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LECTURE # 1 NATIONAL HEALTH SYSTEM

Collaborative Course on Infectious Diseases January 2010. LECTURE # 1 NATIONAL HEALTH SYSTEM A public policy strategy to overcome health inequities in Brazilian society Naomar Almeida- Filho Instituto de Saúde Coletiva Universidade Federal da Bahia naomar@ubfa.br.

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LECTURE # 1 NATIONAL HEALTH SYSTEM

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  1. Collaborative Course on Infectious Diseases January 2010 • LECTURE # 1 • NATIONAL HEALTH SYSTEM • A publicpolicystrategy to overcomehealthinequities in Braziliansociety • Naomar Almeida-Filho Instituto de SaúdeColetiva Universidade Federal da Bahia • naomar@ubfa.br

  2. SUS – NationalHealth System ofBrazil Goal: to introducethe SUS - NationalHealth System - ofBraziland to discuss its history, contexts, structure, actors and trends, as well as its potential as a public policy strategic tool to help reducing health inequities in Brazilian society

  3. SUS – NationalHealth System ofBrazil Summary: • Background • Inequalities in Brazil • Health Policy Research in Brazil • Brief history of Brazil’s Health Reform (1988-2009) • Structure of the Brazilian National Health System (SUS) • Primary Care (Family Health Program) • Secondary & Tertiary Care • Governance and Social Control • Trends & Challenges • Privatization of SUS versus upgrading public institutions • Budget increase + specialization of agencies • Quality control & Social control

  4. Social mobility of the Brazilian populationNowadays, Class C (middle class) represents the base of the social pyramid in Brazil, accounting for 86.2 million people. Between 2006 and 2007, this social segment increased its share from 36% to 46% mainly because of upaward mobility from the lower-level classes (Classes D/E). New social stratification pyramid */ Social classification includes income, wealth and education; class A/B: R$2,217; class C: R$1,062; class D/E: R$850. Source: IPSOS Research (O Estado de São Paulo, page B16, 30/03/2008).

  5. Lifeexpectancyatbirth(years), 2006

  6. SUS – NationalHealth System ofBrazil HealthPolicyResearch in Brazil • Highlights: • CAPES’s evaluation system & CNPq’sLattes Platform • QUALIS system & Portal Periódicos • Scielo open-access digital library • Ministry of Health support of strategic and operational research: • HIV/AIDS Research Initiative • CENEPI’s Epidemiology Research Program • FIOCRUZ - Oswaldo Cruz Foundation • MS Network of Collaborative Centers

  7. SUS – NationalHealth System ofBrazil BriefHistoryofBrazil’sHealthReform (1988-2009) • 1986 8th National Health Conference • 1987 1rst National Mental HealthConference • 1988 The New Constitution • 1990 The SUS Law (Unified Health System) • 1992 Community Health Agents Program • 1996-2000 The Family Health Program • 2000-2007 Budget increase (CPMF) • 2008-present: Overcoming inequities

  8. SUS – NationalHealth System ofBrazil Currentsituationof SUS (sketched) • Principles of the Unified Health System: • universal access • integrality • health promotion • social control • Micropolitics: “municipalization” of SUS • Management: “fundaçõesestatais” • Quality control

  9. SUS – NationalHealth System ofBrazil Currentsituationof SUS (sketched) • High Complexity Care Management • Pro-Saúde (training health professionals) • Special Programs • HIV/AIDS • Epidemiological Surveillance • Pharmaceutical Care • Family Health Program (PSF) • territorial organization • primary health care • health promotion • Community Health Agents (>180,000) • multi-professional health teams (>50,000)

  10. SUS Current Situation • 80% of population depend on SUS • 20% of population have health insurance and medical service plans • 7.000 hospitals • 70,000 health establishments • 29,000 Family Health Care teams • 2.3 billion clinical procedures • 300 million medical consultation • 11.3 million hospitalizations • 15,000 organ transplants

  11. Health and National Development Intervention Plan (PAC-Health) Source: Gadelha, 2007

  12. 1998 1999 2000 2001 2003 2002 Family Health ProgramCoverage trend at municipality level 2005 2006 2004 0% 1 to 25% 25 to50% 50 to 75% 75 to 100% FONTE: SIAB - Sistema de Informação da Atenção Básica

  13. FHT, Oral Health Teams and Community Health Agents – Brazil, March 2009 ESF – 29.149 municipalities - 5.233 ACS – 228.412 municipalities - 5.350 ESB – 17.588 municipalities– 4.567 FHT/CHA/OH FHS/CHA CHA without ESF, ACS E ESB

  14. Family Health ProgramImpact at municipality level longitudinal ecological analysis using panel data from secondary sources. Analyses controlled for state level measurements of access to clean water and sanitation, average income, women literacy and fertility, physicians and nurses per 10,000 population, and hospital beds per 1,000 population. 10% increase in FHT coverage resulted in 4,6% decrease in INFANT mortality Setting: 13 years (1990-2002) data from 26 Brazilian States and Federal District

  15. Changes in InfantMortality Rates in BrazilianMunicipatilitiesgroupedby FHT coverageand HDI, 1998-2003 (Aquino, Oliveira & Barreto, 2008)

  16. SUS – NationalHealth System ofBrazil Healthinequalities (update) • The life expectancy of Brazilian citizens reached 72.57 years in 2007, up 8.3 percent from 67 years in 1991, according to the Brazilian Institute of Geography and Statistics (IBGE) • Among women, life expectancy reached 76.4 years in 2007, from 70.9 years in 1991 • life expectancy of Brazilian men increased from 63.2 to 68.8 years in the same period

  17. SUS – NationalHealth System ofBrazil Healthinequalities (update) • Brazil's infant mortality rate dropped to 24.3 deaths for every 1,000 live births in 2007, a 46 % decrease from the 45.1 deaths per 1,000 births in 1991. • Regional differences in infant mortality rates remain high. The northeastern region, the poorest in Brazil, registered an infant mortality rate of 35.6 deaths per 1,000 living births; in the southern region, the rate was 16.1/1,000 births.

  18. SUS – NationalHealth System ofBrazil Panorama of Brazilian STI in Health: • The bulk of funding for Health Research and HPR in Brazil come from domestic sources • In most areas of Health research, knowledge, information & technology are produced, distributed and used internally • There is a strong institutional network for human resources development for Health Policy Research (in the majority of research lines, scientists are trained within the national borders) • International collaboration and exchange are most welcome both for teaching and STI development

  19. SUS – NationalHealth System ofBrazil Health Policy Research – Current challenges: • How to operate the Health Public Budget: US$ 70 billion (national level - 2008-12)? • SUS-oriented Research Priority Agenda? • How to cope with the explosion of demand on the productive base and a strong pressure on the SUS? • NIH-like system or the current model (multi-institutional, non-specialized network)? • How to evaluate strategically and share the experience of building a universal-access, State-funded, socially controlled Health System in a developing unequal society?

  20. SUS – NationalHealth System ofBrazil Health Policy Research – open questions, open choices • Health: right or commodity? • individual health or collective health? • health care or health situation? • health inequalities or health inequities? • social policy or public policy? • health policy or health politics? • Politics of Disease or Politics for Health?

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