RESUMO

[ABSTRACT]. The G20, representing the world’s largest economies, plays a critical role in shaping global health policies, initiatives and innovative solutions. As these nations navigate the complexities of digital transformation in the health sector, engagement with the Global Initiative on Digital Health (2), aligned with the Pan American Health Organization ́s (PAHO) eight guiding principles for the digital transformation of the health sector (3), becomes imperative not only for advancing technology adoption but also for promoting health equity and universal access to health and universal health coverage. The inclusion of telehealth in the G20 agenda, championed by Brazil’s presidency, underscores the group’s commitment to leveraging digital innovations to improve health outcomes in G20 countries and globally, as telehealth is a key area of the digital transformation of the health sector. Because countries worldwide vary widely in the capacity of their digital health infrastructure and their development stages, there lies a unique opportunity to foster international collaboration, share knowledge and drive global standards that support the widespread adoption of telehealth solutions for leaving no one behind. This strategic focus is predicated on the understand- ing that telehealth serves as both a catalyst for health equity and a critical tool for reinforcing health systems grounded in primary health care (PHC). The scientific rationale behind this concerted effort is clear: by enhancing digital infrastructure and fostering the adoption of telehealth solutions, there is potential to bridge the global digital divide and democratize access to health services. The G20, representing the world’s largest economies, plays a critical role in shaping global health policies, initiatives and innovative solutions (1). As these nations navigate the complexities of digital transformation in the health sector, engagement with the Global Initiative on Digital Health (2), aligned with the Pan American Health Organization ́s (PAHO) eight guiding principles for the digital transformation of the health sector (3), becomes imperative not only for advancing technology adoption but also for promoting health equity and universal access to health and universal health coverage. The inclusion of telehealth in the G20 agenda, championed by Brazil’s presidency, underscores the group’s commitment to leveraging digital innovations to improve health outcomes in G20 countries and globally, as telehealth is a key area of the digital transformation of the health sector. Because countries worldwide vary widely in the capacity of their digital health infrastructure and their development stages, there lies a unique opportunity to foster international collaboration, share knowledge and drive global standards that support the widespread adoption of telehealth solutions for leaving no one behind. This strategic focus is predicated on the understand- ing that telehealth serves as both a catalyst for health equity and a critical tool for reinforcing health systems grounded in primary health care (PHC). The scientific rationale behind this concerted effort is clear: by enhancing digital infrastructure and fostering the adoption of telehealth solutions, there is potential to bridge the global digital divide and democratize access to health services. In envisioning the future of global health, the fourth pillar of the vision of PAHO’s Director emerges with critical importance: the construction of resilient national health systems is firmly rooted in the implementation of the PHC strategy. This vision is not just an aspiration but a necessary evolution, with PAHO standing ready to guide countries towards achieving this goal. PAHO’s commitment involves supporting countries in the organization of health services networks based on PHC, targeting public financing to foster universal access and coverage, and bolstering governance in health under the leadership of health ministries. Moreover, it calls for the rapid deployment of technological innovations such as telehealth and also broader digital transformation initiatives (4). Digital transformation, emerging as a key innovative strategy, offers significant improvements to the strengthening of PHC. Through the adoption of inclusive digital health solutions, it is possible to enhance the delivery of health services, ensuring they become more accessible, efficient and equitable for everyone, everywhere (5, 6). Among the priorities leading this transformation, telehealth emerged at the G20 as a key opportunity in the mission to leave no one behind and as a cornerstone of the digital transformation of the health sector. Telehealth improves access to care and health information, thereby empowering individuals and communities (7). It effectively extends health services to underserved populations, encourages collaborative practices among health professionals, and broadens access to health for the wider community. It can support reduced waiting times and costs through efficiencies in care management. Through telehealth, the transition to a new era of PHC can be accelerated through technological advancements that drive us towards a more inclusive and accessible health care system for all. Concrete efforts should be focused on modernizing normative and legislative frameworks, investment in digital infrastructure, prioritizing the development of robust digital health infrastructures while ensuring that reliable internet access and digital tools are available across urban and rural areas alike. Enhancing digital literacy and telehealth competencies among health professionals and the population will maximize the utilization and effectiveness of digital health services. However, the lack of standardized policies and frameworks for telehealth is a significant barrier to its global adoption and, therefore, G20 nations can lead by example, working towards (a) developing international telehealth guidelines that consider ethical, privacy and security standards for telehealth services to facilitate cross-border healthcare delivery and secure data exchange; and (b) promoting interoperable telehealth platforms that can seamlessly exchange information, thus enhancing the continuity and quality of care. The G20’s leadership and commitment to integrating telehealth into the global health agenda can set an unprecedented opportunity for international cooperation in digital health. G20 countries can significantly impact global health outcomes by integrating telehealth at all levels of care and health service delivery networks, impacting the lives of billions around the world. Equity must remain central to our efforts as telehealth services are integrated into the model of care. This means ensuring the adoption of differentiated approaches in digital health based on (a) the characteristics of a territory (geographical dis- persion, status of infrastructure), (b) the beneficiary population to be served (their health needs, and cultural, racial and ethnic considerations) and (c) the health system capacities and organization (the health services network, coverage capacity and availability of multiprofessional teams). Health outcomes can be significantly positively impacted by undertaking bottom-up planning processes that take into account the latter considerations and by adapting the model of care to leverage the capacity of digital health. Embracing the Regional Roadmap for the Digital Transformation of the Health Sector in the Region of the Americas is imperative for countries aiming to develop expansive, resilient and inclusive health systems based on PHC (8,9). This comprehensive framework, backed by lessons learned and suc- cessful experiences, underscores the significant potential that digital transformation holds for improving health outcomes. Brazil's commitment to the consolidation of the Unified Health System (the Sistema Único de Saúde, or SUS) and its well-established Family Health Strategy as the foundation for the health and well-being of its population is being expressed through the rapid deployment of telehealth, and serves as a model of innovation and effectiveness, showcasing the transformative impact of digital health solutions on accessibility, efficiency and quality of care (10). This editorial, jointly prepared by rep- resentatives of the government of Brazil and PAHO advocates for global standardization of telehealth practices that ensures the scalability and sustainability of health interventions while addressing the core determinants of health equity.

