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The future Minister of Health in the management of Jair Bolsonaro, Dr. Luiz Henrique Mandetta, says the government must reinvigorate policies for the prevention of badually transmitted diseases, such as AIDS.
He baderts however that the state is careful not to offend families. "We will have to see how this goes without offending those who understand that this could be an invasion of the state into their home environment," he declared to Folha .
Mandetta also criticizes the current HIV control policy. "We need to revisit the communication model.This language clearly has no effect."
The new minister says it will prioritize the reorganization of care into basic care and that it will have no effect. he should review the More Doctors program.
Management Priorities
It is not possible to organize the system without starting basic care. The SUS has been municipalised in a very unlimited way, leaving some municipalities without technical conditions and with sufficient staff to manage this system. We must rethink the Brazilian health districts.
Not only is it possible AIDS, but syphilis is developing a lot. I was young at the beginning of the AIDS epidemic. This generation has been marked by intense condom use campaigns, with AIDS provoking a great deal of fear. With the evolution of treatment, generations now think that it is a thing of the past and begin to relativize and neglect the use of condoms.
We will have to send this agenda back to the basic health units. There are two peaks of increase today: one in the young and one after 60 years old.
HIV Prevention Policy
We must revisit the model of communication [da política de prevenção do HIV]. How to talk about syphilis and AIDS in a young adult? The current language clearly does not work. Should we make conversation wheels? Should we encourage families to discuss it at home? How can we tell this young man that baduality is good and that it should be exercised fully, but that there are risks badociated with these badually transmitted diseases?
Then there is prevention, that is, how the condom is made available. We will have to see how this goes without offending families, without offending those who understand that this could be an invasion of the state into their home environment. But anyway, we have to make this available, he has to be closer to people.
Prep [profilaxia pré-exposição, pílula que visa prevenir o HIV] for groups at risk behavior
I have particularly researched science. If [a Prep] is part of science and the best arsenal available, we must go back as a health system. But we can not make politics. We can not trivialize and say "you can have risky behavior that the state will give you a little to solve".
Prep is part of the arsenal and gives a lot in the doctor-patient relationship or in the relationship with the health units. But it's not something that "Look, let's act this way because we have this opportunity". No, we have this opportunity, but let's talk seriously about how you should not use it.
Abortion and Public Health
Abortion is defined by law, it also relates to responsible parenting, pregnancy in adolescence and a number of related issues. Any modification of the law falls within the competence of the Congress. I, as a person of health and medicine, and in that there is no religious bias, I am extremely pro-life because I was trained to become one .
If we legally terminate pregnancy in case of rape In case of risk to the mother's life, the health system must be prepared to offer this service in the least traumatic way possible for the woman . But public health should not call this debate [do aborto].
Abortion as a method of family planning does not do it. It will work within the limits of what the law presupposes, and to the extent that it must be done in the best way.
Vaccination
We must consider the immunization portfolio as one of the documents to most often include a series of opportunities, such as admission to a employment. Today, vaccination is a necessity in the Bolsa Família, but we can also use it for schooling and universities.
More Doctors
Today, the program is conceptually wrong, poorly executed, poorly supervised. I would not say that the program will end, but it will change. We have a huge generation of newly trained doctors in debt. If we are going to spend money to train doctors, bring in doctors from outside, that 's signing a certificate of incompetence. The Brazilian state needs a structuring measure, namely the state career for basic care.
Answer to the exit of the Cubans
Let's see what we will receive on January 2nd. Could this group of Fies, for example, give him debt relief to go to difficult areas? In the exclusion zones, such as Xingu National Park, you can not stay 15 to 20 days, then go back, then go-in-one after?
The country can not have a cake recipe going from Acre to Rio Grande do Sul. The armed forces employ 4,500 doctors to perform their military service. Indigenous areas could somehow be met from the point of view of this military service.
There are also medical residences in which preceptors ask, historically, remuneration. Could we have a month in these areas as a residential activity, with these people properly paid? If we have thousands of residences, would we need this type of external improvisation?
Health Plans
The sector is facing challenges. The life expectancy of the population is increasing. At the same time, the cost becomes prohibitive. If the person is old and is planning for the first time, most plans will charge $ 3,000 a month. It's exclusive.
ANS [agência que regula o setor] worked those years in the plans' financial outlook. He created a series of provisions that now require more than 20 billion d. Capital of these companies to be deposited as collateral capital, for cash, at a time of decline in economic activity and exit of users. The agency has an autonomy. The minister can influence the debate and I will question some of the things that can be done to increase liquidity and competition.
We must stop thinking that the more societies there are, the better. This reduction in coverage should not be discussed. I do not think you can do that. If they want to do it, it is in Congress, because we will comply with the law in force. They are the ones who give up plans for lack of income for the adjustment. This can be discussed, but it has to go through Congress.
Some countries have opted for the average age of the portfolio. It takes up the plan and makes the average age between young, middle aged and old. They say that it can hurt the younger ones, but that it is he who has an interest in being economically active. Brazil is already the 5th biggest buyer of medicines, but in terms of basic care, our list of medicines is very shy and it takes a long time to define it.
Access to medicines in SUS
there is better. There is currently a global trend towards incorporation by sharing the risks.
You bring innovation, tell me that it improves treatment and reduces the cost of clinical trials. But if this medicine does not do that, you pay me.
Brazil has hardly tried this risk-sharing tool. The laboratories will have to be co-responsible for what they say and propose.
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