Joinville Health Minister Andrei Colaqueke officially steps down this Sunday (23). After almost a year in office, Colaqueque takes stock of the period when he headed one of the most responsible areas of public administration in the municipality of Northern Santa Catarina.

Andrei Kolakeke leaves the Department of Health after 11 months – Photo: Joinville City Hall/Disclosure/ND

Civil servant Andrei took over the Department of Health at the end of May 2022, following the departure of then secretary Jean Rodriguez. For Kolacheke, the folder is the most difficult, especially at a time when he is going through a crisis worse than a pandemic. “I think this is the most difficult portfolio in the municipality, without a doubt, because of the whole situation, the whole context and this whole demand profile,” he said in an interview. no data+.

Andrei Colaqueke is leaving the folder team in the context of many criticisms and demands of the public health system in the municipality. In recent weeks, the population has faced long queues at emergency rooms, a shortage of specialists and even a shortage of medicines.

The congestion in the system is the result of a demand shutdown during the Covid-19 pandemic, which is now returning to aggravated units, the Secretary of State said.

“These days we need to think about health in terms of the pandemic, its causes. We had a complete change in how the divisions functioned. Basic health units that previously looked after chronically ill and pregnant women have changed their service profile to function as small emergency departments,” he explains.

The picture shows the queue at UPA Sul, where the waiting for help reached 11 hours – Photo: Ricardo Alves / NDTV

“All this disrupted the exit process, and today we are paying for it. Not only Joinville, it’s a worldwide phenomenon. We have patients who stopped being observed during this period, stopped performing procedures, operations and now seek medical help with this condition already aggravated, so the demand is huge,” he adds.

Not enough resources, secretary evaluates

But it wasn’t just limited demand that challenged the municipality’s health management, at least according to Colaqueke. There is also the problem of funding the system.

“The Joinville context is even more complex because we have a healthcare model where the municipality pays for medium and high complexity. We have a very sophisticated hospital that is 100% public and funded by the City of Joinville,” he explains.

“In other municipalities, such as Florianopolis, the high complexity is almost 100% funded and managed by the state.”

In this scenario, according to the secretary, Joinville is unable to make much progress in this area. “We have to share this resource. A very large part goes to the San José Municipal Hospital, and another part has to pay for other services, and this resource is often not enough. Even by directing 40% of everything it collects to health care, the municipality cannot go any further in some aspects.”

For Andrei, not only the lack of money. “Human resources” is also a deficit facing the Saud de Joinville. “We suffer mainly from a lack of civil servants, because one municipality does not have enough resources to hire larger teams,” he says.

Again, the effects of the pandemic seem to continue to hurt the funding of the system. “What [a falta de verba] exacerbated by cuts in federal resources dedicated to the fight against the pandemic.”

Data from the Ministry of Health shows that in 2020 the body transferred more than 300 million reais to the municipality of Joinville. Last year, the transfer was reduced to 224 million reais, which is 25% less than the allocated amount. “And demand has not decreased, but only increased from that time until now,” Kolakeke warns.

“There are fewer resources, the health needs of the population are greater, and municipalities are not able to develop”

“In normal situations, we manage to equalize this demand. But in times of crisis like the one we are experiencing today, it is extremely difficult – faced with an epidemic – to meet this challenge without the financial support of the Union and the state government, ”the secretary regrets.

The current health crisis in Joinville is worse than the pandemic

Speaking of the health crisis, the situation that Joinville has faced in recent weeks is worse than during the worst days of the pandemic, according to Andrei. “Demand today is greater than during the worst time of the pandemic. We have received over 3,000 consultations a day in our emergency departments and our Dengue service center in the last few weeks. This number has never been reached during the pandemic,” he says.

The secretary points to two major factors in the city’s healthcare system being overwhelmed: various flu syndromes, which account for the most cases, and dengue fever, which is spreading throughout the state of Santa Catarina.

“At the height of the number of people infected with Covid, we had 2000, 2500 people looking for our units. Now we are working with 3000, 3200 and less resources. This is a very challenging situation for the health of Joinville and our staff is doing everything they can to meet the demand for devices with the highest quality possible,” he concludes.

If there are not enough resources, the Union needs to increase the financing of the health care system, according to the manager. However, according to him, the exact opposite happened.

