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GARD - Country Initiatives BRAZIL

GARD - Country Initiatives BRAZIL. Alvaro A. Cruz, M.D. Associate Professor of Universidade Federal da Bahia Scientist of CNPq - National Research Council Co-chairman of ARIA Brazil. GARD - Brazil. Pop. 180 million Area 8,511,965 sq km GDP per capita $7,762 Life expect. 70 years

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GARD - Country Initiatives BRAZIL

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  1. GARD - Country InitiativesBRAZIL Alvaro A. Cruz, M.D. Associate Professor of Universidade Federal da Bahia Scientist of CNPq - National Research Council Co-chairman of ARIA Brazil

  2. GARD - Brazil • Pop. 180 million • Area 8,511,965 sq km • GDP per capita $7,762 • Life expect. 70 years • Child mortality 36/1000 • Health exp. per capita $611, 7% of GDP AA Cruz, 2006.

  3. GARD - Brazilobstacles and advantages • Poverty / unemployment • Limited education • Poor transportation system • Inadequate health care Low wages Poor facilities Unsatisfactory training • Universal coverage of PHS • National health database • Primary care priority • Growing family health program • Qualified reference and research centres • Active NGOs • National telecommunication networks AA Cruz, 2006.

  4. Asthma Rhinitis Recife Prevalence of Asthma and Rhinitis Brazil - ISAAC Phase I, 13 -14 years old Salvador Uberlândia Itabira São Paulo Curitiba % 0 5 10 15 20 25 30 35 Solé et al, 2002.

  5. GARD - Brazilcountrywide approach • Asthma/Rhinitis: Prevalence may be > 20% 4th. cause of hospitalizations Over 2,000 deaths a year • COPD: Prevalence of 14.9% (S. Paulo) 5th. cause of death • Meeting of national CRD leaders to discuss GARD proposal in Rio, 2005 • GARD Brazil Working group: AA Cruz (asthma and rhinitis) JR Jardim (COPD) PA Camargos (pediatrics) ML Barreto (epidemiology) AA Cruz, 2006.

  6. GARD - BrazilMinistry of Health and WHO Recent actions, Brazilian Ministry • Ban on tobacco advertisement • Free pharmaceutical assistance to severe asthma/rhinitis, 2002 • Publication of Asthma/Rhinitis Guidelines, 2005 • Free medication for asthma/rhinitis in primary care, 2006 Preliminary contacts • GARD Working group have consulted for Ministries of Health, Education and National Research Council • GARD Working group offered advisory collaboration • Meeting with Head of Primary Health Department scheduled AA Cruz, 2006.

  7. GARD - Brazilrole of primary health care Primary Care, a Priority in Brazil • A Family Medicine approach recently developed already covers 45% of population Guidance and means • The Asthma and Rhinitis Guidelines was developed for the primary care professional Decentralization of management • each city may control its health budget in agreement with Ministry of Health • example: Salvador (Pop. 2.5 million) will receive US$ 1.2 million specifically for asthma and rhinitis medication in primary care in 2006 AA Cruz, 2006.

  8. GARD - Brazilrole of NGOs Tradition of NGOs • Hospital care • Health professional associations New perspectives for NGOs • Patient associations • “Problem based” NGOs CRD NGOs and Ministry of Health • Medical associations: Pulmonary, Allergy, Pediatrics • ARIA, GOLD • Patient associations: asthma, COPD Collaboration for the Asthma and Rhinitis Guideline and training AA Cruz, 2006.

  9. GARD - Brazilsuccessful experiences in CRD control Various local asthma programs • Care by specialists, education and ... medication? • Some city programs with free medication available in multiple facilities, from 1997 (as in Belo Horizonte) A research project intervention in Salvador City (ProAR) focusing on severe asthmatics (n=1405): • reduction of admissions by 90% • reduction of family expenses with asthma by 86% • reduction of public expenses with asthma by US$566.00 per patient/year AA Cruz, 2006.

  10. ProAR ProAR ProAR asthma GARD - Brazilhospitalizations in public health system, Salvador 6000 pneumonia 5000 4000 3000 2000 1000 acute m. infarction 0 2000 2001 2002 2003 2004 2005 AA Cruz, 2006.

  11. GARD Global Alliance against Chronic Respiratory Diseases

  12. GARD Global Alliance against Chronic Respiratory Diseases

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