New SUS financing model may harm primary care on the islands

Expected to be applied from 2022, the change in the Primary Care financing model will be based on the number of SUS (Unified Health System) users registered in the municipality. So far, Salvador has registered about 85% of the population, and has taken advantage of the vaccination against Covid-19 to try to increase this percentage.

The municipal secretary of Health, Léo Prates, explains that the new financing will combine the number of registrations with productivity, while the current model is based on family health teams and production. Although, globally, the capital has already reached the number of registrations necessary to avoid loss of funding, the manager still sees the risk of underfunding in the health units of the islands of Maré, Frades and Bom Jesus dos Passos.

According to Prates, the islands that are part of Salvadoran territory do not have a number of inhabitants that allows them to fulfill the minimum number of registrations required. Thus, the part that the federal government is responsible for providing primary care services in these areas should be lost, an amount that represents about 30% of the total cost.

“I don’t like this model proposed by the federal government because it only uses a production logic and I think that health is much more complex”, reinforces the secretary. Today, the maintenance of all team members is an obligation, as there is a loss of funding after a period of at least 60 days without a doctor in a unit, for example. With the change: “if the nurse produces, I can have the unit without a doctor”, he says.

Doctor in Public Health, researcher and retired professor at the Collective Health Institute of Ufba, Jairnilson Silva Paim also does not agree with the new format. “Several studies, debates and investigations carried out in Brazil since 2017 indicate that this model tends to disrupt the backbone of PHC (Primary Health Care), as it does not privilege the operation in the territories, as is the family health strategy”, he declares .

In his assessment, “the number of registered citizens without an effective link with primary care teams and services in the territories can reinforce the hegemonic medical model instead of comprehensive care with community participation.” For Paim, the proposal values ​​spontaneous demand and fundraising by municipal secretariats, rather than prioritizing the needs identified in different communities.

Sought to explain the reasons for the change in the SUS primary care financing model, the Ministry of Health did not give feedback until the closing of this report.


If there is no new term extension by the Ministry of Health, the residents of Salvador will be able to update their registration in the SUS until 31/08. The procedure can be done in one of the 155 basic units of the municipal network or on the website Waiting for the second dose of the Covid-19 vaccine at USF Vale do Matatu, last Friday, driver Carlos Alberto Lopes, 45, said he had not found it difficult to re-register online.

On the same day, Érico Fraga, 42, a salesman and hairdresser, said he had been warned about the update by the community agent at the USF Vale do Matatu, where he is monitoring his hypertension. He re-registered at the unit to enable his inclusion in the priority group for vaccination due to comorbidities.

The main difficulties for re-registration have been reported by users whose current registration includes another city or state as place of residence, as it is necessary to change the address by going to the city hall of the region where the user currently lives. Secretary Léo Prates defends that the bureaucracy is due to the need for time to adjust the vaccination plan, absorbing this public, so that there is no shortage of doses for those who were already planned as residents of the city.

“Last week (week before last) we carried out a joint effort and vaccinated around 800 outsiders,” says Prates. The total cited includes people who have taken up residence in Salvador and had not yet updated their registration with the SUS, and also those who for various reasons reside in other cities, but who sought vaccination in the capital of Bahia.