Júlio Frenk, médico, professor e médico sanitarista "está" há seis anos Ministro da Saúde do México. Não sei se continuará no novo governo de Felipe Calderón. Nas páginas do
The Lancet (texto com livre acesso para quem se credenciar na página
http://thelancet.com) ele apresenta os resultados fantásticos obtidos na sua gestão. Frenk é acadêmico respeitável. Porém, como desconheço a realidade mexicana, não tenho como avaliar sua gestão. Os exemplos mostrados no texto indicam que há semelhanças com o Brasil, mas aparentemente estamos mais avançados em termos organizativos e, principalmente temos com o SUS, um arcabouço jurídico mais avançado do que o mexicano. Abaixo, reproduzo o ABCDE daquilo que seria a gestão adequada de um Ministro da Saúde, tal como publicado hoje no
The Lancet.
Comentários transformados em reconhecimento a brasileiros:
A de Agenda, com destaque para o entendimento com o Ministério da Fazenda local (Adib Jatene que o diga o quão importante é o relacionamento com a área financeira); B de Budget ( ao ex-deputado Eduardo Jorge ao ex-Ministro José Serra e todos que lutaram pela emenda constitucional 29 e, continuam exigindo a sua regulamentação); C de Capacity (homenagem às universidades brasileiras, institutos de pesquisa como Fiocruz e Butantã e à FAPESP); D de Deliverables (sem menção, não temos prioridades); E de Evidence (ainda uma proposta não hegemônica, vale somente para economia para pobres, mas não para o alto custo)
Bridging the divide: global lessons from evidence-based health policy in Mexico
Julio Frenk, The Lancet
Agenda
The first ingredient for success is to advance the health agenda amidst competition for attention and public resources. Especially in their interaction with ministers of finance, health officials can make use of global evidence showing that, in addition to its intrinsic value, a well-performing health system contributes to the overall welfare of society by relieving poverty, improving productivity, increasing educational abilities, developing human capital, generating employment, protecting savings and assets, enhancing competitiveness, and directly stimulating economic growth with a fairer distribution of wealth.
Budget
By placing health at the centre of the broader development agenda of a country it is possible to endow it with the degree of priority that it deserves. Such priority enhances the negotiating power of ministers of health in their quest for increased budgetary support. In too many developing countries, current investment is simply not enough to face the growing demands placed on health systems by the double burden of disease. The Mexican experience shows the value of legislating specifi c entitlements and the associated resource requirements. Use of evidence on the value of health for development can help convince policy makers to mobilise more money for health, but the capacity to deliver more health for the money must also be demonstrated.
Capacity
There is no substitute for long-term investments in capacity building. These efforts should be focused on two main areas. The first refers to health-service delivery, through investments in physical infrastructure and, most importantly, in human resources. The second has to do with the development of institutions that can undertake the necessary research to generate sound evidence for policy. In Mexico, the current reform has reaped the benefits of 20 years of sustained efforts to establish and nurture organisations such as the National Institute of Public Health and the Mexican Health Foundation. These centres of excellence have produced relevant research and policy analysis, trained researchers who occupy key policy-making positions, and done independent and credible evaluations.
Deliverables
A key ingredient to garner public support for a reform is to identify and communicate its specific benefits. The best way to do so is to focus on priority diseases and risk factors. In this way, the public can link abstract financial and managerial notions to concrete deliverables. A fundamental lesson from the Mexican experience is that health-system capacity can be built up through the scale-up of effective preventive and therapeutic interventions against specific priority problems.
Evidence
Evidence derived from scientific knowledge has an empowering effect to transform health systems. There is a growing international consensus that the creation and diffusion of knowledge is one of the major driving forces for health progress. While research is a value in itself, an essential part of culture, knowledge also has an instrumental value as a means to improve health. This improvement is achieved through three mechanisms. First, and most obviously, knowledge gets translated into new and better technologies, such as drugs, vaccines, and diagnostic methods. Second, knowledge is also gained by individuals, who use it to structure their everyday behaviour in key domains like personal hygiene, feeding habits, sexual behaviour, and child-rearing practices. In this way, knowledge can empower people to modify their lifestyles and promote their own health. The power derived from knowledge also allows individuals to become informed users of services and citizens conscious of their rights. Third, knowledge becomes translated into evidence that provides a scientific foundation for decision-making both in the delivery of health services and in the formulation of public policies.
