IX - Health

The Real Plan sparked very positive changes in the health sector. Besides enlarging and diversifying the consumption of foodstuffs, and contributing to the improvement of the population living standard, it produced a genuine increase in the government's budget for the Ministry of Health.

These resources rose close to 16% between 1993 and 1994. During the two-year period 1995-96, the average annual outlay represented a 65% increase relative to the early years of the decade. It is estimated that the federal government alone will spend some R$19 billion on health services in 1997. Namely, outlays per capita should approximate R$119, or almost twice the amount spent in 1993.

The delays in paying for health services were a chronic problem during the time of high inflation rates, and one that had a negative impact on hospitals and other health care providers. Not being paid until 60 days after providing a medical service meant that, during an inflationary period, the payment was worth less than when the bill was initially issued. This situation caused services to deteriorate. The economic stability caused by the Real Plan allowed bills to be brought up to date, ending the payment delays and the constant changes in the costs of medical services.

In the communities of the 2,563 cities where the Children's Pastoral Program exists, infant mortality fell from 41 per 1,000 children born alive in 1992 to 31.4 in 1994 and 17.6 in 1996.

In 1994, 56% of SUS (federal health program) resources was spent on interned patients and 44% on ambulatory patients. By the first half of 1996, the percentages had been inverted: 49% for hospitalized patients and 51% for ambulatory patients.

The greater availability of financial resources permitted larger expenditures on essential services to improve the health conditions of the most vulnerable sectors of the population. This change has been especially true since 1995 when the government created and gave priority to the Program to Reduce Infant Mortality (PRMI). This program made it possible to integrate several activities related to pre-natal care, nutrition, immunization and basic sanitary practices, in addition to those activities inherent in the work of the Community Health Agents and in sanitary education programs.

Of the 913 municipalities covered by the Program to Reduce Infant Mortality, 77% are already included in the Food Supplement Program "Milk and Health" that serves three million mothers and children. Moreover, 39% of these cities were provided water, sewage and improved housing, serving 1.2 million people directly and 3.8 million indirectly. The national average for normal immunization (75%) has been substantially surpassed in the areas served by the PRMI, where 97% of children are vaccinated before they are one year old.

The Program of Family Health Teams, begun in 1994, and the Community Health Agent Program aim to change the way health services are provided to the public. This effort combines traditional medical services with a series of measures to improve living conditions. The program has become the entrance to SUS as it seeks to resolve at this level of service the largest possible number of problems.

The Community Health Agents and the Family Health Teams programs have grown rapidly during the three years of the Real Plan. The number of Agents grew from 29,000 in January 1995 to more than 44,000 in 1996, providing services to some 26 million people. The current 847 Teams, serving 850,000 families, will grow to 3,500 by the end of 1998, when they will be assisting 3.5 million families.

Between 1994 and 1996, the System of Information of the Community Health Agents (PACS) allowed the identification of a group of indicators for the areas where the program is working.

The following table shows the mortality rate for the areas covered by the PACS. The decline in the rate is impressive: from 82.6 deaths per 1,000 live births in 1994 to 51.5 deaths per 1,000 live births in 1996. This decline represented a 37.7% drop in the infant mortality rate during the period. It is estimated that 6,500 deaths were avoided.

Table 10

It is important to remember that the PACS were placed in municipalities with a high risk of infant mortality. Priority was given to localities in those municipalities where the situation was the worst, namely, in rural zones and suburban areas.

Grafic 22

The drop in infant mortality is reflected also in the Children's Pastoral Program of the National Conference of Brazilian Bishops (CNBB). According to its data, the mortality rate fell from 41 per 1,000 live births in 1992 to 31.4 deaths in 1994, and 17.6 deaths in 1996. In this last year alone, the death of some 5,000 children was avoided in 2,563 cities. This rate cannot, however, necessarily be applied to the total population of these cities. Still, this decline in infant mortality is highly significant because the Children's Pastoral Program works exclusively with poor families.