Themes SUS: The Unified Health System- main constitutional guidelines – SUS: Decentralization Brazil: Participation (%) of Government Levels in total public spending in health – 1992 / 2004 Brazil: Public spending in health as GDP percentage – 2000 SUS: Popular participation SUS: Primary health care SUS: Family Health Program Coverage (% of the population) – 1998 / 2002 Globalization issues The Globalization Agenda The Globalization Agenda The Globalization Agenda x Social Policy in Brazil The Globalization Agenda x Social Policy in Brazil The Challenges THANK YOU VERY MUCH !! DECENTRALIZATION OF HEALTH CARE DELIVERY IN BRAZIL AND THE IMPACT OF GLOBALIZATIONPresented at the Forum of Federations conference onDecentralization of Health Care Delivery in India –New DelhiFeb. 8 to 10, 2004Ana Cecilia FaveretFebruary 2004ThemesSpecial features of the Brazilian federationThe health system in Brazil –decentralization and primary health careThe impact of “globalization”Brazil: Infantmortality rate -2000Brazil: Improvement in IMR –1997 / 2000Source: Datasus/MS.Brazil: Distribution (%) of MunicipalitiesandPopulation, bypopulationsize -2001Nr. of municipalities: 5,561Source: IBGESUS: The Unified Health System-main constitutional guidelines -Universal accessTax financedDecentralizationHierarchyPopular participationSUS: Decentralization1993 –automatic transfer of resources to municipalities x requisites/obligationsDirect relationship between Union and Municipalities –where are the States?Radical municipalization -> 1996: intergovernmental boards + integrated programmingBrazil: Participation (%) of Government Levels in total public spending in health –1992 / 2004Source: Ministry of Health,Biasoto&Piola, 2001, p. 229. andMédici, 1994, p. 152.Brazil: Public spending in healthas GDP percentage -2000Source: Ministry of Health, 2002.SUS: Popular participationMunicipal, State and National levels:Health CouncilsHealth Conferences⌧50% -users⌧25% -health professionals⌧25% -health authorities and service providersSUS: Primary health carePrinciples of PSF (Family Health Program):substitutive modelcomprehensiveness and hierarchyterritory and clientele delimitationmulti-professional teamSUS: Family Health Program Coverage (% of the population) –1998 / 2002Globalization issuesAn optimistic point of view (for the Brazilian case)Health care as a social right, not as a programThe Globalization AgendaThe Washington Consensus:Reduction of the scope of social policyMinimum State agendaThe Globalization AgendaWorld Bank´s agenda for health:adoption of user´s fees for health servicesincentives to develop health insurance programsstrengthening of non-governmental provision of servicesdecentralization of the health care systemThe Globalization Agenda x Social Policy in BrazilThe 1988 Constitution:acknowledged social rightswas preceded by 10 years of an increasingly stronger social movement for these rightsdefined a social-democratic regime of welfareThe Globalization Agenda x Social Policy in BrazilSome important achievements:no reduction of the scope of social policyminimal State idea not effective in most social areasWorld Bank´s projects coherent with the idea of health care as a social rightdecentralization as a political strategy for redemocratization, and not due to the Bank´s agendatight fiscal adjustment policies have not compromised social policy budgetsThe ChallengesSupra municipal coordination –clarifying the role of the statesProfessional training and salary levelsIs the Unified Health System really unified? PSF x secondary and tertiary health carePolitical elements prevent the “globalization” agenda to be internalizedTHANK YOU VERY MUCH !!