Virus exposes cracks in Brazil’s public health system

Louis Genot

RIO DE JANEIRO (AFP) – Brazil’s public healthcare system, considered among the world’s most advanced when it was launched, is being pushed to the brink by the coronavirus pandemic, which has exposed the impact of years of under-funding and mismanagement.

As Brazil closes in on 100,000 deaths from COVID-19 – the second country to reach that bleak milestone, after the United States (US) – the public healthcare system is struggling to care for those who depend on it.

Launched in 1988, the so-called SUS – for Sistema Unico de Saude, or Single Health System (SUS) – was modelled on Britain’s National Health Service (NHS).

It was created when Brazil adopted a new constitution to steer it out of its 1964-1985 military dictatorship.

The constitution states that “health is a universal right and a duty of the state”.

The SUS is one of the only systems in Latin America to offer universal coverage, meaning free access to healthcare for the entire population – in theory, at least.

“On paper, the SUS is a perfect system. But in reality, we have a lot of problems,” said Emergency Room Physician Fred Nicacio in the southeastern city of Bauro.

Brazilian COVID-19 positive patient Edinilson Silva, 47, is moved into an ambulance on his way to the Santarem Field Hospital after being transferred on a plane equipped as an ICU unit from the municipality of Almeirim to the city of Santarem, Para state, Brazil on July 15. PHOTOS: AFP
A health professional takes a patient out of the post-COVID-19 ward of the Pedro Ernesto University Hospital (HUPE) in Rio de Janeiro, Brazil on July 15
ABOVE & BELOW: A health worker from the Medical Care Ship Unit UBS checks the body temperature of a patient at the riverside community of Selma Barra, on the river Buissu, municipality of Melgaco in Marajo Island, state of Para, Brazil on July 30; and a patient infected with COVID-19 receives treatment at the Intensive Care Unit of the Hospital de Clinicas, in Porto Alegre, Brazil on April 15

“We need more hospital beds, staff and a wider range of medicines,” he told AFP.

Several of his colleagues have been infected with the virus, taking them out of commission for two weeks – sometimes without being replaced.

“The healthcare professionals on the front line are demotivated, underpaid and feel undervalued,” he said.

He also noted that systemic corruption is another major problem.

“It stretches all the way from political leaders embezzling funds for supplies to patients pretending to be sick so they can get a doctor’s note for work,” he said.

Brazil has been rocked by numerous scandals related to the pandemic, including over-billing for emergency ventilator purchases and field hospitals that were budgeted for but never built.


But corruption alone, though a “serious problem”, does not explain the cruel lack of resources for the public health system, said Vice President Guilherme Werneck at the Brazilian Collective Health Association (ABRASCO).

“The constitution says the state has a duty to guarantee access to healthcare, but funding for the SUS is extremely, chronically insufficient,” he said.

A 2019 report by the Organisation for Economic Co-operation and Development (OECD) found Brazil was among the countries making the least public investment in healthcare, with per-capita spending 30 per cent below the average for developed and emerging countries.

Brazil spends just four per cent of gross domestic product (GDP) on public health, less than half the level in countries such as Germany, France and Britain.

“Since the SUS was created 30 years ago, health has never been a strategic priority on the national agenda,” said Researcher Luciana Dias Lima at leading public health institute Fiocruz.

Far-right President Jair Bolsonaro’s administration “is not engaged enough” in coordinating the public health services, she said.


Paradoxically, even as the federal government faces accusations of under-funding the public health system, it indirectly finances the private health system via tax breaks for those who can afford private health insurance.

“No other country with a universal health care system funds the private sector like that,” said Lima.

“That money could be spent on financing the SUS instead,” said Werneck, who has a doctorate in public health and epidemiology from Harvard.

More than 70 per cent of Brazil’s 212 million people depend exclusively on the SUS. Its track record has not been good during the pandemic: the rate of recovery for COVID-19 patients hospitalised in the private system is 50 per cent higher than for those in the public system.

“The pandemic has deepened inequality: the poorest are most exposed, because they often live in inadequate sanitation conditions, have more chronic illnesses and have more problems getting a hospital bed,” said Werneck.

“If the SUS were better-funded, the response to COVID-19 would have been much better,” he added.

“But if the public system didn’t exist, the tragedy would have been even bigger.”