Until the 1970s, Brazilians joked that they only received attention from authorities after they died. Much has changed since then. Although long lines in hospital emergency departments, beds overflowing into the corridors, obsolete and malfunctioning equipment, and a lack of doctors and medicines in rural areas remain common complaints, at another level, Brazil’s national health system – Sistema Único de Saúde (SUS) – has been a success.
The vision of a system that provided “health for all” emerged at the end of the military dictatorship that began in 1964 and during the years of political opposition that, for the most part, was framed in terms of access to health care. This struggle culminated in the 1988 Constitution, which enshrined health as a right of citizens and obliges the State to provide universal and equal access to health services.
It was a dramatic commitment to the ideals of the Alma-Ata Declaration of 1978 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 every individual in need, funded by states and the federal government.
Central 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 rest – those who can pay to avoid the lines and discomfort of the public system – opt for private care. Before Brazil’s “health revolution,” a much larger proportion of the population was excluded.
The 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 Program and through the deployment of auxiliary health agents or “health agents” who work with the poor.
Created in 1994, the Family Health Program – Brazil’s main primary health care strategy – aims to provide a wide range of quality health care to families in their homes, in clinics, and in hospitals.
Today, 27,000 Family Health Program teams are active in almost all of Brazil’s 5,560 municipalities, each serving up to about 2,000 families or 10,000 people. The Family Health Program teams include doctors, nurses, dentists, and other health professionals. Annual resources for primary health care have increased over the past 13 years to about $3.5 billion, with $2 billion allocated to the Family Health Program, from a total government health budget of about $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 with the presence of community members, including representatives from churches, NGOs, and schools. Their contributions are relayed to the authorities.
After two decades in operation, Brazil’s national health system still faces significant problems – not least the dual burden of infectious diseases and the increasing risk of non-communicable diseases, often associated with the aging populations of wealthy 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 on a winding path. Today, the SUS [national health system] functions, but it does not operate at 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 gaining people’s trust. Sometimes, people travel to urban areas to receive treatment that they could have received at primary care units in their rural areas. “We have learned many lessons in the last 13 years with the implementation of the Family Health Program,” says nurse Maria Fátima de Sousa, who holds a PhD 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 care with the principles of equity and solidarity, as long as there is political will for it.”
Source: Bulletin of the World Health Organization