6 YEARS OF THE REAL PLAN GROWTH AND SOCIAL DEVELOPMENT

The health system in Brazil is based upon the principles of universality, equity and integrity, granted by the Federal Constitution of 1988 and made concrete through the establishment of the Single Health System (SUS). SUS is one of the largest public-health systems in the world, and it operates in a decentralised manner, re-directing the role of the Union and entrusting the states and municipalities with the execution of health actions and the delivery of health services., although every sphere of Government has a single command. The management of the system also counts on the participation of society, which operates through Health Councils, in the planning and control of health actions. Its funding is done by means of taxes and contributions collected at federal, state and municipality level. The National Programme for Immunisation has been deemed one of the most complete in the world, providing, free of charge, at the public health service, vaccines for children, young people, adults and the elderly. The range of vaccines provided to the Brazilian population has significantly increased. Currently, new vaccines for the pre-emption of influenza, pneumonia, German measles, measles, hepatitis B, meningitis, diphtheria, tetanus and yellow fever are available. From 1998 to 1999, the Ministry of Health has doubled the volume of vaccines bought and distributed, which moved from 200 million to 400 million doses, representing a considerable increase of expenses, from R$ 124 million to R$ 231 million. 1999 represented a landmark for the National Programme for Immunisation: it marked the tenth year without poliomyelitis (infantile paralysis), deemed eradicated in the country by the World Health Organisation (WHO). Some instruments of the new basic health care policy are Programmes Community Health Agents (PACS), Family Health (PSF), Struggle Against Nutritional Needs, Basic Pharmaceutical Care and Basic Sanitary Surveillance Actions, for the implementation of which specific financial incentives have been transferred. Starting in August, 1999, the total amount available for funding these five programmes was increased to R$ 750 million per year. The Community Health Agents Programme (PACS) is aimed at contributing to the re-organisation of municipality health services, to the integration of different actions geared and to the establishment of an effective link between the community and the health units and professionals. In order to discharge these functions, community agents make house calls and develop sanitary-surveillance and epidemiology actions, among other activities developed by different professionals of the area, aimed at establishing an effective link between the community and its health units. Currently, PACS operates in the 27 States of the Federation, and it counts on over 125 thousand agents. From 1994 to 2000, the number of agents increased by 340%. The Family Health Programme (PDF) is aimed at re-organising the care practise on new bases and criteria, replacing the traditional model, geared to hospitals and to the cure of diseases. This programme concentrates on families, understood and perceived as from their physical and social environment, thus enabling Family Health teams to better understand the process health/disease, and the need for interventions going beyond therapeutic practises. The programme has already been put in place in 2.572 municipalities, and serves over 25 million people. From 1994 to 2000, the number of teams has increased over 20 fold.   The reduction of infantile mortality remains a high priority for the Government. During the last years, efforts developed by Brazil in the promotion of child health achieved a significant reduction in infantile mortality, which reduced by 24% from 1990 to 1998. The expansion in health care and the vaccination campaigns were fundamental for the drop in the mortality rate. The implementation of the Child Health Programme, with the promotion of breast feeding, the adoption of home made serum, the control of respiratory infections and the follow-up of children growth have also contributed for the improvement of this situation. The Programme of the Ministry of Health for the control and pre-emption of AIDS has also been deemed an international reference. Brazil is one of the few countries that distribute free of charge the medicines necessary for the out-patient treatment of AIDS free of charge. Only in 1999, the Federal Government has invested around R$ 600 million in the purchase of medicines for people infected with the AIDS virus. Currently, over 85 thousand people receive treatment at the public health-care network. The policy regarding universal access to medicines, combined with the anti-retroviral therapy, has prevented 146 thousand patients from been hospitalised between 1997 and 1999, and has represented savings of US$ 420 million for Government. The country was able to reduce by 44% the estimation of people infected for 2000. At the beginning of the 1990s, the World Health Organisation (WHO) had forecast that Brazil would have 1.2 million people infected with HIV in 2000. The latest estimation of the Ministry of Health (1999) demonstrated that there are 537 thousand people infected.   The permanent campaign the Ministry of Health has been promoting amongst physicians, in order to encourage the application of HIV tests to all pregnant women is yielding results. By April, 2000, over 1.800 women had been treated with AZT, a medicine that reduces by up to 75% the chances a woman has of transmitting the virus to the baby. The High Commission For Human Rights of the United Nations declared, in May, 2000, that the Brazilian programme against AIDS is the best in the world, including due to its concern about the guarantee of human and fundamental rights to AIDS patients. For the World Bank, the actions in terms of care and pre-emption of AIDS highlight in Brazil because of the quality of the educational campaigns and because of the ability of the Federal Government to articulate with several sectors of society, such as non-governmental organisations, enterprises and the armed forces. The Programme of the United Nations for AIDS (UNAIDS) has chosen Brazil for launching the world-wide campaign against AIDS in 1999, because Brazil is one of the few countries offering the drugs used for treating the disease in a full and universal manner. The 1999 issue of UNAIDS’, The Best Practices, esteems that pre-emption and care actions developed in Brazil to be exemplary.