Brazil's March towards Universal Coverage: Brazil's Landmark Reform in 1988 Has Brought Health Coverage to Millions of People, but the System Is Underfunded, Report Claudia Jurberg and Gary Humphreys in a Continuing Series on Health Finance

By Jurberg, Claudia; Humphreys, Gary | Bulletin of the World Health Organization, September 2010 | Go to article overview

Brazil's March towards Universal Coverage: Brazil's Landmark Reform in 1988 Has Brought Health Coverage to Millions of People, but the System Is Underfunded, Report Claudia Jurberg and Gary Humphreys in a Continuing Series on Health Finance


Jurberg, Claudia, Humphreys, Gary, Bulletin of the World Health Organization


In 1988, half of Brazil's population had no health coverage. Two decades after establishing its Unified Health System (Sistema Unico de Saude), more than 75% of the country's estimated 190 million people rely exclusively on it for their health care coverage.

One beneficiary is 44-year old Marlene Miranda da Cruz, who lives in the Manguinhos slum of Rio de Janeiro and receives care through the Family Health Programme (Programa de Saude da Familia).

Da Cruz, who struggles to make a living by selling beauty products, has two sons, one of whom has a neurological disorder and is bedridden. "My son needs care 24 hours a day," she says, "meanwhile I have to look after my four grandchildren." Today she has come to the Family Health Programme clinic because one of her grandchildren has contracted chickenpox. "I know that I will be well attended here," she says.

Da Cruz is one of 35 000 people served by the Manguinhos clinic, which is run by 11 teams of health workers, including physicians, nurses, dentists and community agents. "At the end of the year there will be 16 teams to take care of 45 000 Manguinhos residents," says Alex Simoes de Melo, the clinic's managing director.

[ILLUSTRATION OMITTED]

The Family Health Programme, which covers some 97 million Brazilians, is a key part of the national Unified Health System. It employs more than 30 000 teams of health-care workers who make concerted efforts to reach the country's poor and isolated communities.

Apart from offering primary health care free at the point of service, mainly through the Family Health Programme, the Unified Health System provides a wide range of hospital services, including heart surgery, sophisticated medical imaging and laboratory diagnostics. It also supports a robust vaccination programme, prevention campaigns, basic dental care and 90% subsidization of many essential medicines.

Decentralization has played a fundamental part in Brazilian health-financing reform. In 1996, legislation transferred part of the responsibility for the management and financing of health care to the country's 26 states and more than 5000 municipal governments. States are required to allocate a minimum of 12% of the total budget to health while municipal governments must spend 15% of their budget on health. The federal government also contributes money raised from taxes. At the municipal level this system seems to work well: 98% of the municipalities meet the 15% budgetary requirement and some spend more than 30%, according to Antonio Carlos Nardi, health secretary and president of the National Council of Municipalities Secretaries for Health (Conselho Nacional de Secretarios de Saude).

"Communities are actively involved in decisions about municipal budgets," says Professor Sulamis Daim, of the State University of Rio de Janeiro.

"Maringa municipality is a particularly striking example of popular participation," says Nardi, with the community "participating in discussions at city hall, in how budgets are allocated, in the supervision of accounts and in the approval of the annual management reports." Maringa municipality, 400 kilometres west of Sao Paulo in Parana state, has committed more than 20% of the total budget to health in the past six years, well above the 15% required.

This kind of commitment is less evident at the state level, with more than half of the 26 states failing to meet the required 12% funding target. "One of the weaknesses of this system is that there is a very broad concept of health expenditure," says Dr Francisco de Campos, national secretary of the Secretariat of Human Resources for Health at the Ministry of Health. "Some states have used the money for sanitation or additional health insurance for civil servants. While this may indirectly affect the health of the population, we need to define health expenditure more precisely."

At the federal level, the main problem is the lack of funds. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Brazil's March towards Universal Coverage: Brazil's Landmark Reform in 1988 Has Brought Health Coverage to Millions of People, but the System Is Underfunded, Report Claudia Jurberg and Gary Humphreys in a Continuing Series on Health Finance
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.