 main points of SUS: integrality, universality and equity must in fact be applied (MALTA, 2007).

2.3 . Improvement of Service Quality

Even if public health support in Brazil is not ideal, it is necessary to mention the positive changes that occurred after the creation of SUS (MALTA, 2007) .

It is necessary to recognize that society cannot abdicate from the Judiciary to guarantee its rights. However, it is necessary to point out the paradoxes surrounding the lawsuits that demand the government to purchase medicines. The Judiciary determines the supply of medicines included in the policies, which are often denied to users due to their unavailability in SUS health units, thus constituting pertinent demands. However, this same Judiciary also determines the supply of pharmaceutical products not included in these policies, which establish the offer of other drugs or therapeutic approaches ( VIEIRA, 2008 p. 05).

The creation of SUS reflected positively for Brazilian health, with the implementation of some programs such as: comprehensive and free assistance for people with HIV, chronic kidney patients and cancer patients, implementation of the PSF- Family Health Program, distribution free medication. As a result of these factors, it would be wrong to state that there were no positive changes in Brazilian public health, however it is still not ideal to offer to citizens (MINISTÉRIO DA SAÚDE, 2003).

The mortality rate caused by iatrogenesis by health professionals was reduced after the implementation of SUS, such reduction is due to the better structure offered by hospitals, increased availability of medication, specific training of teams working in large hospitals and mainly due to the practice of humanization in the health area, which positively contributes to the quality of life of the patient served by the public health network (SANTANA, 2009)

2.4 . Integrality , Universality and Equity

The SUS base is made up of three specific points : integrality, universality and equity, based and established by the Federal Constitution in 1988, are also called ideological or doctrinal principles (TRAVASSOS, 1997) .

Comprehensiveness – health care must be applied individually or in groups, regardless of their need and quantity, prevention and treatments must be applied effectively.
Universality- guarantees the right to health of all citizens regardless of their socioeconomic profile, health is a right for everyone and the state has an obligation to provide support to individuals seeking treatment in the public health system.
Equity – based on this principle, everyone should have equal opportunities when using public health services. However, patients’ needs vary due to regional disparities, so it is necessary that the equity principle be rigorously applied (MACHADO, 2007) .
The support offered by SUS is a right of all Brazilians and must be fulfilled, regardless of the pathology, general condition everyone should receive medication, curative, preventive and palliative care for free ( RIBEIRO, 1997 ).

  1. 5 . Assistance

It is the distortion of assistance, that is, it is the government’s obligation to citizens to ensure their duties through a constitution. In the case of SUS, this right is guaranteed in accordance with the Federal Constitution of 1988 ( MALTA, 2007 ).

Art. 6 The following are also included in the field of action of the Unified Health System (SUS): I – the execution of actions: a) health surveillance; b) epidemiological surveillance; c) worker health; and d) comprehensive therapeutic assistance, including pharmaceuticals; I – participation in the formulation of the policy and in the execution of basic sanitation actions; I – ordering the training of human resources in the health area; IV – nutritional surveillance and dietary guidance; V – collaboration in the protection of the environment, including that of work (VIANA, 1998 p. 01).

2.6 . The Relevance of SUS to the Quality of Life and Health of Brazilians

The Unified Health System, SUS, enabled the organization of Brazilian public health, developing protocols for care, ensuring the provision of services aimed at preventing and curing diseases for all Brazilians ( RIBEIRO, 1997 ) .

Health in Brazil is not 100% effective and with quality. However, it should be noted that our country is the only one in Latin America to incorporate the rotavirus vaccine in the childhood vaccination calendar, previously this vaccine was only available in the private health network, other advances deserve to be highlighted, such as: polio eradication , the creation of the PSF- Family Health Program that offers patient monitoring by a multidisciplinary team, combating the HIV virus and treatment against chemical dependency that is available in the public health network ( MACHADO, 2007 ).

Undeniably, when it comes to reconstructing the history of Brazilian medicine in order to demarcate the emergence of a social medicine project, the text by Roberto Machado and collaborators (1978) becomes a mandatory reference. Among other reasons, because, as will be seen below, there is a concentration of studies that highlight a certain period of Brazilian history – the Proclamation of the Republic, between 1889 and 1930, also known as the Old Republic period ; and this very original study is dedicated to discovering how the thematization of health arises as an object of medicine, instead of disease and, at the same time, how the process of medicalization of Brazilian society took place. It outlines an extensive panorama that covers the colonial period until the first decades of the 19th century. It is considered a pioneer text in the “characterization of medicine as a disciplinary power whose action would fall on urban social life” (Carvalho and Lima, 1992). Thus, scholars show the emergence of a social medicine project for the beginning of the 19th century, linked, above all, to public hygiene and the medicalization of urban space, and this will occur within the framework of changes that were imposed with the transfer of the Portuguese Court. , in 1808 (NUNES, 2000 p. 02).

