Access to health services: a right and a utopia
This thematic issue is an in-depth study on the theme of the 14th National Health Conference that was held between November 30 and December 4, 2011, with a focus on access to the Brazilian Unified Health System (SUS). During the event, which is a follow-up to the National Conferences that occur every four years, and in which issues that concern the health and quality of life of the population are open to national debate, the following questions were examined in greater depth: (1) access and care with quality: a challenge for the SUS, (2) health policy in line with principles of comprehensiveness, universality and equality, (3) community participation and social control; and (4) SUS management and funding; "Pact for Health"; public versus private relations; labor management and health education.
This Journal is the result of a partnership between the Department of Strategic Management of the Ministry of Health and the Brazilian Association of Public Health that has always based its policy on fostering the enhancement of the SUS. The publication of this special edition seeks to provide input for the discussion about accessibility, bringing research results and reflections of prominent researchers from across the country and with divergent viewpoints to the debate. The expectation is that such studies and the proposals ensuing from it will contribute to improve the quality of operational policies, management and practice.
The issue of accessibility is not straightforward. The most varied research highlights several important steps taken in this direction, but also shows that accessibility is an ideal and a utopia, since numerous problems and obstacles still stand in the way of the reality of the SUS promised by the 1988 Constitution and that Brazilian society wishes for and deserves.
In the debate article, the authors stress that accessibility to the health services is related to living conditions, nutrition, housing, purchasing power and education. It transcends the geographic dimension and encompasses the economic aspect relating to the expense of the user with health, the cultural aspect involving norms, techniques adequate to the habits of the population and the functional aspect which accounts for matching the supply of the services and the quality thereof to the people who use the system. Therefore, the concept of accessibility has a multidimensional sense of a social and political nature that is present in the execution of the policy, the management, the rendering of services and the relationship between professionals and users.
All of the articles in this thematic issue touch upon some aspect of this set of issues that are based upon the principle of equality, universal entitlement and operational processes of popular regionalization, hierarchization and participation. They could be classified into major categories: (1) questioning and theorizing the concept of accessibility; (2) historical, political and economic constraints of the processes of regionalization and operation of the SUS; (3) conditions of social inequality and access to health services; (4) the rationale and know-how in the organization of networks geared to accessibility to primary healthcare services and to care for patients with specific complications; (5) training of health workers and professionals striving for accessibility; (6) empowerment practices of SUS users for the social control of services; and (7) evaluation of specific programs, from the standpoint of accessibility.
The set of texts provides a critical overview of the obstacles to be overcome, but it also underscores the importance of what has already been achieved and what still needs to be done.
Luiz Odorico Monteiro de Andrade
Secretary of Strategic Management of the Ministry of Health, guest editor
Maria Cecília de Souza Minayo