[RESUMEN]. Sin resumen disponible Texto completo en inglés

[RESUMO]. Não existe resumo disponível Texto completo em inglês

Assuntos

RESUMO

Cumpre salientar ab initio que, para elaboração do presente artigo, em face dainterdisciplinaridade exigida pelo tema escolhido, foi necessária incursão na área da Ciência Jurídica, bem como, na área da Saúde Coletiva para uma compreensão contextualizada do tema trabalhado. O objetivo deste artigo é realizar o levantamento bibliográfico de obras sobre Direito Administrativo e seus princípios, Direito Sanitário, acesso ao Sistema Único de Saúde e os fenômenos da "fila dupla" ou da "segunda porta" no SUS a fim de analisar a relação entre a inobservância do Princípio da Impessoalidade e a geração dessas iniquidades no acesso aos Serviços de Saúde do SUS. O referencial teórico se baseia tanto em autores que definem os princípios do Direito Administrativo, o conceito de acesso e ainda naqueles que denunciam as iniquidades no SUS, especialmente o fenômeno da "segunda porta" ou "fila dupla".

Assuntos

RESUMO

Este trabalho tem como objetivo analisar o Sistema de Pedido Administrativo como alternativa ao fenômeno da Judicialização da Saúde no Estado e Município do Rio de Janeiro. Para tal, inicialmente, são feitas abordagens históricas para uma melhor compreensão da garantia do direito à saúde no Brasil, até o surgimento e crescimento do fenômeno da Judicialização da Saúde. Em seguida, analisamos o Ciclo de Políticas Públicas como marco teórico que sustenta nossa análise. Buscando compreender as etapas do Ciclo das Políticas aplicadas ao Sistema de Pedido Administrativo, realizamos entrevistas com cinco atores chave: Defensoria Pública do Estado do Rio de Janeiro, Procuradoria Geral do Estado do Rio de Janeiro, Procuradoria Geral do Município do Rio de Janeiro, Central de Atendimento à Demanda Judicial e Gerência de Atendimento à Mandado. Para além da visão jurídica ou sanitária, nosso estudo aborda o tema por uma perspectiva interdisciplinar que aponta para uma necessidade de diálogo entre os campos de conhecimento, entre os Poderes Judiciário e Executivo e, sobretudo, para o respeito à lógica do Sistema Único de Saúde, como um bem de todos os cidadãos brasileiros, que deve ser preservado e compreendido para além da assistência farmacêutica.

The aim of this paper is to examine the Administrative Request System as an alternative to the phenomenon of judicialization of Health Care in the State and Municipality of Rio de Janeiro.In order to achieve this, an historical review is initially developed for a better understanding of the guaranteed right to health care in Brazil, until the emergence and growth of the Judicialization of Health Care phenomenon. Then the Public Policy Cycle is reviewed as a theoretical framework to support our analysis. To understand the steps of the Policy Cycle applied to the Administrative Request System, five key players were interviewed: The Public Defenders‟ Office of Rio de Janeiro State, Attorney General of Rio de Janeiro State, Attorney General of the Municipality of Rio de Janeiro, Lawsuit Advice Centre and Subpoena Management Office. Extending beyond a purely legal or public health viewpoint, our study approaches the theme from a multidisciplinary perspective, pointing to the need for improved dialogue between the distinct fields of knowledge, between the Judiciary and Executive Authorities and, above all, to the observance of the underlying logic of the Unified Health System, an asset which belongs to all Brazilian citizens and should be preserved and comprised of services beyond pharmaceutical care.

Assuntos