Despite the evident relevance of SUS, it is necessary to work for it to be expanded in practice to the entire national territory, because in more isolated and difficult to reach regions , Brazilians are not benefited by the help of the single health system ( MARINHO 2010 ).

The Program “Comprehensive Assistance to Women’s Health: bases for programmatic action” (PAISM) was developed by the Ministry of Health and presented to the Mixed Parliamentary Commission of Inquiry (CPMI) of the demographic explosion in 1983, the discussion was predominantly based on the control of birth. The Ministry of Health played a fundamental role, as it influenced the Federal Government and this, in turn, took a stand and defended the free will of Brazilian people and families in relation to when, how many and what is the spacing between their children /as.It is a historical document that incorporated the feminist idea for comprehensive health care, including making the Brazilian state responsible for aspects of reproductive health. In this way, the priority actions were defined based on the needs of the female population, which meant a break with the maternal and child care model developed until then ( MALTA, 2007 p.02 ).

The assistance given to women’s health has made more diagnostic imaging equipment available. HPV prevention campaigns, increase in the number of professionals working in women’s health reference centers, greater support for pregnant women in order to reduce the maternal mortality rate during childbirth, in the puerperium period and reduce the number of stillbirths (SILVA, 2003).

CONCLUSION

The SUS this its creation and deployment in the 80s allowed improvements to the Brazilian public health in general. However, it is worth noting that there is a need to inspect basic health promotion services in order to avoid cases of mortality due to omission, lack of trained professionals, medication, and a precarious hospital structure. In Brazil due to the demand of people who enjoy the sa service ú public unfortunately the service provided does not show excellence approaching more basic.

Expanding the service to places of difficult access is also necessary, a large part of the indigenous population, for example, is not benefited by SUS preventive and curative actions, this situation needs to be reversed so that we can reduce the still existing cases of mortality from diseases treatable diseases such as malaria, yellow fever, viruses and malnutrition. It is not acceptable that in 2011 there are still cases of death due to lack of medical assistance.

SUS, despite so much criticism , is the first Brazilian attempt to democratize access to health care, as it guarantees the right to health of all Brazilians without distinction of socioeconomic class. However, it should be emphasized that SUS was the first health system in Latin America is an achievement for Brazilians , but it is constantly undergoing phases of adaptation.

The new era of health has also perfected blood donation programs, made modern and complete structures available in blood centers, and the main factor has implemented the NAT platform, in order to more specifically detect the HIV virus.

During the evolution of serological blood screening tests in Brazil, there is no maintenance of serological targets, there is a need to apply the complete NAT test, which addresses all genotype subtypes Compra de Diploma, Comprar Diplomas, Comprar Diploma Quente. In Molecular Biology tests, it is important to differentiate between the clinical and analytical sensitivity of NAT tests, to avoid wasting resources by blood centers during blood analysis, which will later be released for transfusion. It is important to note that the implementation of the NAT test in Brazil is being carried out, but they are slowed down, due to research costs.

The evolution of research in Hemotherapy is notable, however it should be noted that there are no serological tests on the world market with 100% specificity efficiency, for this reason a considerable percentage of false positives is generated Compra de Diploma, Comprar Diplomas, Comprar Diploma Quente. However, making this serology screening test available on the public health network was a milestone in the fight against HIV and infectious diseases.

Offering quality public health services implies diagnosing early, offering immediate treatment, providing medication support, guiding the individual on the importance of care with diet, body and oral health, promoting campaigns on systemic arterial hypertension and diabetes mellitus, emphasizing prevention through vaccination and adoption of healthy habits.

The participation of the population is of paramount importance to quantify the satisfaction and dissatisfaction of patients in relation to the care provided, changes in the Brazilian health system will only be possible if everyone is committed to this cause Compra de Diploma, Comprar Diploma, Comprar Diploma Quente, the participation of society to improve the health model applied in the country and extremely relevant.

It is up to Brazilians to exercise their right as a citizen and taxpayer so that the improvements made by SUS in public health can add more and more specificity of care and a positive reflection on the quality of life of Brazilians.

SUS is more than an adjustment in Brazilian public health, it implies a huge sectoral reform in order to overcome the irrationality of health spending in the context of institutional fragmentation, unifying service units aimed at healing and prevention for Brazilians in the general Compra de Diplomas, Comprar Diplomas, Comprar Diploma Quente.