Confederação Nacional de Saúde, Brazil

Signatory since 2021

The National Confederation of Health, Hospitals, Establishments and Services, which is known as CNSaúde, is a trade union of employers representing all health-service establishments in Brazil, including hospitals, clinics, nursing homes, healthcare-related laboratories, and related services. Bruno Sobral, the Confederation’s executive director, and Esther Flesch, a Brazilian lawyer who has provided pro bono advice to the Confederation, explain why EPiHC immediately appealed to them, how the principles build trust, and what it takes to actually implement EPiHC.

BECOMING A SIGNATORY

SOBRAL: We joined EPiHC to connect with others and gain assistance for improving our practices. It is very helpful to have the World Bank and EPiHC along with us. Until 2018, CNSaúde was supported by a government-mandated tax on healthcare businesses. But in a financial reform measure, that tax was eliminated, and so was our budget. We had to attract funds directly from our member companies or we would not survive. On behalf of our member companies, we became more involved in developing policies related to ethical issues, such as corruption and anti-trust. Pushing an ethical agenda for healthcare is key for us, to do our part to make sure that clients are paying for better-quality healthcare, not just for access.

FLESCH: When Bruno and the rest of the CNSaúde leadership read the EPiHC materials, they immediately said, “That’s exactly what we want.” They saw written in clear, plain language exactly what they wanted to see implemented. We all live in a global world, and we need a global standard. When I saw the EPiHC statement of purpose, I liked it quite a bit. It reminded me of the need to have purpose in life.

THE PRINCIPLES #4 Conducting Business Matters Responsibly

SOBRAL: Health ethics have been debated a lot in Brazil, especially when health plans raise their prices. Our member companies have been accused at times of not being honest about the cost of our inputs. So, we have to show society at large that we use resources in the most ethical way—to save lives. We are still learning how the principles work, and the opportunity to work with the World Bank and IFC can help us increase the level of healthcare ethics in Brazil. One of the critical issues will be raising the level of goodwill between healthcare insurance and payor plans, and health care providers such as hospitals. These two groups have a history of not trusting each other, and that keeps us from finding the most ethical solutions. But we can only pursue this if healthcare payors and hospitals are together in the quest, with incentives that are aligned to support improvement.

#2 Making a Positive Contribution to Society

FLESCH: When you think about compliance and doing the right thing, it cannot be only about the financial side or government relations. It has to be broader, including the human rights perspective, treating staff and patients the right way, and meeting socio-environmental concerns. All of these concerns are in people’s minds right now. And it’s also in the principles. The organizations have to behave in the right way, not only in terms of having the right financials, the right relationship with healthcare professionals, and the right standards of quality, but also in how they treat people. This includes all of the people involved with the organization: the patients, the people that work there, the supply chain, everybody.