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EF: How has your background contributed to your ability to perform in your role at the Ministry of Health, and what advice do you have for other professionals seeking to take a similar path?
AEH: It has been a long journey since my undergraduate course in dentistry, starting when I began teaching and working as a clinician specialising in pediatric dentistry. After teaching for some years and finalizing my PhD, I became a professor at the University of São Paulo, considered one of the best universities in Latin America, which was a dream come true for me.
Starting to work in public policies at the Ministry of Education was a difficult step and a challenging decision. Until then, I had been a researcher, a clinician, and a teacher, but never a public policy maker, a move that changed my life forever. I no longer see things in the same way; public policies are incredibly hard to design and implement. However, when a proper balance is found, it can make a huge difference to the country and many people's lives. Young people can start dreaming, and taking positive life decisions within the policy we create. Public policies should be seen as a science and it is not that public policies and politics related to political parties are independent. In fact, they are interdependent. At the same time, after elections, the executive power should focus on the design and implementation of public policies based on the best evidence for the good of the whole population.
EF: As the Secretary of Information and Digital Health, you lead several initiatives, including DATASUS and the Innovation and Digital Health Lab. Could you tell us about these initiatives and how they will be integrated into physical health spaces?
AEH: In 2023, when President Lula da Silva began his third mandate, our Health Minister, Nísia Trindade, created a new Secretariat of Information and Digital Health. Three departments were detached from the Executive Secretariat to constitute the new Information and Digital Health Secretariat to constitute the new Information and Digital Health Secretariat.
The main goal of the new Secretariat is to promote the digital transformation of the Unified Health System, with the aim of expanding citizens' access to health actions and services, as well as achieving continuity of health care. High-quality data allows good health decisions to be made by policymakers, healthcare professionals, and the citizens themselves, who are the ones with the most influence on their own well-being. With adequate information and resources in the palm of their hands, citizens can control their own electronic health records, a big step in self-managing their health and making better decisions with regard to lifestyle, diet, sleeping, exercise habits, etc. This not only helps to treat conditions but increases preventative ability as well.
We consider the citizen’s journey, and we are digitally transforming and reorganizing the health system, integrating primary healthcare and specialized high-complexity care within digital health, reducing the need for patients to attend appointments in person unless necessary, relieving pressure from our universal health system. SUS is responsible for 100% of the population and around 75% depends exclusively upon SUS, which amounts to 150 million people who depend exclusively on SUS. SUS performed 2.8 billion healthcare procedures last year.
EF: You mentioned the importance of data integrity and complete electronic health records; what challenges are you facing in this regard? How are you ensuring the quality of data and equal access to digital resources? What is challenging about collecting high-quality data?
AEH: We face similar challenges to all governments when attempting such a big change; the cycle of producing and treating data is a long and complex process that involves many people. Ensuring data integrity and quality is not simple, especially when dealing with a universal health system that spans federal, state, and municipal levels. We must work considering all these stakeholders. At the beginning of this year, we launched the “Digital SUS Program,” supported by financial resources for all the municipalities and states, where we provide tailored support and guidelines, and receive information related to our digital transformation.
Each municipality and state must diagnose their healthcare network, what they have, what they lack, their biggest challenges, and what they want to prioritize, such as cancer or women’s health, for example. Following this, a national index of digital maturity in health is applied to the given municipality in order to have a baseline and understand the big picture across the country. Our health system is divided into macro-regions, of which we have about 120 and we will provide an action plan for digital transformation to each and support them technically as well as financially. Each region has specific differences, both cultural and economic, that must be respected.
The Innovation and Digital Health Lab will be a space where we can interact with the private and public sectors to participate in the SUS agenda, which will drive innovation. We also have some national structuring actions: we are developing a national health data network, a platform of interoperability, and it will be an ecosystem to have and exchange data for both the public and private sectors. Creating an ecosystem will be crucial for connecting electronic health records, health professionals, and different services nationwide. Connectivity remains a challenge but has developed significantly over the years after addressing problems of inequity. When we started the SUS Telehealth Program in 2006, connectivity was really a huge challenge, but now we have made important advancements. Currently, we have many programs, and the Ministry of Communication is working to improve the infrastructure of connectivity, especially in rural areas, remote areas and in the Amazon region. However, we are in a good place with a roadmap to advance together.
EF: The Ministry of Health aims to boost national self-sufficiency in pharmaceuticals and medical technology, with a goal of producing 70% of medicines locally. Is the same philosophy being applied to the data and information space?
AEH: Ministra Nísia added a new dimension to the already existing Secretariat of Science, Technology and Innovation: the health economic-industrial complex. She considers health an important component of the country's economic growth. This is not a task for the government alone; it requires the collaboration of both public and private sectors. Secretary Carlos Gadelha is working on this, and we work closely with him to apply the model to digital health in the partnerships we make in the public and private sectors. This collaborative approach gives us optimistic perspectives on the future of digital health in Brazil.
