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Brazil Final Paper

For the final paper incorporating the research previously posted on this blog, please see here.

Problems in the Health Care System

The funding of the healthcare system tends to be a little complicated and some benefit more than others. The problem is the funding comes from the federal, state and municipalities. The larger states will get more funding than the smaller states so in fact the larger states would have better care and facilities to treat the people than the smaller and more poor states. The percentage of GDP that is spent on SUS is only 3% which is completely not accurate with the amount of people who depend on SUS. Most of the rest of the health GDP is invested in the private sector of health. This leads to a constant competition between the public and private sectors which leads to conflicting goals.

See The Economist. Health Care in Brazil. An Injection of Reality. http://www.economist.com/node/21524879

There also seems to have been corruption within the Ministry of Health. In which funds designated to the SUS wasn’t completely going to the system. Since only a specific percentage has to be recorded the amount that could have been taken out isn’t known. There were also instances where the same doctor was being hired in multiple different specialties instead of just one. The doctors were also found to be charging patients for surgeries or practices that were already covered by SUS. This leads there to be a system of checks and balances needed to be put in place with the health care system.

See  Brazil’s SUS National Health Problems by Felicia Bryson in The Rio Times

For all the programs the problem seems to be that there aren’t enough doctors, nurses, clean hospitals, equipment and sanitation in the system. There aren’t enough beds to service the population who rely in the system and the long waits for care at the moment and in the future causes people to at times worsen in their respective conditions. Also, what a doctor makes in providing his work to the public sector he can be making twice as much in the private sector. There is no incentive for any doctor to stay in the public sector of health when they can easily make the switch to the private sector which is growing. The income inequality is especially large in Brazil and more and more people who are rising out of poverty are leaving the system in order for better care in the private side of it. In October of this year there was a massive strike in Rio and 21 other states by the doctors and health professionals in protest against the low pay and poor working conditions. They are protesting that the care that is being provided by the SUS isn’t sufficient for the people and for those who provide it.A federal hospital in Rio also went on strike because of the lack of physicians, other medical professionals and funding being provided. A survey was later conducted and showed that there were many parts of the hospitals that were shut down due to lack professionals working in them.

See The SUS Doctors in Brazil Strike in 21 States and Federal Hospitals to go on Strike in Rio by Brennan Stark in The Rio Times 

Financing the Family Health and HIV/AIDS Program

The Family Health Program is funded by the federal, state and municipal governments. The program’s budget in 2005 was U.S. $1,175 million and the cost per team was U.S. $173,400. Per person this means that each was covered with U.S. $31-$50 depending on the municipality. 

 See Widening access to healthcare: an evaluation of Brazil’s family Health Programme by Rocha Romero and Rodrigo Soares.

The HIV/AIDS program in 1998 had a budget of U.S. $436 million; the federal government spent roughly U.S. $352 million for treatment; US$42 million for prevention; US$41 million for institutional development; and US $1 million for surveillance. In 2000, treatment still represented the largest component of the budget with the antiretroviral drug taking the biggest share of the budget for treatment

See HIV/AIDS in Brazil by the AIDS Policy Research Center, University of California San Francisco 

Financing SUS

Health expenditure is 9% of GDP according to the World Bank. Only 3% of GDP is for the public spending on health. The spending per inhabitant in Brazil in 2007 was $ 715 in U.S. dollars and the budget for 2010 was R$62.5 billion which had increased 4.5% from the previous year.

See http://www.youblisher.com/p/196488-Access-to-and-financing-of-health-care-in-Brazil/

Brazil’s federal, state and local governments all come together to raise funds. It derives two thirds from the public sector and one third from the private sector. The government derives money from the Social Security budget which is predominately based on contributions and taxed from employee payroll and business profits. State and local governments have also been mandated to increase their spending on health until it reaches 12% and 15% of their respective budgets.

See Health Reform in Brazil: Lessons to Consider by PhD. Elias, M. Eduardo Paulo and PhD. Cohn, Amelia Amelia Cohn PhD and Paulo Eduardo M. Elias PhD. Also see Access to and Financing of Health Care in Brazil by the Associacao da Industria Farmaceutica de Pesquisa. 

