In recent years, we have followed the real difference that the Unified Health System (SUS) makes for our country and how much it matters to all of us. We watched – distressed and at the same time proud – health professionals become true heroes in the face of the Covid 19 pandemic, demonstrating ethics and altruism in the treatment of patients even in sometimes subhuman conditions. I pay here my most sincere tributes to these women and men.
Why then so many complaints? Why is healthcare close to elections always an important demand of the population and, government after government, does this not change? In the next few lines, I will try to tell the story of a SUS that worked, a model that works, using as an example the Pérola Byington Hospital in São Paulo, where I worked for 15 years with my Father, Dr. José Aristodemo Pinotti, who implemented the Women’s Health Care Program (PAISM) there in the 1990s.
The practical application of the concept of comprehensive health care requires a series of conditions that include political will, encouragement and training of the health team, as well as the organization of the system, according to decentralized models, with regionalization, hierarchy of actions of health and delegation of functions.
The starting point is the integration of health actions during medical consultations motivated by certain symptoms. In other words, we need to take advantage of the patient’s arrival to add actions aimed at prevention, detection and early diagnosis.
With this idea in mind, at the Pérola Byington Hospital (HPB) a health microsystem aimed at women was structured with the characteristics described above, but which ended up expanding beyond what was planned and serving a significant number of women (about 600,000) .
The results of the practical application of the concept of comprehensive health in São Paulo were perceptible (HPB), from 1991 to 1998, that is, in eight years we were able to create the model and demonstrate its efficiency and possibility of multiplication, having achieved most of its objectives. by offering the simplest services to the most complex diagnostic and therapeutic technologies available.
How did we do? I would like to emphasize the organization of a new model of primary care for women’s health, which puts into practice the concept of integrality and “horizontalization” of health actions, fighting the different traps and bureaucracies that prevent the practice of real and effective prevention. coherent.
Our team was made up of different health professionals, including doctors, who worked together to achieve their goal, using strategies of integration of actions and delegation of functions according to traditional skills and those obtained through training.
As the number of diagnosed patients was very large, each pathology was transformed into a specific program for patients who presented positive results. Each of these programs was coordinated by a physician, also encompassing delegation of functions and organization of groups of women according to their disease (diabetes, hypertension, obesity, urinary incontinence, osteoporosis, STDs, etc.).
The medical consultation was completed in other sectors of the hospital, such as the pharmacy, where, while receiving her medications, the patient was guided again, or even in the laboratories where samples were collected and she had access to new information. And they all left with their scheduled returns, negative exams were sent by mail, with the proper interpretation, to avoid unnecessary displacement of patients.
Bureaucracy was minimized by this organization. The results of the program – as a whole – demonstrate the feasibility of this strategic organization in detecting the main pathologies among women, the possibility of diagnosing and treating the hidden demand.
The fundamental condition for achieving the integration of women’s demand for health care services with epidemiological interventions to achieve a “global approach” in primary care is the delegation of functions to different members of the health team.
Considering the positive results obtained, I am convinced that the delegation of competence to the various members of the health team helps to simultaneously achieve quality, economy, comprehensive and universal care.
Analyzing the results, we found that this model achieves, at the same time, economic viability, a greater scope with a significant reduction in bureaucracy, an improvement in quality and an important increase in coverage. It is a low-cost model that significantly increases the percentage of early diagnoses of female pathologies with characteristics of public health problems, thus favoring the reduction of morbidity and quality of life for women.
It can, in its principles and in its strategy, be easily reproduced in adult men and children. Unfortunately, this program was discontinued in 1999, based on the new health policies adopted in the country and today the Pérola Byington Hospital has become one more in the care of breast and gynecological cancer, without any work in the area of comprehensive care. Today it remains alive at the Center for Integral Attention to Women’s Health (CAISM) at UNICAMP and is reproduced in other countries.
We need to value quality and guarantee quantity, that is, quality cannot be considered if it does not include the tendency to universalize the benefit. My father, Dr. Pinotti, wisely said that “we need to bridge the huge gap that exists between what we know and what we offer in health for those who depend on public health in our country”.
This utopia moves me to continue fighting, alongside SUS professionals.
*Marianne Pinotti, 54 years old, gynecologist, obstetrician and mastologist