Lessons from the Brazilian radiotherapy expansion plan: A project database study.

Area of Science:

• Public Health
• Health Services Research
• Oncology Infrastructure

Background:

• Brazil's Unified Health System (SUS) faced challenges in radiotherapy access.
• The Radiotherapy Expansion Plan for Brazil's Unified Health System (PER-SUS) was initiated in 2012 to address these access issues.

Purpose of the Study:

• To analyze the execution and implementation of PER-SUS.
• To evaluate the program's capacity in improving radiotherapy access in Brazil.

Main Methods:

• Retrospective analysis of PER-SUS progress reports (February 2015 - October 2021).
• Collection of data on beneficiary institutions, project status, and reasons for delays/cancellations.
• Correlation of project data with Brazilian geographic, healthcare demand, and cancer incidence data.
• Application of Ishikawa diagram and 5W3H methodology for analysis.

Main Results:

• PER-SUS achieved nearly 50% of its planned radiotherapy equipment implementation over ten years.
• National linear accelerator (LINAC) growth was 17%, while cancer incidence rose by 32%.
• Identified issues include high beneficiary exclusion rates, execution delays due to bureaucracy, and underestimation of logistical needs.

Conclusions:

• PER-SUS implementation fell short of targets, with significant delays and beneficiary exclusions.
• The actual need for radiotherapy in Brazil exceeds the program's current capacity.
• Recommendations include reevaluating planning variables, enhancing stakeholder engagement, and prioritizing regions with LINAC shortages for future optimization.