By Nátali Bahena Benck, Grants Development Consultant (Brazil)
In the realm of public healthcare in Brazil, the Unified Health System (SUS) is of great significance. Established in 1988, SUS serves as a cornerstone in ensuring that all Brazilians have unfettered access to quality medical care, free of charge. However, SUS does not operate in isolation; it relies on a vital partner, the National Health Fund (FNS).
FNS plays a pivotal role in managing public resources earmarked for healthcare, with a mission to enhance citizenship by continually improving the allocation of resources in alignment with the National Health Plan, the Ministry of Health's Annual Plan, and established guidelines.
To empower local healthcare initiatives, resources within FNS get transferred to States, Municipalities, and the Federal District. This decentralized approach allows governments at various levels to tailor healthcare actions and services to local needs, thus fostering a more personalized approach to healthcare delivery. These transfers take place through various modalities such as Fund-to-Fund, Agreements, Repayment Contracts, and Cooperation Terms, thereby ensuring flexibility in resource allocation.
In 2022, FNS committed a sum of BRL 101.1 billion to bolster healthcare services nationwide. This substantial allocation not only sustains accessible healthcare but also creates opportunities to fortify the healthcare sector in Brazil in new ways.
Expanding Opportunities for Healthcare Investment
In 2018, the National Health Fund (FNS) initiated a transformative shift in resource allocation to municipal and state health funds. This overhaul streamlined allocation into two primary categories: investment and operational expenses. Recognizing the importance of this change, Complementary Law No. 172/2020 was enacted. This pivotal law allowed the utilization of funds from accounts predating 2018 and expanded their utility.
A salient aspect of this law is the flexibility it affords, enabling States and Municipalities to choose between utilizing these resources for current or capital expenses without the need for specific application plans. Proper budget allocation in the Municipal Health Plan and the Annual Budget Law of the Municipality streamlines the process for healthcare managers.
Fast forward to Complementary Law No. 197/2022, a continuation of the initiatives introduced by Complementary Law No. 172/2020, which has opened doors for municipal and state healthcare managers. It grants access to approximately BRL 2.2 billion in financial balances from FNS accounts predating 2018. What sets this law apart is its commitment to enhancing healthcare infrastructure, modernizing healthcare systems and services, and providing flexibility to address various other critical needs.
Complementary Law No. 197/2022 offers Brazilian municipalities and states a pivotal opportunity to strengthen their healthcare services significantly. It allows for the use of pre-2018 financial balances from the National Health Fund to revamp infrastructure and modernize healthcare delivery. While the law's flexibility was designed to ensure comprehensive resource utilization, the year-end deadline is rapidly approaching, underscoring the vital need for a strong public commitment to achieving this goal.
Transparency and Accountability
To enhance transparency, financial balances in accounts opened before January 1, 2018, underwent assessment by official federal financial institutions (Banco do Brasil and Caixa Econômica Federal). These balances were published and made accessible on the National Health Fund's Portal at the following web address: https://painelms.saude.gov.br/extensions/LC_Saldos_197/LC_Saldos_197.html .
This allows states and municipalities that have accounts in this system to go through the verification process and utilize these funds in a transparent manner in accordance with established regulations.
How to utilize the resources:
The process of requesting these resources is relatively simple, ensuring accessibility for public entities. It does not require authorization but rather only a usage report:
- Inclusion of transposed and transferred financial resources in the Annual Health Program.
- Inclusion of transposed and transferred financial resources in the Annual Budget Law.
- Notification to Health Councils.
Unlocking these resources is pivotal as it offers the chance to dramatically enhance the Brazilian healthcare system. The ability to allocate these funds strategically according to specific needs and priorities is a significant advantage that should not be overlooked. As we move forward, responsible and effective resource utilization is not just a call to action but a fundamental responsibility. Any unused funds will ultimately be returned to the federal government, underscoring the urgency of maximizing their potential.