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- 1. Professional Nursing Concepts III NUR 411 Spring 2023 Article presentation Students: Hibatollah Khazem , Amjad Aridi, Samira Sharaan, Zahraa Mustafa Course Instructor: Dr. Bahia Abdallah
- 2. Title: Brazil’s unified health system: the first 30 years and prospects for the future Castro, M. C., Massuda, A., Almeida, G., Menezes-Filho, N. A., Andrade, M. V., de Souza Noronha, Kenya Valéria Micaela, Rocha, R., Macinko, J., Hone, T., Tasca, R., Giovanella, L., Malik, A. M., Werneck, H., Fachini, L. A., & Atun, R. (2019). Brazil's unified health system: The first 30 years and prospects for the future. The Lancet , 394(10195), 345-356. https://doi.org/10.1016/S0140-6736(19)31243-7
- 3. Background • Brazil declared health to be a basic right and an obligation in 1988. Brazil established a health system in 1990, “Sistema Nico de Sade [SUS]”, which allowed the country to attain a universal health care. • Although Brazil was able to respond to its populations changing health requirements, due to the SUS, it is needed to urgently address the Brazilian government’s 2016 decisions of austerity measures. Why ?
- 4. Introduction The SUS assisted in minimizing the health disparities by improving coverage and access to healthcare across the nation, Example : such as the “Generic Medicines Policy and an Essential Medications List”, to better regulate health products and to increase their accessibility and affordability
- 5. Introduction The Brazilian government started to implement changes and followed a” decentralization process “for fighting infectious diseases increased mortality, epidemiological changes, and elderly populations. Example ? 5570 municipalities in Brazil provide PHC and family health to ensure access to both general and specialized hospital care
- 6. Introduction SUS is facing insufficient staffing, unequal access to healthcare service, and inefficient resource utilization due to inadequate funding. reasons? Such as : money spent on the private health sector (56%) is more than that spent on public health (44%).
- 7. To examine how can economic, epidemiologic, demographic, social, and political changes can influence the SUS and 4 of the” health indicators “which are part of goal 3 UN sustainable development. Purpose/objective
- 8. METHOD 8 4 hypothetical schemes of “federal transfer of funds” towards the municipalities were considered assumed that “federal health transfers” towards municipalities were left constant with the same amount from 2015 to 2030 having the same amount For the rest of the 3 schemes, it was assumed that the transfers will increase at the same gross product rate of the country 1st scheme annually 1% for the second Annually 2% for the third Annually 3 % for the fourth
- 9. 9 01 02 03 04 In each of these schemes, 4 indicators were considered and were related to applying the UN sustainable development goal 3 plan till 2030 METHOD Indicators Infant mortality proportion of births whose mother attended 7 or more antenatal care visits family health care strategy coverage ( FHS ) Amenable Mortality
- 10. 10 01 02 Findings In scheme one, where funding remained constant, the results showed a decline in all four health indicators. Most significantly, the decline was more pronounced in smaller municipalities. For scheme 4, a lower decline was observed. Infant mortality declines, increased FHS coverage, and more frequent visits to prenatal care centers were all linked to increases in federal funding transfers to municipal governments
- 11. 11 Findings The reduction in FHS coverage is going to have a larger impact in smaller municipalities versus larger ones. This is going to increase infant mortality rates and will worsen other health outcomes. Increase in federal funding results in a decrease in amenable cardiovascular disease mortality by 2030. With a tilt to far-right populism and austerity measures certain to exacerbate inequality. 03 04 No significant influence was observed with schemes 2 and 3
- 12. 12 Discussion and Conclusion - Brazil achieved the second-best performance in reducing mortality in children younger than 5 years between 1990 and 2006, but austerity policies enacted in 2016 are anticipated to worsen regional infant mortality disparities. - Because fewer people smoke and more people have access to PHC, Brazil saw a 20% decrease in age- standardized cardiovascular disease mortality between 1996 and 2007. In municipalities with stronger public sector management, federal money increases were linked to mortality decreases. Brazil is going through a significant sociopolitical and economic disruption.
- 13. 13 Discussion and Conclusion Notably ,the Brazilian government rejected the phrase "including universal access to sexual and reproductive health care services" and prohibited the use of images in pamphlets given to teenagers. The austerity measures put in place in 2016 will worsen the SUS’s chronic underfunding, resulting in a health system that provides poor quality care to the poorest populations and worsening health outcomes, financial security, and disparities.
- 14. 14 Discussion and Conclusion An integrated network of public and private health services should be created to increase efficacy, efficiency, and access to healthcare for the entire population. This network should be supported by excellent PHC practice.
