History:

Throughout much of the 20th century, improvements in health in Brazil favored only the wealthiest populations. While there were some social protection systems in place in the first half of the century, programs were fragmented and did not cover large swaths of the population in need of services. During military dictatorship between 1964 and 1985, Brazil’s coverage of services expanded, particularly through the private sector. However, fee-for-service payments for private providers during this time contributed to a funding crisis and catalyzed reform in the late 1980s, coinciding with the country’s transition to democracy.1

How population health management was integrated into health reforms:

Starting in the late 1980s, Brazil began committing substantial resources towards restructuring its health care system, reorienting towards primary health care – and community-based care in particular – as a means of achieving universal health care. Brail established a national health system -  the Sistema Unicao de Salude (SUS) - in 1986 which encompassed both the public and the

What is local priority setting?

Local priority setting is the translation of local needs and health outcomes to actionable health services and plans. Local priority setting involves the collection of relevant indicators or data and a clear process for translating those data into action, ideally with appropriate and robust input from communities.

private sector. The Family Health Program (FHP) is at the center of the new primary care oriented system. The FHP created a team-based care organizations comprising a physician, nurse, nurse assistant, and multiple community health agents who collectively assumed responsibility for a geographically empaneled group of approximately 1000 households.2 Within this catchment, each community health agent is responsible for serving approximately 150 households, visiting families regardless of their contact with the facility.2 In the communities, health agents provide screenings, conduct promotion of adherence to medications, and provide health education. Thus, they provide both preventive and chronic care outreach activities as part of proactive population outreach. Additionally, community health agents – who reside in the communities they serve - collect vital data and perform disease surveillance, and the latter helps the care teams set local priorities in order to tailor services to the community needs.3

Outcomes and impact:

Brazil has demonstrated immense success in the scale-up of the FHP. In 1998, 2000 teams served only 4% of the Brazilian population, and as of 2014, 39,000 teams provide services to 62% of the population.2 Because these teams serve geographically empaneled populations, this system has increased geographic access to primary health care services and has established first contact accessibility for a significant portion of the population. Additionally, because community health agents work with only a small portion of the team’s panel, they can establish relationships with the families they serve, familiarizing with their health needs and providing continuous care. Coinciding with increased service coverage throughout Brazil, health outcomes have also improved over the last few decades. Vaccination coverage is now at 95%, 75% of women complete antenatal care, and infant mortality has decreased by 64% over the last 20 years.3

Suggested citation: “Population Health Management: Brazil.” Improvement Strategies. Primary Health Care Performance Initiative, 2018, https://improvingphc.org/brazil. Accessed [insert date].

References:

  1. Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet (London, England). 2011 May;377(9779):1778–97.
  2. Macinko J, Harris MJ. Brazil’s family health strategy--delivering community-based primary care in a universal health system. N Engl J Med. 2015 Jun;372(23):2177–81.
  3. Brazil: A community-based approach to comprehensive primary care [Internet]. [cited 2017 Sep 26]. Available from: https://improvingphc.org/promising-practices/brazil