Until the 1970s, Brazilians used to joke that they had to die before the authorities paid any attention to them. Much has changed since then. While long queues at hospital emergency departments, beds spilling into corridors, outdated and malfunctioning equipment and a

scarcity of doctors and medicine in rural areas remain common complaints, on another level, Brazil’s national health system – Sistema Único de Saúde (SUS) – has been a success.

The vision of a system providing “health for all” emerged towards the end of the military dictatorship that started in 1964 and during the years of political opposition that was to a large extent framed in terms of access to health care. This struggle culminated in the 1988 constitution, which embody health as a citizens’ right and which requires the state to provide universal and equal access to health services.

 

It was a dramatic commitment to the ideals in the 1978 Alma-Ata declaration of “health for all”.

Under a subsequent health reform in 1996, Brazil established a health system based on decentralized universal access, with municipalities providing comprehensive and free health care to each individual in need financed by the states and federal government.

Key to this strategy was primary health care. Today, primary health care remains one of the main pillars of the public health system in this country of 190 million people.

About 70% of Brazil’s population receives care from this system, while the remainder – those that can afford to avoid the queues and inconvenience of the public system – opts for private care. Before Brazil’s “health-care revolution”, a much greater proportion of the population was excluded.

All three levels of government in Brazil – federal, state and municipal – have worked hard to encourage the poor to use and benefit from the health system through initiatives, such as the Family Health Programme and through the deployment of auxiliary health workers or “agentes de saúde” working with the poor.

Created in 1994, the Family Health Programme – Brazil’s main primary health care strategy – seeks to provide a full range of quality health care to families in their homes, at clinics and in hospitals.

Today, 27,000 Family Health teams are active in nearly all Brazil’s 5,560 municipalities, each serving up to about 2,000 families or 10,000 people. Family Health teams include doctors, nurses, dentists and other health workers. Annual resources for primary health care have increased in the past 13 years to about US$ 3.5 billion, with US$ 2 billion of that money devoted to the Family Health Programme out of an overall government health budget of about US$ 23 billion.

Community participation is crucial to the program’s success. Since 2004, on the last Tuesday of each month, there are meetings at the clinic attended by members of the community, including representatives from the church, NGOs and schools. The input brought by them is passed to authorities.

After two decades in operation, Brazil’s national health system still faces significant problems – not least a double burden of infectious diseases and increased risk of noncommunicable diseases often associated with aging populations of affluent countries.

In Brazil, primary health care remains the most effective way to provide greater access to health services. Although Brazil did not achieve the Alma-Ata goal of “health for all” by the year 2000, it has made significant progress, albeit along a tortuous road. Today, the SUS [national health system] works, but it is not operating to its full capacity because there are many obstacles, such as conservatism and politics. The lack of political will to help people in rural areas causes problems for the health system. One of the biggest challenges is to gain people’s confidence. Sometimes people travel to urban areas to receive treatment that they could have received from primary health units in their rural areas. “We have learned many lessons in the past 13 years from the implementation of the Family Health Programme,” says the nurse Maria Fátima de Sousa, who has a doctorate in health and science and is a researcher at the University of Brasília.

“We have learned that it is possible to build a new model for primary health with the principles of fairness and solidarity as long as there is the political will to do this.”

Source: Bulletin of the World Health Organization