Las tareas para la sanidad pública en 2021

Marciano Sánchez Bayle, portavoz de la Federación de Asociaciones para la Defensa de la Sanidad Pública

Para establecer las tareas de la Sanidad Pública en 2021 es imprescindible hacer un balance de 2020, e inevitablemente hacerlo del impacto de la pandemia del covid19 en nuestro país.

España ha sido uno de los países de la UE con mayor impacto de la covid19. según los datos de Health at a Glance 2020 (OCDE) éramos, a principios de octubre de 2020, el 3º país con más casos por millón de habitantes, el 2º en muertes por millón y el primero en exceso de mortalidad por millón de toda Europa, y aunque los datos admiten valoraciones diversas (el número de casos esta obviamente relacionado con la política de realización de test diagnósticos; las muertes por coronavirus igualmente con la precisión de los diagnósticos; y el exceso de mortalidad también con la desatención de enfermos con otras patologías) es evidente que nuestro país ha sido uno de los más afectados de Europa y de todo el mundo, y que somos uno de los países que más han sufrido la pandemia.

Otro asunto muy importante es el impacto sobre la economía que ha sido especialmente relevante en nuestro caso, sobre todo porque tenemos un empleo muy precario, y una gran parte de la economía enfocada hacia el turismo, que se ha desplomado con la pandemia, aunque es cierto que el Gobierno ha tomado medidas significativas que han disminuido los daños.

Hay muchas y muy diversas explicaciones del porque de esta situación, pero habría que resaltar:

Los recortes previos. El sistema sanitario había sufrido importantes recortes presupuestarios que no se habían recuperado desde la crisis anterior y se habían trasladado a menos camas hospitalarias, menos personal, mayores listas de espera, etc
Las privatizaciones habían disminuido aún más los recursos de la Sanidad Pública y aumentado los sobrecostes.
Las deficiencias en Salud Pública y Atención Primaria. La salud Pública estaba prácticamente abandonada y la Atención Primaria, ya de por si infradotada sufrió de manera especial las reducciones de efectivos.
Se tardo en reaccionar. La reacción de las autoridades sanitarias fue lenta, y luego la desescalada fue demasiado rápida lo que favoreció la segunda ola.
Un enfoque inapropiado del sistema sanitario, pensado para atender enfermedades crónicas y degenerativas, y no emergencias infectocontagiosas, con poca atención a la epidemiología y a la información sanitaria.
La ausencia de elementos de protección que se produjo en la primera ola y que explica en parte el elevado numero de sanitarios contagiados (86.028 caso a 27/11) un 16% de los trabajadores del sistema sanitario (26,02% en la Comunidad de Madrid).
La situación de las residencias, privatizadas con escaso o nulo control que fueron y siguen siendo uno de los principales focos de mortalidad.
La desatención a los determinantes de salud que ha favorecido contagios y una mayor incidencia y mortalidad en los grupos más desfavorecidos.
Falta de coordinación entre las CCAA y el Ministerio de Sanidad, que ha fomentado descoordinación de las estrategias para afrontar la pandemia. Casos especialmente negativos han sido la actuación de la Comunidad de Madrid y durante la primera ola también la de Cataluña.
Los enfrentamientos partidarios que han utilizado la pandemia como arma política, lo que favorece la desconfianza de la población ante las medidas de las autoridades sanitarias y dificulta la ya problemática coordinación.

Todas ellas han tenido influencia en la extensión y gravedad de la pandemia, con diferencias importantes en cada una de las CCAA. Algunas de estas cuestiones tienen su origen en el hecho de que estábamos ante una enfermedad nueva y desconocida, otras son específicas de nuestro país, y otras son de ámbito bastante general y responden a los planteamientos neoliberales y la ilusión tecnológica que impregna nuestras sociedades.

Las actuaciones ante la pandemia han variado mucho en las CCAA, algunas de las cuales han afrontado el problema con responsabilidad, y otras en cambio han favorecido la confusión y han antepuesto los intereses económicos y los enfrentamientos políticos por encima de la salud, como ha sucedido y sigue pasando en Madrid, empeorando la situación.

Parece que ya se ha aceptado que la tercera ola es inevitable tras las vacaciones navideñas, y de nuevo las medidas que se adoptan para evitarla y/o controlarla son insuficientes y descoordinados, lo que supone de nuevo una dejación de sus funciones de las distintas administraciones públicas, otra vez más con muchas diferencias entre CCAA.

Aparte de las respuestas concretas, desde el punto de vista sanitario y de las medidas de control de la movilidad, la respuesta institucional ha sido la Comisión de Reconstrucción organizada en el Congreso de los Diputados, desgraciadamente sus recomendaciones han sido poco relevantes y claramente insuficientes para abordar el necesario reforzamiento de la Sanidad Pública, por otro lado los aspectos más positivos de las mismas no se han trasladado a medidas concretas.

