"Public health in Brazil goes from bad to worse." For decades this phrase has permeated the reality of all Brazilians, whether they are users of the Unified Health System (SUS) or workers in the sector. And who is responsible for the problem? For a complex question, there are several answers, one of which is very common - corruption.

Yes, corruption is ingrained in negotiations, fraud and deviations from the SUS, and must be combated with rigor. But would corruption be a cause or an effect? Diagnosis or symptom? The main causes of the permanent crisis in the public health system stem from the lack of focus on actions and the devaluation of the civil servant's career. To summarize in two words: inefficient management.
The first step is to shift the focus to results. A recent report by the Federal Court of Auditors ratified the chaotic conditions of public health in Brazil, but innovated by including in the audit procedures the analysis of the quality of care.

For the first time, a control body was concerned not only with the correct application of public money, but also with the standard of care provided to SUS users. This does not mean that, from now on, the ends justify the means, but that, in addition to bids, contracts and agreements, managers and inspectors will also have to turn to the user's satisfaction.
It is also necessary to change the reality of health unit professionals. Maintaining the status quo of civil servants is unable to meet society's demand for quality services.

It is necessary to review the career plans of statutory professionals, with the inclusion of remuneration based on performance indicators, so that workers feel motivated to overcome their own limits and, thus, return to invest in the public career as a life goal. .

All public health problems result from the current management model. Or rather, the lack of management. The current model is eminently procedural, without due observance of the results to be achieved, based on backward legislation that plagues public administration.

It is a model devoid of the managerial tools necessary for the strategic, tactical and operational planning of SUS, as well as for the management of the daily routine of public health units.

Reinventing the current SUS management model is the main challenge in offering quality services to patients and family members, as well as curbing the rampant corruption that plagues SUS from the north to the south of the country.

By José Carlos Pitangueira Filho, physician, he is the Director of Projects of the National Institute of Assistance to Health and Education (Inase).

Originally published in O Globo, on 20/06/2014.

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