Primary Health Care in Action
Brazil in numbers1
- Life expectancy (both sexes, 2006): 72 years
- Gross National Product per capita (PPP in international $, 2006): 8700
- Per capita total expenditure on health (PPP in international $, 2005): 755
- Number of physicians (per 10 000 population, 2005): 12
BRAZIL’S HEALTH CARE REACHES OUT TO THE PEOPLE2
- 70% of population receives free health care from public system
- 27 000 family health teams are active in nearly all Brazil’s 5560 municipalities
- Each family health team serves up to about 10 000 people, teams include doctors, nurses, dentists and other health workers
- Community members provide feedback on health services
Dr Maria das Graças Vieira Esteves admits that at first she was not a believer. But after 11 years as a director of one of Brazil’s health clinics she has no doubts.
“Initially, I did not believe the Family Health Programme could be effective, but gradually I saw they were doing marvellous work and getting results,” she says.
Over the past two decades, Brazil has worked hard to put into practice the 1978 Declaration of Alma-Ata and its goal of achieving health for all by means of a primary health care approach.
Brazil’s 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.
HEALTH CARE IS A HUMAN RIGHT IN BRAZIL
This struggle culminated in the 1988 constitution, which enshrined health as a citizens’ right and which requires the state to provide universal and equal access to health services for all of the country’s 190 million people, regardless of their ability to pay.
While long queues at hospital emergency departments, beds spilling into corridors, outdated and malfunctioning equipment and a scarcity of doctors and medicine in rural areas remain common complaints, on another level, Brazil’s national health system, has been an outstanding success.
About 70% of Brazil's population receives health care from the public system, with the remainder opting for private care.
The centerpiece of this public system is the Family Health Programme – established in 1994 which provides a full range of quality health care to families in their homes, at clinics and in hospitals.
FAMILY TEAMS FACE NEW CHALLENGES
Today, 27 000 family health teams are active in nearly all Brazil’s 5560 municipalities, each serving up to about 2000 families or 10 000 people. Teams include doctors, nurses, dentists and other health workers.
The health system also faces new pressure in a changing health-care environment. It must cope increasingly with the noncommunicable risks often associated with more affluent societies, such as cancer and accidents.
One of the key tenets of Brazil’s health system – and of a primary health care approach – is community participation. “Every month there are meetings attended by members of the community, including representatives from the church, nongovernmental organizations, and schools,” Dr Esteves explains. The feedback goes to the municipal health council, which implements some changes – a vital step in convincing communities that the system is working for them.
This is an abridged version of an article published in the Bulletin of the World Health Organization in April 2008.
1World Health Statistics 2008, Online version: http://www.who.int/whosis/data/Search.jsp (accessed on 24/09/2008)
2Flawed but fair: Brazil’s health system reaches out to the poor, WHO Bulletin Vol 86: 4, http://www.who.int/bulletin/volumes/86/4/08-030408/en/index.html