- 15. 15 Limitations Strength and limitations The current study achieved reliability since the results obtained are consistent with other studies and with the recently posted “vital statistics” -Administrative data was used which poses the risk of underreporting -459 “small municipalities” were excluded The schemes used do not demonstrate the whole exact influence of austerity measures on the health of the population since only specific outcomes were selected The results obtained are limited since it is anticipated that municipalities will be receiving lower funds due to the austerity measures
- 16. 16 Recommendations 01 02 03 Increasing social dialogue among government ministers, healthcare providers working in SUS, academic research, and Brazilian citizens is necessary so that SUS can persist. Developing health industrial policies to increase the allocation of resources and healthcare providers training Importance of creating an integrated network for the delivery of health services
- 17. 17 Recommendations 04 05 06 Upgrading organizational forms is essential to promote health care and creating an agreement between the government and municipalities will aid to enhance the healthcare services provided. Adequacy of public funding and proper resources’ allocation are essential to also maintain SUS. health services given by the SUS must be listed on local and national levels with proper assessment and setting prioritization.
Editor's Notes
- Background :Brazil declared health to be a basic right and an obligation in 1988. Brazil established a health system in 1990, “Sistema Nico de Sade [SUS]”, which allowed the country to attain a universal health care. The SUS's growth provides important insights into how to increase and maintain universal health coverage in a country with a high level of inequality and relatively inadequate government funding for healthcare services in comparison to middle- and high-income nations. Although Brazil was able to respond to its populations changing health requirements, due to the SUS, it is needed to urgently address the Brazilian government’s 2016 decisions of new environmental, educational, and health policies and austerity measures which can impede the progress and benefits of the SUS for all the population’s health.
- Additionally, to increase the funding for the SUS, the “Provisional Contribution on Financial Transactions tax ensured the allocation of around 30% of the federal budget to healthcare services”.
- Method : 4 hypothetical schemes of “federal transfer of funds” towards the municipalities were considered. The first one assumed that “federal health transfers” towards municipalities were left constant with the same amount from 2015 to 2030 having the same amount. For the rest of the 3 schemes, it was assumed that the transfers will increase at the same gross product rate of the country ; annually : 1% for the second,2% for the third, and 3 % for the fourth scheme. In each of these schemes, 4 indicators were considered and were related to applying the UN sustainable development goal 3 plan till 2030 (which is the promotion of health for all ages and of healthy lives). 1st indicator was infant mortality,2nd the “proportion of births whose mother attended 7 or more antenatal care visits”, 3rd “FHS (family health care strategy “coverage “, 4th the proportion of mortalities that could have been prevented if given access to proper healthcare such as deaths resulting from cardiovascular diseases.
- Amenable Mortality (premature deaths under the age of 75 years that could have been avoided, given effective and timely health care) due to cardiovascular diseases, the main cause of death in Brazil among those aged 60 years or older
- Findings -In scenario one, where funding remained constant, the result showed a decline in all four health indicators. Most significantly, the decline was more pronounced in smaller municipalities, escalating geographical disparities. For scheme 4, a lower decline was observed. -Infant mortality declines, increased FHS coverage, and more frequent visits to prenatal care centers were all linked to increases in federal funding transfers to municipal governments -Because municipal governments rely on the FHS for the delivery of PHC to the public, the reduction in FHS coverage is going to have a larger impact in smaller municipalities versus larger ones. This is going to increase infant mortality rates and will worsen other health outcomes. The population FHS coverage in scheme one decreased from 2015 till 2030, yet this coverage increased with the 4th scheme - Increase in federal funding results in a decrease in amenable cardiovascular disease mortality by 2030 particularly in municipalities with stronger public sector management. With a tilt to far-right populism and austerity measures certain to exacerbate inequality, Brazil is going through a significant sociopolitical and economic disruption. -No significant influence was observed with schemes 2 and 3.
- Findings -In scenario one, where funding remained constant, the result showed a decline in all four health indicators. Most significantly, the decline was more pronounced in smaller municipalities, escalating geographical disparities. For scheme 4, a lower decline was observed. -Infant mortality declines, increased FHS coverage, and more frequent visits to prenatal care centers were all linked to increases in federal funding transfers to municipal governments -Because municipal governments rely on the FHS for the delivery of PHC to the public, the reduction in FHS coverage is going to have a larger impact in smaller municipalities versus larger ones. This is going to increase infant mortality rates and will worsen other health outcomes. The population FHS coverage in scheme one decreased from 2015 till 2030, yet this coverage increased with the 4th scheme - Increase in federal funding results in a decrease in amenable cardiovascular disease mortality by 2030 particularly in municipalities with stronger public sector management. With a tilt to far-right populism and austerity measures certain to exacerbate inequality, Brazil is going through a significant sociopolitical and economic disruption. -No significant influence was observed with schemes 2 and 3.
