Brazil widens access to health care
In Brazil, the launch of a community-based family
health programme has led to a sharp drop in infant mortality rates
in several of the states involved. In one city, infant death rates
fell by almost 75% over a 6-year period. Elsewhere, the number of
cases of diarrhoeal disease was halved within a year -- a drop that
was helped by an increase of almost 100% in the number of mothers
who exclusively breastfed their babies. In some of the municipalities
involved, attendance at antenatal clinics has almost doubled.
In Brazil, the launch of a community-based family health
programme has led to a sharp drop in infant mortality rates in several
of the states involved. In one city, infant death rates fell by almost
75% over a 6-year period. Elsewhere, the number of cases of diarrhoeal
disease was halved within a year, a drop that was helped by an increase
of almost 100% in the number of mothers who exclusively breastfed
their babies. In some of the municipalities involved, attendance at
antenatal clinics has almost doubled.
Before the programme started in 1994, Brazil relied
almost exclusively on a specialized, hospital-based system of medical
care which failed to meet the needs of many families who either could
not afford or could not access these services. Today, 20% of the population
of 160 million have access to primary health care.
Launched as a partnership involving the Ministry of
Health, UNICEF, and communities, the Family Health Programme is based
on a network of teams who work with communities to ensure that families
know when and where to seek help or advice on health issues such as
antenatal care, immunization, and child nutrition, or treatment for
diseases such as malaria and diarrhoeal diseases. Dental care is now
being added to the list of services available. Where necessary, people
are helped to gain access to specialized care and hospital treatment.
The teams comprise a doctor, a nurse, a nurse's aide, and five or
six health agents who live in the community.
Each team covers about 800 families. They respond to
the needs of the whole population, particularly those who could not
easily access the hospital-based medical system. With federal government
financing and political commitment at all levels, Brazil's Family
Health Programme has grown from 328 teams in 1994 to over 10 000 today,
serving more than 3000 municipalities. The aim is to create another
10 000 teams by the end of 2002. Since 1998, the family health team
is being trained in the IMCI approach in some states in the north-east.
The use of nutrition counselling has helped improve the nutritional
status of children under five. The results have been dramatic. In
Camarigabe, in the poor north-eastern state of Pernambuco, infant
mortality dropped from 65 per 1000 live births in 1993 to 17 per 1000
live births in 1999. Elsewhere, in Palmas, the capital of the state
of Tocantins, the rate of exclusive breastfeeding increased from 38%
in 1999 to 73% in 2000. This increase is believed to have contributed
to a reduction in cases of diarrhoea, which dropped by 50% in the
city between 1997 and 1998. Meanwhile, the number of pregnant women
receiving antenatal care in Palmas almost doubled, from 43% in 1997
to 80% by 1998.
The programme has helped steer families away from a
reliance on expensive specialized care. In the city of Sobral, for
example, the once high demand for specialized care has dropped in
direct proportion to the increase in demand for primary care since
the programme began in 1997. And this change has found its way into
general medical training in the country, since the programme's 21
training centres for family health are linked to 58 medical schools
and 62 nursing schools in 16 of the country's 27 states. The programme
has also contributed to a profound shift in the concept of health
care in Brazil. Today, health professionals and community members
alike place high value on general community practice in preference
to expensive, specialized care that only a few can afford.