Synergies between health systems
and global health initiatives: the
example of Brazil".
José Carvalho de Noronha
National Secretary for Healthcare
Ministry of Health of Brazil
WHO, Geneva, 29th, May 2008
Brief data on Brazil
•
•
•
•
•
•
•
Population (2007) 184 millions
Surface: 8.5 millions sq. km
GDP (2006): US$ 1.2 billion
Life expectancy at birth (2006): 72.35 yrs
Infant Mortality Rate (2005): 21.17 ‰ live births
Total Health Expend. (2006):US$ 87.3 millions
Health Expenditure as % GDP (2006): 7.48%
• The Brazilian Unified Health System (SUS) is one of
the largest public health care systems in the world.
• All Brazilians citizens are entitled to free care at the
point of delivery, financed by general taxations and
social contributions.
• The Right to Health was established in the 1988
Constitution that ended a 21 yrs. dictatorial period.
• Medical care migrated from Social Security to the
Ministry of Health for achieving integration of services
(preventive & curative, vertical & horizontal)
Basic Structure of the SUS
• Three tiered system: Federal, 27 States,
5,562 Municipalities
• Share in the financing
– Federal
48.0 %
– States
23.4 %
– Municipalities 28.6 %
• Integrative Commissions at Federal and
State level
Examples of GHI
• Disease Specific
– Malaria & TB – Global Fund & WB
– AIDS – WB
• Sector Wide
– Expansion of Family Health Programme - WB
– Quality improvement of Emergency Services WB
Examples of DSP
• National Immunisation Programme
• AIDS Programme
• TB Control
• National Cancer Network
Cases of Measles
AIDS Mortality Rates
Cases of TB
Population covered by Family Health
Teams
1999
2005
2001
2003
2006
December 2007
- 27,327 FH Teams in 5,125
municipalities
- 15,694 Oral Health Teams
- 210.064 Community agents
FONTE: SIAB - Sistema de Informação da Atenção Básica
0%
0 a 25%
25 a 50%
50 a 75%
75 a 100%
Changes in Infant Mortality Rates in Brazilian
municipalities grouped by FHT coverage and HDI,19982003
Mean Annual Change (since 1998)
6
3.96
4
2
0
High HDI
-2
Low HDI
-2.08
-4
-4.24
-6
-8
-5.64
-6.82
-6.97
-6.77
-8.38
-10
0-20
21-50
51-70
71+
PSF Coverage (% population covered)
Fonte Ministério da Saúde. Saúde da família no Brasil : uma análise de indicadores selecionados:19982004. Brasília: Ministério da Saúde, 2006. disponivel em :
http://dtr2004.saude.gov.br/dab/caadab/documentos/saude_familia_brasil.pdf
Starfield 10/07
WC 3915
Doenças preveníveis por imunização e
condições sensíveis à Atenção Primária
30
Taxa de internação por 100.000 habitantes - doenças preveníveis
por imunização e condições
Brasil
90
25
75
20
60
1 a 4 anos
Taxa
5 a 9 anos
15
45
10 a 14 anos
15 a 19 anos
0 a 19 anos
10
30
5
15
0
Menor de 1 ano
0
1998
1999
2000
2001
2002
2003
2004
2005
2006
Ano
Taxas para menores de 1 ano no eixo à direita, em escala diferente.
2008-06-23
Fonte: Sistema de Informações Hospitalares do SUS. Datasus/MS
12
Final Remarks
• The main strategy for improving healthcare should be through
strengthening of the system and of the services provided in an
integrated manner.
• Healthcare systems should be strongly anchored in a sound primary
care strategy.
• Healthcare networks, with well-defined lines of care and appropriate
disease management protocols are essential to good healthcare
delivery.
• Disease specific programmes can only succeed when they are
supported by healthy healthcare systems.
• When very specific, and “single action once for a long time”, DSP
may succeed.
• When targeted programmes are developed they should be directed
to specific populations rather than to specific diseases.
Thank you!
[email protected]