COMMITMENT 6

Brazil invests the equivalent of 5.2% of GDP in education. It is a reasonable portion, equal to that invested by many developed countries, yet insufficient to face the many-decade delay the country has accumulated due to lack of concern for mass education.

Although the panorama of Brazilian education is still far from the position it should present, it has indeed shown significant improvement in the last five years, with a decline in the illiteracy rate, an expressive increase in the number of enrolments at all levels of learning and with the gradual growth of the population’s average level of schooling.

There currently are in Brazil, enrolled in all levels of learning, circa 54.3 million students, what represents 1/3 of the population. Public-sector schools serve 45.8 million students in kindergarten, elementary and secondary school. This figure corresponds to 87.8% of the total of students.

Strategically, it befell the Federal Government to perform a new role. Until the mid 1990s, the Ministry of Education directly implemented several programmes of support for the development of basic education, competing with the states and municipalities. Starting in 1995, emphasising the policy of decentralisation, the function of central government in basic education became a re-distributive and supplementary one, in order to ensure the equalisation of educational opportunities and a minimal standard of quality in learning, by means of the provision of technical and financial assistance to the states and municipalities. Several programmes were established with this goal.

 The National Education Guidelines and Bases Act

The Brazilian educational system began its transformation with the enactment of the new National Education Guidelines and Bases Act - LDB, in December 1996. Starting from the approval of this law, the Union, the States and the Municipalities had their responsibilities defined. Another innovation, schools acquired more autonomy, the curricular contents became more flexible and qualification in the teaching profession was encouraged.

The main initiative of Government to render feasible the strategy of attributing absolute priority to the expansion of access to elementary education, FUNDEF has completely changed the mechanisms for funding education. Until the Fund was established, there was no correspondence between the apportionment of funds and the number of students enrolled. In richer cities, with small municipality learning networks and few students, money was plentiful. In poorer cities, with large networks and many students, resources fell short of the needs.

Constitutional Amendment nº 14, which established FUNDEF and was approved in 1996, came to correct this distortion. The apportionment of revenues between the state and its municipalities became proportional to the number of students enrolled in the schools of each learning network. Out of the 25% the Constitution mandates the states to invest in education, 60% - the equivalent of 15 % of the whole tax excision - must be exclusively earmarked for elementary education.

The Fund also defined a minimal expenditure per student/year. Poorer states, which fail to reach this minimal expenditure, receive complementary funds from the Federal Government. The new system has encouraged local governments to enrol all children at school.

 Programme All Children at School

The transformations of the educational panorama in Brazil gained momentum with the implementation of Programme All Children at School, a wide mobilisation of the federal, state and municipality governments and of the community to enrol children who were still out of the classrooms. In 1999, only 4% were not enrolled, which places Brazil very close to providing universal access to elementary education.

Another relevant datum is the sharper drop in the illiteracy rate among the population of 15 or more years of age. In 1990, 18.3 % were illiterate; in 1998, 13.8%. The most encouraging development took place in the age group from 15 to 19, where the rate of illiteracy dropped by half, from 12% to 6%. With the rapid reduction of these rates amongst the young population, illiteracy in Brazil tends to become a phenomenon increasingly restricted to older generations.

Percentage of children out of school - Brazil 1992-1999

The new National Education Guidelines and Bases Act triggered a wide process of transference to municipalities of the responsibility for elementary education and of the responsibility for secondary education to the states. This change in the profile enhanced the social control of public expenditure in education. An example of decentralisation, transparency, participation, inspection and efficiency of public expenditure is Programme Money Directly to School. By means of this programme, schools began receiving federal funds directly, which before were transferred by means of a bureaucratic, expensive system which allowed education funds to be politically manipulated.

Without the agency of state and municipality governments, the use of funds is now effected with the direct participation of the community. In order to be accredited before the programme, the Ministry of Education requires schools to have a Parent and Teacher Association or a School Council. The budget is deposited into an account of the Association or Council, which administrates the funds in partnership with the school management. Another goal of Government’s - that of strengthening social mobilisation in favour of the quality of learning in public schools - has been achieved by means of this programme: over 56 thousand new Parent and Teacher Associations have been created in the last five years all over the country.

