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Brazil: achievements and challenges to the health system

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Brazil: achievements and challenges to the health system Camila Giugliani Denise Nascimento Porto Alegre, Brazil IPHU Short Course Savar November 2007 – PowerPoint PPT presentation

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Title: Brazil: achievements and challenges to the health system


1
Brazil achievements and challenges to the health
system
  • Camila Giugliani
  • Denise Nascimento
  • Porto Alegre, Brazil
  • IPHU Short Course Savar November 2007

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In Brazil, the search for alternative ways of
guaranteeing the health of the population took
place alongside the re-introduction of the
democratic process and the construction of a
Public Health System for all. National Policy
on Health Promotion (Brazil, 2006).

5
  • In the second half of 1970s various conferences
    and meetings
  • were organized to discuss the national health
    policy. The inhabitants
  • of shantytowns supported by priests and health
    professional formed
  • groups know as Popular Health Councils to
    demand better
  • conditions and health care.
  • In 1979, following the guidelines of Alma-Ata,
    the National
  • Programme of Basic Health Services was
    introduced.
  • It was an attempt to reverse the curative
    approach previously
  • adopted by the National Institute of Health.
  • In the 80s the lobby of multinational health
    care companies
  • In 1988 New Constitution the provision of
    health care became
  • a statutory right to all Brazilian citizens.
  • Law 8.080 1990 - SUS
  • Law 8.142 1990 Social participation

6
Since 1988, when the current Brazilian
Constitution passed, the Brazilian Public Health
System, namely Unique Health System (SUS) has
been in charge of providing universal, integral
and equitable access for the Brazilian
citizens.
7
  • Sistema Único de Saúde (National Health System)
  • Equity
  • Comprehensiveness
  • Universality
  • Descentralization
  • Social participation (social control)

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1,68TOTAL 1,111iiii
25 of population covered by private insurance
schemes which do not not guarantee comprehensive
services ANS National Health Agency regulates
the private health sector (19/11/2007)! Example
agreements on standardization of health
information system 85 population dependent on
Public Health Services
11
Community Health Workers
  • First project 1970s
  • 80s Ceara (Northeast) draught employing the
    women
  • National program - PACS 1991
  • Workers lived in the community and were selected
    on a community-based process

12
Family Health Program
  • 1994 National level Incorporated the PACS and
    became a full team program
  • Based on a philosophy that prioritises actions
    of promotion, protection and recovering of the
    health of individuals and families, from the
    newborn to the elderly, healthy or ill, on an
    integral and continuous basis.
  • Follows the principles stated on the SUS (NHS).
  • In the beginning (1994), objective was to provide
    access to the more vulnerable, by prioritising
    the implementation of family health teams in
    vulnerable areas throughout the country.
  • Actually, the PSF became a more comprehensive
    strategy, with the objective of reorganizing
    health practices, based on a comprehensive
    understanding of the health-disease process.

13
Family Health Strategy
  • Strategy of reorientation of the assistance
    model, ... by the implementation of
    multiprofessional teams in health facilities...
    In charge of the care of a defined number of
    families, in a limited geographical area. The
    teams perform actions of health promotion,
    prevention, recovering, rehabilitation of the
    more frequent illnesses, and in the maintenance
    of the health of this community....
  • Reorganize the system (SUS) towards a network
    with strong organisational basis oriened to
    primary health care.
  • Ministry of Health, 2005.

14
Family Health Strategy teams
  • Minimal team
  • 1 physician
  • 1 nurse
  • 2 nurse assistants
  • 4-6 community health workers
  • every 2 minimal teams 1 oral health team
    (dentist and dental assistant)

Catchment area ? 800-1000 families ( 4000 people)
Micro-areas of responsibility ? 750 people
15
Coverage of Family Health Teams in BRAZIL,
1998/2005
2000 2001
1998 1999
2002 2003
2004 2005
16
Evolution of population covered by Family Health
Teams BRAZIL - 1994 AUGUST/2006
17
Some supportive evidence
  • Evaluation of the impact of the Family Health
    Program on infant mortality in Brazil, 19902002
  • From 1990 to 2002 IMR declined from 49.7 to 28.9
    per 1000 live births. During the same period
    average Family Health Program coverage increased
    from 0 to 36. A 10 increase in Family Health
    Program coverage was associated with a 4.5
    decrease in IMR, controlling for all other health
    determinants (plt0.01).

Macinko et al, 2006. Journal of Epidemiology
Community Health
18
Where are we going?
  • 2006 - PACT FOR HEALTH
  • Signed by the MoH and the State and Municipal
    Councils of health secretaries
  • Consolidation of the SUS
  • 3 PACTS
  • PACT FOR LIFE
  • Include strengthening of primary care
  • PACT FOR THE DEFENSE OF THE SUS (NHS)
  • Permanent social mobilisation to achieve right to
    health and budget increase and regulation
  • PACT FOR THE MANAGEMENT

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PACT FOR THE MANAGEMENT DEFINE INEQUIVOCALLY THE
RESPONSABILITY OF EACH SPHERE federal, state,
municipal ESTABLISH THE DIRECTIVES FOR THE
MANAGEMENT OF THE SUS, with emphasis in
descentralisation, regionalisation, financing,
pactuated and integrated program, regulation,
social participation and control, planning,
management of health education.
20
Problems, questions, challenges
  • Implementation of law
  • Barriers to Access in all levels
  • Reference system (specialties)
  • Budgets and equity in the allocation of
    resources
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