Como resultado de la pandemia se ha producido una desestructuracion de la Atención Primaria con una drástica reducción de la asistencia presencial y aumento de las demoras, y en atención especializada se ha incrementado de manera notable las listas de espera (quirúrgica, de consultas y pruebas diagnósticas) lo que conlleva una desatención de las enfermedades no covid19 con graves repercusiones sobre la morbilidad y la mortalidad.

Además, algunas CCAA como Madrid, Cataluña y Andalucía han aprovechado la situación para aumentar las privatizaciones, debilitando aún más la Sanidad Pública, y esta es por supuesto una de las amenazadoras salidas de la situación actual, que se utilicen los daños producidos por la pandemia para desmantelar y depauperar aun más nuestro sistema sanitario público.

Por otro lado, los presupuestos para 2021 suponen una importante inyección económica para el sistema sanitario, pero de nuevo con gran variabilidad entre CCAA, y con un compromiso con la Sanidad Pública bastante difuminado. No esta nada claro que respondan a las necesidades principales que tiene ahora la Sanidad Pública y que desde la FADSP venimos reiterando:

Establecer mecanismos eficaces para la contención de la covid19 que deben de pasar por restricciones de movilidad, generalización de las medidas de protección y sistemas eficaces de detección de casos e identificación y seguimiento de sus contactos (al menos 40 rastreadores/100.000 habitantes). Es irresponsable dejarlo todo en manos de las alternativas farmacológicas, que en el mejor de los casos tardaran bastantes meses en ser efectivas en el control de la pandemia.
Necesitamos un sistema de información potente y homogéneo para todo el Sistema Nacional de Salud que permita, a las autoridades sanitarias, a los profesionales de la salud y a la población, tener un conocimiento actualizado sobre la evaluación de esta y de las demás enfermedades, así como de los principales parámetros de funcionamiento del SNS:
Unos presupuestos que garanticen una financiación suficiente de la Sanidad Pública, crónicamente subfinanciada y recortada, que estimamos en un aumento de 1.000 € por habitante y año para poder afrontar las necesidades de salud de la población en este momento.
Establecer mecanismos de financiación finalista que permitan asegurarse de que los nuevos fondos van destinados a las áreas clave (refuerzo de la Atención Primaria, Salud Pública, Investigación, aumento de camas hospitalarias en centros públicos).
Reforzar especialmente la Atención Primaria y la Salud Pública, pero también el conjunto del sistema sanitario incrementando las plantillas de todas las categorías para evitar una situación de colapso.
La mayoría de las necesidades asistenciales de la población no están relacionadas con la Covid19, sin embargo, se está produciendo una postergación en la asistencia sanitaria de la población que padece otras enfermedades, en muchos casos de mayor gravedad. Se precisa organizar urgentemente circuitos asistenciales para los enfermos no-covid19 que permitan su atención en un tiempo razonable.
Debemos considerar los determinantes sociales de la salud como un factor clave en la expansión del virus, frente a los discursos y políticas que estigmatizan a los colectivos más vulnerables. En este sentido es importante la aprobación de un Plan Integrado de Salud con dotación económica para el cumplimiento de sus objetivos
Hay que potenciar una mejor coordinación entre los servicios sanitarios y sociales, mejorando las condiciones de las residencias y su control, y potenciando la ayuda domiciliaria.
Adoptar medidas legislativas de protección del SNS frente a la privatización y para recuperar de la sanidad privatizada.
La protección de la salud es un derecho de la ciudadanía reconocido constitucionalmente, y en última instancia el gobierno del país es el garante del mismo. El Ministerio de Sanidad y el Gobierno deben de arbitrar mecanismos que aseguren su tutela efectiva, mediante la coordinación y la integración de las estrategias de política sanitaria con las CCAA, y si fuera preciso mediante la intervención directa.

Es urgente cambiar la política sanitaria. La pandemia ha puesto en evidencia las carencias de nuestro sistema sanitario que hay que solventar reforzando la Sanidad Pública, especialmente la Atención Primaria y la Salud Pública. Desgraciadamente el cambio en la persona titular del Ministerio de Sanidad en nada facilita las cosas porque como mínimo ralentizara la adopción de las medidas necesarias. Desde los trabajadores sanitarios, las entidades sociales, las organizaciones políticas y las autoridades sanitarias tenemos que trabajar para poner en marcha estas medidas que son imprescindibles para responder adecuadamente a la situación actual.

Fotografía José Mesa bajo licencia de Creative Commons.

https://www.nuevatribuna.es/articulo/sociedad/tareas-sanidad-publica-2021/20201231132449182877.html

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