According to recommendations of the World Health Organization (WHO), the ideal ratio of beds in the Intensive Care Unit (ICU) is 1 to 3 beds for every 10,000 inhabitants. Brazil has a proportion of 2.2 beds, which is considered satisfactory on a consolidated basis. However, more detailed analyses, segmenting the data between public and private systems, show, for example, that the Unified Health System (SUS) has an average of 1.4 beds for every 10,000 inhabitants, against 4.9 in the private network, showing the existing disparity in access to health services.
In a technical note developed by the Institute for the Study of Health Policies (IEPS), it is pointed out that 32% of the Brazilian Health Regions do not have any ICU bed in the SUS. Specifically in the North, a region that covers the Legal Amazon, 22% of the population solely dependent on the SUS resides in places without ICU beds. We still face the challenge that most of the available beds are concentrated in specific Health Regions, usually in metropolitan regions.
According to data from the National Register of Health Establishments (CNES), at the beginning of 2020, in the State of Amazonas alone, of all adult ICU beds specialized in the treatment of COVID-19 by SUS, 68% were concentrated in Manaus.
This scenario highlighted the urgency of articulating investment in the North Region, together with the public sector and with knowledge in the application of collective strategies to overcome it. To this end, Fabiana Peroni, a consultant in Public Policy and Project Management with over 18 years of career in the areas of Public Health, Management and Health Planning, was invited by Grupo +Unidos to join the development and execution team of the equipment project public services in the Legal Amazon region, through the investment of the PPA Solidarity initiative.
With experience nationwide, Fabiana has also dedicated a large part of her career to dialogue and the development of public health projects in the northern region of the country. Based on her experiences, such as her contribution to the development of the Xingu Regional Sustainable Development Plan (PDRSX), the role of the Ministry of Health as a consultant for the State of Pará and in the development of the strategic planning of the Acre State Department of Health , was able to experience up close the difficulties faced by the inhabitants, public managers and health professionals in the territory. According to Fabiana, “it is very common in our area to talk about decentralization, the need to organize services in a network, guaranteeing access and efficiency. When we look at the northern region of the country, the challenges are enormous, aggravated by social and economic indicators and by the large geographic distances, difficult even to describe. It is necessary to know this reality, live some of these challenges in order to actually contribute with public policies that are adequate to the local reality”.
This knowledge was the starting point for the project and guided all the mapping developed to carry out the proposal aimed at investing in UCI beds and Ventilatory Support for the state of Amazonas. “The lack of beds prepared for the care of patients with Covid shed light on a reality faced for many years in this territory, but which with the current health crisis has become even more evident. Given this scenario, it is essential to work in partnership with the public sector to plan an intervention that adds to public efforts, that is, that the action is directed to expand government action and leave a legacy for the benefited territory", reports Fabiana .
To consolidate the partnership and implementation of hospital beds and equipment, it was necessary to have the support of the government and, therefore, it is pertinent to highlight the involvement and articulation carried out with the Departments of Health and Decentralization and Regional Assistance of the Interior, represented by Rita Almeida, Nurse by training and specialist in Health Management, with more than 20 years of experience in public health in Amazonas, who currently holds the position of Deputy Executive Secretary for Decentralization and Regionalization of Assistance for the Interior.
With the expertise of both specialists, it was possible to understand the importance of the investment not only for the fight against Covid, but also for the long-term benefit of public health in the state of Amazonas. Rita points out "that the installation of beds, in addition to helping at this time, will be seen as a legacy for citizens residing in these municipalities", considering that the installation of beds generated an increase of 61% in the service capacity of these municipalities.
The project's impacts go beyond the expansion of access in remote areas, which in itself represents a lot for the state. The partnership brought lessons and dynamism to public management, accelerating the procurement and delivery logistics processes, and was a way for Grupo +Unidos to contribute to the SUS, leaving a post-pandemic legacy and increasing expertise in working with the public sector.