Brazil sets marker for effective healthcare

Infant mortality has dropped from 48 per 1 000 to 17 per 1 000 in the past 15 years.

Meanwhile, in the past five years, deaths due to diabetes or stroke have decreased by 25 percent, the proportion of children under the age of five who are underweight has fallen by 67 percent.

Three-quarters of women now receive seven or more antenatal consultations, while almost 95 percent of children under the age of a year have been vaccinated for diphtheria, tetanus, and pertussis (DTP).

Writing in the British Medical Journal at the end of last year, Matthew Harris of Kings College, London and Professor Andy Haines at the London School of Hygiene and Tropical Medicine, said first world health system’€™s such at the United Kingdom National Health System would do well to look to Brazil.

‘€œWe have a lot to learn ‘€“ get the system right and the results will follow, even with limited resources,’€ said Harris and Haines.

Healthcare reforms in Brazil began in 1998 following 20 years of military rule.

An acknowledgement that health and access to healthcare was a universal human right led to the establishment of Sistema Unico de Saude or Unified Health System, and began a nationwide shift from tertiary centre based healthcare to comprehensive primary healthcare, free at the point of use, funded by the taxpayer and inspired by the Alma-Ata Declaration of 1978.

The Declaration of Alma-Ata was adopted at the International Conference on Primary Health Care in 1978. It expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world. It was the first international declaration underlining the importance of primary health care.

The Unified Health System, now referred to as the Family Health Programme (FHP), has expanded nationally and now provides comprehensive primary care to over 55% of the population   – more than 85-million people.

The FHP is based on a model whereby multidisciplinary teams comprising a doctor, nurse, nurse auxiliary, and four to six community health workers, work in health units located in geographically defined areas, each covering no more than 5 000 residents.

A community health worker is responsible for up to 120 families in a defined area, and aims to provide home visits to every household at least once a month.

Community health workers are fully integrated into the primary care team. Although child and maternal healthcare forms the bulk of their work, they also provide curative care, triage and referral into the health unit, health promotion for chronic disease, and support and encouragement for community participation.

These workers must be from and live in the area where they work.

In just 15 years, Brazil has recruited 250 000 community health workers and 30 000 medical generalists.

But Harris and Haines caution that despite these remarkable achievements, the FHP is confronting challenges that include difficulties in the recruitment and retention of doctors trained to deliver primary healthcare, large variations in the quality of local care, patchy integration of primary care services with existing secondary and tertiary care, and the slow adoption of the FHP in large urban centres where the middle-classes are more accustomed to private healthcare.

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