RE: [Action required] [chifa] Children who die between the pillar and the post (6)

1 September, 2022

Dear CHIFA colleagues,

I would like to describe the way we regulate our newborn intensive care unit (NICU) beds in the State of Santa Catarina (south of Brazil).

I will talk about the Public Health System.

The Intensive Care Units are regulated by regional regulations from local cities, in our case eleven cities are linked to central State regulations.

The systems use local phone calls and public e-mails for communication. The State created a locoregional unit with the presiding medical doctor with regulatory function. I worked in 2016 for nine months in this role, and we had responsibility for the regulation of the Adult, Child, and Newborn regulation care units. These beds have to be authorized by the State to have financial care from the SUS [SUS in Portuguese - Sistema Único de Saúde is our National Health System (NHS)], but we don't always have a place for all so sometimes we call for the regulator from another region.

We used to have a simple plan done by the regulatory doctor for each patient​ that we had waiting for the NICU bed. This ended the personal regulations between proximity MD and gave a unique orientation for transfers.

The advantage to this approach (central control of beds) is that it is better to know where the beds are and how we can change places for the needs of the patient, for example, peritoneal dialysis and an experienced team. Unfortunately, we also have some colleagues who sometimes don`t want to receive patients from other localities. Also, it is an important advantage in the workplace because we send just once a day the needs and wait for the regulatory team to look for a place, and other times the doctor has to be directed at the phone and talk to each local or regional hospital the patient needs. The disadvantages are for the hospitals that have continuing attendance, emergency room, obstetric room because they are always receiving new patients.

I recommend the approach to other countries, but it has to be closed units (regulatory beds for regional hospitals without open attendance), we call here a closed-door hospital. All people working for the regulatory place and with time you will have better teams for what You need. For sure, information is the key to this situation and the government has to give the financial conditions for the needs of the patients.

CHIFA profile: Marcio Fossari is a medical doctor from Brazil, currently working in public health policy and clinical neonatology in Itajai, southern Brazil. His interests include child and maternal health and he is a co-moderator for the CHIFA global child health forum.