Brazilian Ministry of Health Note of Clarification
The Secretariat of Health Surveillance (SVS) of the Brazilian Ministry of Health (MoH) clarifies that it is not true that discussions of any nature are taking place regarding the “end of the Federal AIDS policy allocating funding to States and Municipalities” as was erroneously disseminated in the international media.
The MoH is not only fulfilling all commitments to the transfer of specific AIDS funds to States and Municipalities in 2013, but is also adopting measures to facilitate the implementation of such actions. This funding has been modified over the years to become aligned to the more general National Health System (SUS – Sistema Único de Saúde) rules on funding, action planning and agreements among the System’s managers, namely: the Ministry of Health, State and Municipal Health Departments.
Two measures are in discussion at the Tripartite Health Service Management Commission, which includes the above mentioned three levels of SUS management (Federal, State and Municipal) aiming at facilitating funding transfer and implementation of disease surveillance, prevention and control actions, including those related to STDs, AIDS and Viral Hepatitis. These changes are essential for bringing this transfer in line with the new rules set in 2012 by new Decrees and Law issued to ensure transparency and efficiency in action implementation and use of transferred monies. One of the measures addresses the possibility of using the unspent balance of the already transferred funds. Another fundamental measure refers to the way these transfers will come in effect as of 2013. These changes are urgent and essential.
Currently the total amount of this specific fund for STDs, AIDS and Viral Hepatitis transferred by the Ministry of Health to States and to some 500 Municipalities qualified to receive this resources reaches R$ 168 million per year (US$ 84 million/year).
Nevertheless, in 2012 the unspent balance in State and Municipal Health Departments accounts is, at least, R$ 160 million (US$ 80 million), which equals an entire year transfer. The new proposal will enable this and any other unspent balance of monies transferred for health surveillance actions to be used in any disease surveillance, prevention and control action approved in Municipal and State Health Plans, including for STDs, AIDS and viral hepatitis. As such, the new rule ensures that these resources will not return to the central government, remaining with States and Municipalities with broad possibilities for their use.
The new Ministry of Health proposal for the transfer of resources to STD/AIDS will occur:
1. Through a specific incentive scheme for STD, AIDS and Viral Hepatitis actions; and
2. Through a new incentive scheme for enhanced health surveillance actions, which also may include novel actions for STD, AIDS and Viral Hepatitis.
This means that the specific funding (number 1 above) will not only be maintained, but will also be improved by unifying its three components (“enhancement”, “support home care” and “infant formula”), to facilitate resource implementation and avoid unspent balances accumulating as currently happens. This Ministry of Health position is a concrete demonstration of the need for a specific response to AIDS epidemic and it will be the only disease-oriented specific funding in the new proposal for Health Surveillance action financing. In addition, the incentive scheme to enhance health surveillance actions (number 2 above) will have indicators of quality improvement of STD, AIDS and Viral Hepatitis actions, thus representing a new source of State and Municipal Health Department to fund these actions.
It must be emphasized that the Ministry of Health’s current total budget for actions against STD, AIDS and Viral Hepatitis is R$ 1.2 billion per year (US$ 608 million/year); and this budget has been increasing yearly as needed and thus the allegation that Federal funding for States, Municipalities and NGOs is at risk of being extinguished is unfair and untrue. It is important to recall that the Ministry of Health, through the Department of STD, AIDS and Viral Hepatitis (DDAHV) has been supporting non-governmental organization’s (NGO) STD/AIDS prevention actions through public calls for proposals since 1999. Since then 6,387 projects received a total of US$ 123.5 million (R$ 247 million).
In 2012 alone, through a national selection process, US$ 650,000 (R$ 1.3 million) were allocated to NGOs. This initiative contemplated projects aimed at prevention and at encouraging early diagnosis for AIDS, Viral Hepatitis and other STDs during the 2012 LesbianGaysBisexual Transvestites (LGBT) Pride celebrations. Early diagnosis is fundamental for the prevention effort and to this effect a national mobilization with rapid tests for HIV, Syphilis, Hepatitis B and C provided by the Ministry of Health will happen from the 20th of November to the 1st of December, in partnership with State and Municipal Health Departments and civil society.
In closing, the Ministry of Health reiterates its commitment to overcome the AIDS epidemic, in continuous partnership with civil society and academia, in a transparent, strong and clear stance to fight discrimination, gender and sexual orientation violence, homophobia, aiming at a more just and equitable world.
Jarbas Barbosa da Silva Jr – Secretary of Health Surveillance (SVS)
Dirceu Greco – Director of the Department of STD, AIDS and Viral Hepatitis/SVS
Ministry of Health, Brazil