Brazil - Child Deaths

Brazil widens access to health care

In Brazil, the launch of a community-based family health programme has led to a sharp drop in infant mortality rates in several of the states involved. In one city, infant death rates fell by almost 75% over a 6-year period. Elsewhere, the number of cases of diarrhoeal disease was halved within a year -- a drop that was helped by an increase of almost 100% in the number of mothers who exclusively breastfed their babies. In some of the municipalities involved, attendance at antenatal clinics has almost doubled.

In Brazil, the launch of a community-based family health programme has led to a sharp drop in infant mortality rates in several of the states involved. In one city, infant death rates fell by almost 75% over a 6-year period. Elsewhere, the number of cases of diarrhoeal disease was halved within a year, a drop that was helped by an increase of almost 100% in the number of mothers who exclusively breastfed their babies. In some of the municipalities involved, attendance at antenatal clinics has almost doubled.

Before the programme started in 1994, Brazil relied almost exclusively on a specialized, hospital-based system of medical care which failed to meet the needs of many families who either could not afford or could not access these services. Today, 20% of the population of 160 million have access to primary health care.

Launched as a partnership involving the Ministry of Health, UNICEF, and communities, the Family Health Programme is based on a network of teams who work with communities to ensure that families know when and where to seek help or advice on health issues such as antenatal care, immunization, and child nutrition, or treatment for diseases such as malaria and diarrhoeal diseases. Dental care is now being added to the list of services available. Where necessary, people are helped to gain access to specialized care and hospital treatment. The teams comprise a doctor, a nurse, a nurse's aide, and five or six health agents who live in the community.

Each team covers about 800 families. They respond to the needs of the whole population, particularly those who could not easily access the hospital-based medical system. With federal government financing and political commitment at all levels, Brazil's Family Health Programme has grown from 328 teams in 1994 to over 10 000 today, serving more than 3000 municipalities. The aim is to create another 10 000 teams by the end of 2002. Since 1998, the family health team is being trained in the IMCI approach in some states in the north-east. The use of nutrition counselling has helped improve the nutritional status of children under five. The results have been dramatic. In Camarigabe, in the poor north-eastern state of Pernambuco, infant mortality dropped from 65 per 1000 live births in 1993 to 17 per 1000 live births in 1999. Elsewhere, in Palmas, the capital of the state of Tocantins, the rate of exclusive breastfeeding increased from 38% in 1999 to 73% in 2000. This increase is believed to have contributed to a reduction in cases of diarrhoea, which dropped by 50% in the city between 1997 and 1998. Meanwhile, the number of pregnant women receiving antenatal care in Palmas almost doubled, from 43% in 1997 to 80% by 1998.

The programme has helped steer families away from a reliance on expensive specialized care. In the city of Sobral, for example, the once high demand for specialized care has dropped in direct proportion to the increase in demand for primary care since the programme began in 1997. And this change has found its way into general medical training in the country, since the programme's 21 training centres for family health are linked to 58 medical schools and 62 nursing schools in 16 of the country's 27 states. The programme has also contributed to a profound shift in the concept of health care in Brazil. Today, health professionals and community members alike place high value on general community practice in preference to expensive, specialized care that only a few can afford.