Desafios no cumprimento da Lei dos 60 dias, segundo as auditorias do DENASUS, em um contexto de dependência

Abstract

The object of the study are the main issues identified in the audits carried out by the State Audit Units (SEAUD) of the National Audit Department of the SUS (DENASUS) between 2017 and 2020 regarding the actions and organization of the oncology network at state level. Based on the Marxist Theory of Dependence (TMD), the study examines how the characteristics of a dependent state affect cancer care and the effectiveness of public health policies. Research question: how can the situation of dependence on the Brazilian state have limited compliance with the 60-day law and the work of SEAUD/DENASUS/MS? The general objective was analyze compliance with Law nº 12.732/2012, pointing out the elements that hinder timely access in relation to the organization of the oncology network and the actions developed at the state level, based on the audits carried out by SEAUD/DENASUS/MS, in the light of the TMD. The specific objectives were: to provide an overview of the national action aimed at complying with the 60-day Law and its findings of non-compliance; to identify and classify the main problems found in the audits, including deficiencies and irregularities not foreseen in Protocol nº 35/2017; to evaluate the compliance of Protocol nº 35/2017 and its application by SEAUD/DENASUS/MS; and to discuss how the condition of dependency impacts the implementation of the 60-day Law and the performance of the audits carried out by SEAUD/DENASUS/MS. The main result of the study was the finding that oncology patients were not being treated in a timely manner, with treatment starting after the legal deadline. Other problems found include the absence of monitoring and control to guarantee the quality of oncology services, failures in state planning and continuity of care, underuse of information systems, lack of specific medical records for oncology, outdated registration data in the National Health Establishment Registration System (SCNES) and insufficient production capacity at the units. In addition, the Hospital Cancer Registry (RHC) and Cancer Information System (SISCAN) systems were often not implemented, updated or functioning properly, jeopardising the sending of timely data to the Ministry of Health. The audits revealed regional inequalities, with a lack of action in states such as Alagoas, Paraíba and Piauí, and a concentration of audits in large urban centres, making it difficult to assess access to treatment in peripheral and vulnerable regions. The low participation of state and municipal components in the National Audit System (SNA), with 88 per cent of audits carried out by the federal level, reinforces this disparity. The late implementation of Protocol nº 35/2017, coupled with a lack of clarity in the methodological guidelines, has compromised the effectiveness of audits and the comparability of results, limiting their role as an instrument. The analysis revealed that the dependency of the Brazilian state weakens its capacity to finance, plan and implement public policies, hindering the consolidation of Health Care Networks (HCN) and compliance with the 60-day law. The shortcomings identified reinforce the need for investments in modernization, greater federative coordination and efficient governance, which are fundamental to overcoming regional inequalities and guaranteeing timely and equitable access to cancer treatment in the SUS.