With information from Flávia Albuquerque, from Agência Brasil

A survey by the Brazilian Society of Pediatrics (SBP) showed that in the last nine years Brazil has disabled 15,900 pediatric hospitalization beds, those intended for children who need to stay in the hospital for more than 24 hours. According to SBP, data obtained from the National Register of Health Establishment (CNES), maintained by the Ministry of Health, indicate that in 2010, the country had 48,800 beds in the Unified Health System (SUS). By 2019, according to May data, the number dropped to about 35,000.

The survey also shows that beds available in health plans or private facilities fell by 2,130 in the same period, with 19 states losing pediatric beds in this network. São Paulo comes with the biggest drop: in all, 762 units were closed, followed by Rio Grande do Sul (-251) and Maranhão (-217).

According to the data, the states of the Northeast and Southeast were the ones that suffered the most with the reduction of hospitalization beds in SUS, with 5,314 and 4,279 fewer beds, respectively. Following are the South (-2,442 beds), Midwest (-1136) and North (-643) regions.

São Paulo was the state that lost the most hospitalization beds between 2010 and 2019, with 1,583 disabled pediatric beds. In the opposite direction, two states had an increase in the number of SUS beds: Amapá, which jumped from 182 existing pediatric beds in 2010 to 237 at the end of last year, and Rondônia, from 508 to 517.

Among the state capitals, São Paulo leads the ranking of the most lost beds in the public network (-422), followed by Fortaleza (-401) and Maceió (-328). Three capitals, Salvador, Macapá and Manaus, managed to raise the bed rate, suggesting that the great impact of the fall has fallen on the other metropolitan or inland cities of the states.

Poor Infrastructure

According to the president of SBP, Luciana Rodrigues Silva, the information coincides with the panorama of limitations and precarious infrastructure presented to those who daily work in pediatric care services. “The decline in quality of care is directly related to insufficient material resources. This progressive reduction in the number of beds obviously entails more risks for patients, as demonstrated by the widespread scrapping of most health services in the country, ”he said.

According to Luciana, among the problems that have caused children to be hospitalized most often are respiratory diseases, with a marked prevalence in the fall and winter periods, such as bronchiolitis, asthma attacks and pneumonia. Gastrointestinal problems, cases of allergies and so-called arboviruses, also occurring seasonally, complete the list that contribute to the growth of this demand.

Neonatal ICUs

According to the SBP, taking into account the number of preterm infants born in Brazil (912 per day), there are at least 2,657 neonatal intensive beds missing throughout Brazil, and ideally there should be at least four beds for each group of 1,000. born alive.

“Currently, however, data from the National Registry of Health Establishments (Cnes) indicate the existence of 9,037 public and private beds in the country, corresponding to 3.1 per 1,000 live births. If only the beds offered in SUS are considered, this rate drops to 1.6 beds per 1,000 thousand, considering the 4,764 existing units, ”says SBP.

Among the states, the worst result found by the SBP is in Roraima, where the 12 available neonatal ICU beds make up the rate of 1.02 beds per 1,000 live births. In the second worst position, Amazonas, with 1.29 beds per thousand, followed by Acre, where the same group of newborns has 1.34 beds. At the other end, three federation units reached the minimum rate recommended by pediatricians: Rio de Janeiro, with 5.53 beds per 1,000 live births; Espírito Santo, with a rate of 4.82 beds; and Distrito Federal, with 4.22.

Ministry of Health

By note, the Ministry of Health reported that from 2010 to May 2019 there was a nearly three-fold increase in the number of complementary beds in the SUS, including those of Intensive Care Unit (ICU), from 10,787 to 30,855, of which 4,764 from the Neonatal ICU and 2,525 beds from the Pediatric ICU. ICU beds are the most complex, which require structure and effort from professionals, and are intended for patients in severe cases.

“In recent years, the Ministry of Health has invested in the expansion of pediatric and neonatal beds for more complex care, aimed at critically ill patients who require more professional structure and effort. The increase in the supply of intermediate and intensive care beds for these cases was 25% between 2010 and 2018, currently totaling more than 11,600 beds in SUS, from July 2010 to March 2019, ”says the note.

According to the Ministry, the qualification of new beds must be requested by local managers. The enabling and release of resources are done by submitting projects, which are analyzed by the folder. “The local manager also has the autonomy to expand the number of beds with their own resources, based on their evaluation in relation to the demand and need and the installed capacity of assistance offer. The qualification of beds by the Ministry of Health ensures additional resources to fund the service. ”