- Discussion and Conclusion The World Summit for Children set a goal to lower infant mortality by third, or 70 deaths per 1,000 live births, in 1990. While austerity policies enacted in 2016 are anticipated to reverse this drop and worsen regional infant mortality disparities, Brazil achieved the second-best performance in reducing mortality in children younger than 5 years between 1990 and 2006. Because fewer people smoke and more people have access to PHC, Brazil saw a 20% decrease in age-standardized cardiovascular disease mortality between 1996 and 2007. In municipalities with stronger public sector management, federal money increases were linked to mortality decreases. With a tilt to far-right populism and austerity measures certain to exacerbate inequality, Brazil is going through a significant sociopolitical and economic disruption. The Brazilian government rejected the phrase "including universal access to sexual and reproductive health care services" and prohibited the use of images in pamphlets given to teenagers. The austerity measures put in place in 2016 will worsen the SUS’s chronic underfunding, resulting in a health system that provides poor quality care to the poorest populations and worsening health outcomes, financial security, and disparities. An integrated network of public and private health services should be created to increase efficacy, efficiency, and access to healthcare for the entire population. This network should be supported by excellent PHC practice.
- Discussion and Conclusion The World Summit for Children set a goal to lower infant mortality by third, or 70 deaths per 1,000 live births, in 1990. While austerity policies enacted in 2016 are anticipated to reverse this drop and worsen regional infant mortality disparities, Brazil achieved the second-best performance in reducing mortality in children younger than 5 years between 1990 and 2006. Because fewer people smoke and more people have access to PHC, Brazil saw a 20% decrease in age-standardized cardiovascular disease mortality between 1996 and 2007. In municipalities with stronger public sector management, federal money increases were linked to mortality decreases. With a tilt to far-right populism and austerity measures certain to exacerbate inequality, Brazil is going through a significant sociopolitical and economic disruption. The Brazilian government rejected the phrase "including universal access to sexual and reproductive health care services" and prohibited the use of images in pamphlets given to teenagers. The austerity measures put in place in 2016 will worsen the SUS’s chronic underfunding, resulting in a health system that provides poor quality care to the poorest populations and worsening health outcomes, financial security, and disparities. An integrated network of public and private health services should be created to increase efficacy, efficiency, and access to healthcare for the entire population. This network should be supported by excellent PHC practice.
- Discussion and Conclusion The World Summit for Children set a goal to lower infant mortality by third, or 70 deaths per 1,000 live births, in 1990. While austerity policies enacted in 2016 are anticipated to reverse this drop and worsen regional infant mortality disparities, Brazil achieved the second-best performance in reducing mortality in children younger than 5 years between 1990 and 2006. Because fewer people smoke and more people have access to PHC, Brazil saw a 20% decrease in age-standardized cardiovascular disease mortality between 1996 and 2007. In municipalities with stronger public sector management, federal money increases were linked to mortality decreases. With a tilt to far-right populism and austerity measures certain to exacerbate inequality, Brazil is going through a significant sociopolitical and economic disruption. The Brazilian government rejected the phrase "including universal access to sexual and reproductive health care services" and prohibited the use of images in pamphlets given to teenagers. The austerity measures put in place in 2016 will worsen the SUS’s chronic underfunding, resulting in a health system that provides poor quality care to the poorest populations and worsening health outcomes, financial security, and disparities. An integrated network of public and private health services should be created to increase efficacy, efficiency, and access to healthcare for the entire population. This network should be supported by excellent PHC practice.
- Strengths Although limitations exist, the current study achieved reliability since the results obtained are consistent with other studies and with the recently posted “vital statistics” which also demonstrate a severe decrease in coverage of vaccinations from 2015 to 2016. In addition, to an increase in children, maternity, and infancy mortality rates. Limitations For the result’s analysis, administrative data was used which poses the risk of underreporting. Additionally, 459 “small municipalities” were excluded since they had an absence of information related to “federal health care funding”. The schemes used do not demonstrate the whole exact influence of austerity measures on the health of the population since only specific outcomes were selected. The results obtained are limited since it is anticipated that municipalities will be rescuing lower funds due to the austerity measures, therefore, showing that these measures can have a greater negative impact on the health indicators than the predicted results.
- Several recommendations were suggested in order to maintain SUS To illustrate, this can be done by integrating both private and public health services
- Recommendations Several recommendations were suggested in order to maintain SUS and cease health inequalities and the health outcomes to get worse Increasing social dialogue among government ministers, healthcare providers working in SUS, academic research, and Brazilian citizens is necessary so that SUS can persist. developing health industrial policies to increase the allocation of resources and healthcare providers training will help to address the occurrence of health services inequalities and further improve SUS. It is important to create an integrated network for the delivery of health services. To illustrate, this can be done by integrating both private and public health services with the support of efficient primary health processes. Upgrading organizational forms is essential to promote health care and creating an agreement between the government and municipalities will aid to enhance the healthcare services provided. In addition, equalizing the government’s municipalities’ money transfers will minimize inequalities between large and small municipalities and contribute to better healthcare. Adequacy of public funding and proper resources’ allocation are essential to also maintain SUS. The 2016 austerity measures must be addressed since they increase SUS underfunding leading to worse health outcomes, inequalities, and poor quality of care given to poor citizens. To ensure the continuity of the SUS with its free provided care and to achieve general Brazilian health coverage, the health services given by the SUS must be listed on local and national levels with proper assessment and setting prioritization.