HIV/AIDS Program = Success

The mortality rate began to decline and by 2002, the Ministry of Health had determined that due to the availability of the drug it had prevented around 358,000 HIV-related hospitalizations. By 2008, it was estimated that almost 200,000 people living with HIV were receiving the antiretroviral drugs. The extent of the success of the program in Brazil can be taken into consideration with the fact that the World Bank had stated that 1.2 million people in Brazil would be infected with HIV/AIDS by the year 2000 and in reality there were 600,000 people infected. 

See http://www.avert.org/aids-brazil.htm#contentTable1

Beginnings on the HIV/AIDS movement

The first case of AIDS in Brazil was in 1982. The government set up the National AIDS Program (NAP) in association with different civil society groups in 1985. These society groups wanted to make sure the government was aware of what was going on with regards to the disease in order to give the people the care they needed.  Around the same time the first HIV/AIDS NGO was created known as GAPA or in English as the AIDS Prevention and Support Group, Grupo Pela Vida (Group for Life) and ABIA (Brazilian Interdisciplinary AIDS Association).These groups constantly pressured politicians into improving the treatment and care of those living with this disease. After the constitution of 1988, it gave legal protection to the people who had been infected with regards to any discrimination and defended their right to free health care. As soon as in 1996, the antiretroviral drugs had shown to considerably help the victims of HIV/AIDS, many activist groups began to pressure the Brazilian government to provide the drug to everyone who had been infected. Later on that same year, the Brazilian Minister of Health announced that the drug would be provided to all free of cost.

For more access http://www.avert.org/aids-brazil.htm

Family Health Program

The family health program is a division of SUS in which was started 1994 to be completely dedicated to families as the name suggests and to enhance the care to more groups of people. It also became one of the most if not the most important division of SUS. It’s based on multidisciplinary teams, comprised of a doctor, a nurse, a nurse auxiliary and four to six community health workers that work in health units located in geographically defined areas each covering no more than 5000 residents. Community health workers 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. The care is supposed to enhance the relationship between the residents in the given area with the health providers since it’s in a smaller defined place.

In order to recruit qualified personnel to the program the Ministry of Health created training centers that are regionally located to create competent workers to the program. The municipalities have also been able to invest in better hardware such as regulatory systems, increase service supplies, create clinical guidelines and use the electronic medical records in order to incorporate it to specialized systems for specialized care. 

For more see: http://dab.saude.gov.br/atencaobasica.php

Statistics on SUS

Brazil’s unified health system (SUS) is one of the largest universal health care systems in the world.  It is the main supplier of health care to 76% of the population in Brazil. It has 5,900 thousand registered hospitals. It also has an agreement with almost all public hospitals, private and university hospitals which guarantees all the citizens the right to care. It has 64,000 primary health care units and 28,000 family health care teams. It also created the Mobile Emergency Health Care Service (SAMU) and National Policies for Women’s Integral Health Care. The mobile service was created in 2003 as part of the National Emergency attention policy. It is the largest public organ and tissue transplant program. It carries out 2.3 billion outpatient procedures, has 11.3 inpatient stays every year, 254 million medical consultations every year and 2.3 million babies delivered every year. Their national immunization program applies about 130 million vaccinations every year.  They also have a project called the Farmacia Popular or the Popular Pharmacy in which certain drugs are provided to people at very low costs. 

For more see: http://www.brasil.gov.br/para/worker/service/what-does-sus-stand-for/br_model1?set_language=en

Role of Municipalities in the Health Care System

.  Since social control and social participation became such a major component of the reform in the constitution it created health councils to initiate the participation and thus make easier the implementation of the policies. The Municipal Health Council consists of governmental institutions, providers of health services, health professionals, civil societies organizations and citizens.They approve on annual plans and health budgets but if the council can’t come to an agreement on something no funding is provided. Therefore, the council is necessary for the municipality to receive federal funds. 

For more information see Democratization of the Brazilian Health Councils: The Paradox of Bringing the Other Side into the Tent by Vera P. Schattan Coelho