The situation of Primary Health Care in Sorocaba was debated in a public hearing of the City Council, held on the night of Tuesday, 30th, in the plenary of the House, on the initiative of councilor Iara Bernardi (PT), who presided over the work table and shared it with the following authorities: councilor Fernanda Garcia (PSOL); director of Regional Health, Carlos Moura; director-president of Santa Casa de Misericórdia, Father Flávio Jorge Miguel Júnior; planning advisor Vanderson Brito Santos, representing the Secretary of Health, Cláudio Pompeu; and nurse Regina Cardoso, from the Women’s Committee.
The Strategic Support coordinator of the Ministry of Health, Lívia de Paula Nascimento, participated virtually in the public hearing. At the extended table were representatives from various bodies and entities, such as UBS do Carandá; Popular Legal Prosecutors; Popular Women’s Struggle Committee; São Paulo Health Union; Municipal Council of Public Service Users; Centro Paula Souza Workers Union; Union of Employees of Fundação Instituto de Terras; Instituto Pleno Cidadania, represented by former councilor Tânia Bacelli, and former councilor Antônio Sérgio Ismael.
As explained by the Ministry of Health, Primary Health Care is characterized by a set of health actions, at the individual and collective level, which covers the promotion and protection of health, through diagnosis, treatment and maintenance of health with the objective of developing comprehensive care that positively impacts the health situation of communities. This includes, for example, the Family Health Strategy. “Basic health is that which must be provided within the network formed by the Basic Health Units and, in this public hearing, I will present some numbers”, stated Iara Bernardi, highlighting that the hearing was held following a request from the Committee of Women for Democracy .
“Emergency Care Culture” – Councilor Iara Bernardi recalled that the Budget Guidelines Law (LDO) project has already been processed in the City Council and will begin to be debated in public hearings, providing an opportunity to question guidelines relating to health, such as the construction of Units Basic Health, since, as emphasized, the last UBS built was that of Carandá, financed by the Ministry of Cities. Next, the councilor presented the health numbers, such as the area’s budget in 2023, which was R$841 million (R$610.1 million from own resources; R$34.5 million from state resources; and R $197.1 million from federal resources).
The City of Sorocaba invests in Primary Health Care an amount of R$ 197.3 million of its own resources, in addition to R$ 4.9 million of state resources and R$ 22.2 million of federal resources. Iara Bernardi highlighted that investments in Primary Health Care revolve around 10% of the amount. “Primary Health Care is the focus of our debate, because if it does not have the necessary structure, all other levels of health are harmed. In Sorocaba, a culture of Emergency Care was created, so queues form and what should be treated in the Basic Health Unit, with monitoring, can become a case of hospitalization”, warned the councilor, highlighting the numbers of waiting lines for specialty care, based on the Executive’s response to a request from councilor Ítalo Moreira (União Brasil) at the end of last year.
Councilor Fernanda Garcia (PSOL) said that she has received several complaints from residents regarding the delay in receiving care in the municipal health network in the area of specialties. “There was a reduction in the number of doctors during the pandemic period, many doctors had to work in Basic Health Units and the Polyclinic was scrapped. This is reflected in the increase in people on the waiting list for orthopedics, ophthalmology, dermatology and several other specialties”, she stated, also highlighting the issue of mental health, which, according to her, needs more psychologists for clinical consultations. For the councilor, it is necessary to hire more doctors, nurses and several other professionals.
Expansion of service – The representative of the Ministry of Health, Lívia de Paula Nascimento, master in Public Health from the Oswaldo Cruz Foundation (Fiocruz), gave an explanation about the Federal Government’s actions in the area. “Primary Health Care is the only service that is present in 5,568 Brazilian municipalities, reaching around 167 million people across the country. Our priority is the Family Health Strategy, made up of doctors, nurses, nursing technicians and community health agents. With this, we are able to bring together the demands that emerge from the territories and plan our actions based on community health agents, including taking into account local specificities”, explained the representative of the Ministry of Health, highlighting the comprehensiveness of the care that guides Primary Care to Health and emphasizing that this care, when well structured, can solve around 80% of the population’s health problems.
According to her, a new Family Health Strategy model is being studied, which is not limited to serving the individual, but also considers the territory, which requires a team of five to six community health agents. Lívia Nascimento volunteered to study the case of Sorocaba to find out how many teams would be needed in the municipality, since the city could expand these teams. According to her, with the return of the Mais Médicos Program, it is being possible to expand primary care in the city, placing doctors in more vulnerable municipalities. “We need to expand, but expand with quality, through dialogue with municipalities”, she emphasized, highlighting, for example, the need to expand oral health teams. Today, the country has 51,678 Family Health teams and 267,000 community health agents, covering 80% of the national territory. In the State of São Paulo there are 6,647 Family Health teams and 32 thousand community health agents and 60 teams from street clinics.
Population growth – The planning advisor at the Municipal Health Department, nurse Vanderson Brito Santos, presented service data across the city’s territories and noted that one of Sorocaba’s biggest challenges is population growth, as the city has grown a lot in the last ten years and part of this population will demand public health services.
Another challenge, according to him, is the aging of the population, with a new epidemiological profile, in which more people will live with chronic diseases, demanding specialized services. The secretary’s representative also spoke about the department’s achievements, citing as an example the revitalization of 26 Basic Health Units, the implementation of electronic medical records in the 33 Basic Health Units and the call for public servants, which, according to him, had not occurred for almost ten years. “Of the 2,578 employees who are on the Transparency Portal, 1,275 are employees who work in Primary Health Care”, he said.
Nurse Regina Cardoso, from the Sorocaba Women’s Committee, stated that the challenge is the need for investment: “For four years, in a city that is developing, no Basic Health Unit was built. We also need a resource policy human resources, as workers in health units today work a lot and work a lot of overtime to provide care. And we need to review our territories, a long time ago we carried out the last territorialization process and, since then, Sorocaba has grown a lot and changed”, he highlighted, highlighting, for example, people with post-Covid illnesses who need care and the occurrence of syphilis cases.
Building lag – The representative of the Regional Health Directorate, Carlos Moura, said that he has already visited more than 30 municipalities of the 48 that make up the Regional Health and found that the health units, for the most part, were built a long time ago and do not meet the demands current. He also listed other problems, such as the large number of employees who are close to retiring; the need to review care protocols, highlighting the importance of nursing within Primary Health Care units; the need for planning and continuity of care. “Why is medium and high complexity care increasing? Because, unfortunately, basic care is failing,” he warned.
Father Flávio Jorge Miguel Júnior, director-president of Santa Casa de Misericórdia, said: “The feeling I have, in the health of Sorocaba, is that we have the bakery selling meat and the butcher shop selling bread, that is, what was supposed to be treated in the basic unit, we are treating in the hospital. Santa Casa today has a large number of clinical beds, much more clinical than surgical, where we are treating urinary infections, diabetics, respiratory and cardiological problems, everything that has not been resolved preventively and ends up occupying hospital beds”, he stated. , discussing the issue of care flows in the city, which, in his opinion, should involve all health units and hospitals.
After all panel members spoke, the debate was opened to the other participants in the public hearing and, among the topics raised, one of the highlights was the treatment of dengue cases. Councilor Iara Bernardi said that a lot of mobilization and demand is needed. “We have to start fighting, mobilizing, because the model of the City Hall today, in terms of health, is failing, it is extremely dangerous for people’s health” – she emphasized. The public hearing was broadcast live on TV Câmara and on the Sorocaba City Council’s social networks (YouTube and Facebook), where it can be seen in full.