“Throughout our history, since the creation of SUS, the share of costs that the Union absorbs has been decreasing every year. Each year, the Union cooperates proportionally less to maintain SUS, the states retain their participation, and the municipalities, therefore, must advance and cover these costs, ”he notes.

The commission will monitor the health

Following steps to create a CPI (Parliamentary Commission of Inquiry) in Joinville’s House of Councilors, the parliamentarians decided to set up a Special Commission to oversee the health care work of the municipality.

For the current secretary, the initiative is positive and can improve the situation. “SUS is a product of institutional dialogue. We need to bring three powers into the discussion,” he argues.

“The more help, the more governments are empowered with health information derived from all of this reality, the better for the future of SUS,” concludes Kolacheke.

“We have no restrictions regarding the participation of the Legislative Assembly”

According to Andrey, the involvement of advisors through the committee can add different perspectives, in addition to conveying requirements from the community to the Department of Health, which sometimes don’t make it to the knowledge portfolio.

A special commission will analyze the recurring public health criticism of the people of Joinville. Users complain about long queues in emergency rooms and lack of appointments with therapists and specialists.

The advisers will also assess the budgetary and financial possibilities. The text that creates the Special Commission recognizes the public health problems in the municipality.

“I see this as a great opportunity to bring legislative power under the control of the Secretariat, so that advisers understand these measures, difficulties and challenges well and help propose solutions,” says Kolakeke.

In addition to being involved in the search for solutions, the political power of the councilors is seen as an ally by Colaqueke in addressing Joinville’s health problems, including in sectors outside the municipal administration.

“Counselors have the political power to seek state and federal solutions. Involving them in the game can be very beneficial for the new leadership of the Ministry of Health, ”he argues.

No regrets

In 11 months as Minister of Health, Andrei Kolacheke never regretted it. “Not necessarily all the decisions I made would be the same, but there is no decision that I would regret, that I would have made differently, given the circumstances in which I was at that moment,” he estimates.

For Andrei, the “big mark” of being in the portfolio is precisely the improvement in performance and what he calls “the resumption of health promotion processes.” Joinville achieved in the last month of February 6.94 points in the Synthetic Performance Index from the Ministry of Health, up from the previous index, which registered 6.91 points.

“We are working hard to change the face of public health in Joinville. This is a process that did not necessarily start with me and will not necessarily end with me leading the Secretariat,” explains the secretary.

Over the past 11 months, there has been an attempt to change the logic of public health, Kolakeke said. According to him, the system began to direct efforts to improve health so that the population does not get sick.

“All this context will bear fruit and avoid overloading services. We managed to break out of a vicious cycle in which we had to respond to more emergencies, and enter a virtuous cycle in which we manage to prevent more every year,” he explains.

“If I can be proud of my heritage, it is in this sense. We are in a cycle of improving the health and quality of life of the population. These fruits may not be immediately, but they will definitely appear, ”adds Andrey.

Prospects for new leadership

The state government recently announced talks to take over part of the payroll of the San Jose Community Hospital. This measure, according to Kolakeke, can help improve the current scenario, as it will provide more resources for investment. “I believe that there is a great opportunity to not completely solve the problem, but at least significantly improve the situation,” he says.

As for the folder’s new leadership, Andrei believes that the path he started, with an emphasis on health prevention and strengthening of primary health care services, should be maintained. “This should be a priority in the municipality to avoid diseases in the population and, as a result, overcrowding of hospitals, emergency departments and other specialized services,” he says.

“The ideal way is, in this sense, to work on prevention, health promotion”

According to Andrei, the vision of the new secretary, Tanya Eberhardt, regarding the healthcare system is similar to his. “We have a lot in common regarding health policy, how we see SUS, and priorities within the network,” he notes.

Tanya goes into action this Monday (24) – Photo: Joinville City Hall/Disclosure/ND

Tanya Eberhardt will lead the folder this Monday (24th) with the mission of addressing the various challenges that healthcare has faced in Joinville, especially in recent weeks.

To do this, Eberhardt brings luggage through the Department of Health of the State of Santa Catarina, the Hans Dieter Schmidt Regional Hospital and the Municipal Hospital of San José, in addition to having previously served as Minister of Health for Joinville, and more recently, from Araquari.