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Making the right to health a reality to Indigenous People in Brazil

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This presentation was given by Vera Schattan Coelho (CEBRAP) and Alex Shankland (Institute of Development Studies) at a Future Health Systems Consortium event at the Global Symposium on Health Systems …

This presentation was given by Vera Schattan Coelho (CEBRAP) and Alex Shankland (Institute of Development Studies) at a Future Health Systems Consortium event at the Global Symposium on Health Systems Research, November, 2010.

Published in: Health & Medicine

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  • Segundo o Data-SUS a média nacional de consultas básicas por habitante/ano subiu de 2,21 em 1995 para 2,59 em 2008.
  • Transcript

    • 1. First Global Symposium on Health Systems Research Montreux November, 2010 Making the right to health a reality to Indigenous People in Brazil Innovation cycles, quality and equity Vera Schattan Coelho - CEBRAP Alex Shankland - Institute of Development Studies
    • 2. The Brazilian Public Health System: A large scale change “Health is the right of all and its provision is the duty of the state” (1988 Constitution, article 196) Population Covered by FHP 1994 -2010 Infant Mortality Rate (per 1000 births) 1990 - 2007 47.1 (1990) 19.3 (2007)1.1 million (1994) 96.1 million (2009) Source: SIAB / SCNES Source: MS
    • 3. A cycle of innovation: lessons learnt • PSF, HIV-AIDS • Partnerships for implementation • Contracts, clear division of labour • Councils and Conferences
    • 4. New challenges: focus shifting to equity and quality Infant Mortality Rate (per 1000 live births) among different ethnic groups in Brazil 22,9 34,9 51,14 White Black Indigenous Source: IBGE, Censo 2000
    • 5. How to reach the ‘hard to reach’? • MoH resistance to ‘target’/differentiate services - Why deviate from established practice in the case of well adapted urban Afro-descents? - Why create a subsystem for 700 thousand Indigenous in a country of 190 million? • Indigenous Health Subsystem as centre of experimentation for restarting innovation in the SUS in pursuit of quality and equity? • Mobilization of Afro-Brazilians, Indigenous, Quilombolas and the creation of special programs
    • 6. A radical experience: universalization and difference • 1999, creation of the Indigenous Subsystem Amazonas: 7 DSEIs DSEI South Coast: 5 states • Decentralisation & outsourcing to a mix of providers (mainly NGO) • 34 Indigenous Health Districts; 5.561 municipalities
    • 7. 0,00 100,00 200,00 300,00 2000 2001 2002 2003 2004 2005 2006 Source: MS/SVS and DSEI/COMOA/DESAI Opportunities for improvement and institutional challenges TB Incidence Rate (per 10.000 hab.) Among Indigenous peoples 30 40 50 60 70 80 2000 20012002 2003 2004 20052006 2007 Indigenous IMR (per 1000 live births) Source:DESAI/ SIASI • Uneven health gains, management problems, centralization and blueprint approach • Per capita spending is 5.6 times higher than the Brazilian PHC average 0 150 300 450 600 2003 2004 2005 2006 2007 Indigenous Health Resources (in millions R$) Source:CGPAS/DESAL/DOU, ASTEC/CGASI/DESAI/FUNASA
    • 8. A learning approach to restart innovation in indigenous health care • IDS, SSL and Cebrap formed a consortium, a learning process rather than prescription •Regional workshops with several hundred participants stimulating horizontal exchange for shared reflection and innovation spread • October 2010: Presidential decree creates a new Special Secretariat of Indigenous Health (SESAI)
    • 9. An opportunity for restarting the cycle: innovation and institutional alignment Social oversight: accountability + flows of information Partnership: MoH + states +district + municipalities + NGOs + communities Authority and Autonomy: clear responsibilities (health care + administrative) and degrees of autonomy
    • 10. Thank you ! veraspc@uol.com.br a.shankland@ids.ac.uk