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Poverty and Universal Access to TB Care Services Improving Availability of Services: The Example of Brazil NTP Coordina

Poverty and Universal Access to TB Care Services Improving Availability of Services: The Example of Brazil NTP Coordinator Dr. Draurio Barreira. Departamento de Vigilância Epidemiológica. Brazil 192.000.000 inhabitants (5 th world largest population)

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Poverty and Universal Access to TB Care Services Improving Availability of Services: The Example of Brazil NTP Coordina

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  1. Poverty and Universal Access to TB Care Services Improving Availability of Services: The Example of Brazil NTP Coordinator Dr. Draurio Barreira Departamento de Vigilância Epidemiológica

  2. Brazil • 192.000.000 inhabitants (5th • world largest population) • 27 States, 5562 municipalities • TB incidence rate: 37.1 cases • per 100.000 inhabitants • 72.000 TB cases per year • 1.4% of TB-MDR • Approximately 4.500 deaths per • year (1st cause of death among • AIDS patients) • 18th highest country in burden of • TB • 108th in TB incidence rate

  3. Health System Organization TERTIARY HEALTHCARE - Hospitals, Maternities (emergency and research centers) SECONDARY HEALTHCARE – Reference Unities PRIMARY HEALTHCARE – Traditional Basic Unities and the Family Health Strategy (FHS) • 94% municipalities covered by FHS in 2009 • 49,7% population covered by FHS in 2009

  4. Responsibilities of the involvedlevels State Regional Boards Municipality Sanitary Districts Federal • Deliver services • Follow up the with quality of the service delivery • Guarantee the quality of actions and the achievement of the established goals • Identify the epidemiological situation • Define control measures • Set political guidelines

  5. Health context • TB is one of the 5 top priorities in public health for the Brazilian MoH • Brazilian Public Health Care System • Unified and universal • Primary, secondary, and tertiary healthcare is provided for all and free of charge • Approximately 25% of the population is covered also by health insurance plans (National Agency of Supplemental Health) • All this is determined by our Federal Constitution (article 196: “The health is right of all and an obligation of the State, guaranteed by social and economical politics that seek to the reduction of the risk of disease and other offences and to the universal and equalitarian access to the actions and services for promotion, protection and recovery“)

  6. Available resources (in US$ millions) for TB in Brazil, from 2000 to 2009 (medicines included). US$ 74.0 71.6 58.8 44.3 29.7 27.4 13.6 9.3 6.3 5.2 Ano Fonte: MS / SVS / PNCT

  7. TB incidence rate. Brazil, 1990 - 2015*. 2015 goal of 50% reduction:25,9 Por 100 mil hab 51,4 37,1 (2008) Decrease = 26% (1,6% per year) 27,4* 1990 2000 2001 2003 2004 2009 2015 1993 1994 1997 1998 1999 2002 1995 2006 2014 2005 2007 2008 2010 2011 2012 1996 1991 1992 2013 Source: MS / SVS / SINAN e IBGE * estimation

  8. TB mortality rate. Brazil, from 1990 to 2015*. Óbitos por 100 mil hab 2015 goal 50% reduction: 1,8 3,6 2,4 1,5* 1990 2000 2004 1995 2009 1993 1994 1997 1998 1999 2001 2002 2003 2006 2015 2012 1991 1992 1996 2010 2011 2014 2005 2007 2008 2013 Decrease= 32% (2% per year) Source: MS / SVS / SIM e IBGE * estimation

  9. All forms of TB incidence rate.Brazil, 2008. Brasil: 37,1/ 100.000 hab. Southeast: 39,6/100.000 Fonte: MS / SVS / SINAN e IBGE * Casos por 100.000 habitantes.

  10. TB incidence rate*. Brazil and federal units, 2008 Brazil - 37,1/100.000 Incidence rate Federal Unities Source: SVS / MS

  11. TB incidence rate*. Brazil city capitals, 2008. Brazil city capitals - 58,4/100.000 Incidence rate

  12. TB mortality rate per State. Brazil, 2007. Brazil - 2,5/100.000 • Brasil: 2,4/100.000 habitantes Source: SIM – SVS - MS

  13. TB mortality rate in Brazil’s city capitals. Brazil – 2007. Brazil city capitals - 3,5/100.000 Rate per 100.000 Source: SIM – SVS - MS

  14. TB P+ incidence rate, according to gender and age. Brazil, 2008. Por 100 mil hab. SOURCE: MS/SVS/SINAN e IBGE Updated data base: july/09

  15. Education percentage of TB identified cases. Brazil, 2008. Source: MS / SVS / SINAN – set_09

  16. Education percentage of TB identified cases. Brazil, 2008. 73% have less than 8 years of study Source: MS / SVS / SINAN – set_09

  17. Vulnerable Groups (in relation to the general population) • Indigenous peoples: 4 times • Convicts: 25 times • PLHA: 30 times • Homeless: 60 times

  18. Advances

  19. Advances • Political commitment (budget, Mais Saúde, GF, etc.) • Strengthening partnerships (Brazilian Stop TB Partnership, creation of metropolitan committees, NGOs forums, etc.) • Widening of the civil society participation and social control • Joint activities with Global Fund, National Program of Aids, Department of Primary Health and other governmental institutions and non governmental organizations • Contacts with National Council of State Health Secretaries and National Council of Municipal Health Secretaries and Health Councils at the three levels of the Public Administration • Decentralization (FHS e Primary Health) continue...

  20. Advances • New National TB Guidelines • Change in the therapeutic scheme (adoption of four drugs, FDC presentation) • Increase of counseling and testing for HIV and TB chemoprophylaxis • DOT Expansion

  21. Draurio Barreira draurio.barreira@saude.gov.br +55 61 32138231

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