 Programme Speeding Up Learning

One of the main problems of the Brazilian educational system is the high rate of drop-out, often deriving from discouragement brought about by flunking, which distorts the ratio between the student’s age and the grade he or she attends. To tackle this issue, the Ministry of Education created Programme Speeding Up Learning, which enables students to advance faster in their studies until they reach grades compatible with their ages. Circa 1.2 million students are already attending those special classes, in all Brazilian states, out of a total of seven million students enrolled out of their age groups in elementary education establishments.

The rate of promotion, which measures the number of students having gone through a grade, has increased from 64.5%, in 1995, to 72.7%, in 1997. During the same period, flunking has dropped from 30.2% to 23.4% of students and the rate of drop-out diminished from 5.3% to 3.9%.

 The curricular reform

In order to improve quality, the Ministry of Education promotes a curricular reform at all levels of learning. In an unprecedented initiative, the national curricular parameters were defined for the eight grades of elementary education, in addition to references for infantile education and for a broad re-shaping of the system of teacher training.

This programme features as one of the major instruments for the improvement of learning all over the country. Until 1995 restricted to students of the first four grades of elementary education, the programme currently accounts for the distribution of school textbooks for the eight grades. The books go through a rigorous assessment carried out by teacher committees, created five years ago. Only in 1996, the Ministry of Education distributed free of charge, circa 110 million school textbooks.

Programme School Libraries has also been upgraded. Schools all over the country have received 20 thousand collections of the teacher’s library, made up of reference books on the historical, social and political formation of Brazil. Thirty-five thousand more libraries of literature for children and young people, meant for elementary-education students, have been delivered to schools in 1999.

 Television School and IT in the classroom

Programme Television School, being broadcast for three years now, with the main goal of providing long-distance training and development for teachers all over Brazil, currently represents much more than that. It also contributes to render classes livelier and works as a vehicle for the continued education of teachers, extending its action towards the community. During weekends there are documentary programmes open to the population.

All elementary education schools having more than a hundred students have received a technological kit made up of a television set, a videocassette recorder, VHS tapes and a parabolic aerial. In two years, circa 57 thousand sets of equipment have been distributed. Schools receive the educational programmes via satellite. Approximately one million teachers and 28 million students benefit from this initiative.

Another action meant to improve the quality of public education is the National Programme for IT in Education, which is channelling technology into classrooms. So far, 30 thousand computers and ancillary equipment have been installed in over two thousand schools all over the country, directly benefiting circa 200 thousand students. The Programme’s target is to put in place, by 2001, one hundred thousand computers in six thousand schools, thus serving 7.5 million students.

 The reform of secondary education

The appropriate preparation of Brazilian youth for the labour market depends upon a comprehensive reform of secondary education, which is underway. The first step was the definition of the National Curricular Guidelines for secondary education, which have a mandatory character. Afterwards, secondary education was separated from technical education, both sectors having become independent, and it was decided that the professional course would become a complement to secondary education. This split will contribute for rendering universal the access to secondary education, another governmental target.

The expansion of elementary education led to a mushrooming of the number of students enrolled in secondary education: 57% between 1994 and 1999. During that year, 22.7% of young people from age 15 to 17 were enrolled in secondary education; five years later, this rate attains 32.6%, which still is very low. Brazil currently has over 7.8 million students in secondary education, and the forecasts indicate that, in 2002, they will be circa 10 million.

In view of the important increase in enrolment, the Federal Government decided to provide resources and technical assistance to the states, which are responsible for secondary education, as provided for in the Constitution. A U$ 500 million financing from the IDB will fund the qualification and development of teachers, the building, upgrading and improvements of school facilities and buildings and the adaptation of laboratories and libraries.

 The reform of technical education

The proposal of this reform is to bring professional education closer together with the local and regional labour markets, by offering courses according to the demand. This will attract lower-income young people, who will not go to college because they have to work. A curricular structure organised in modules, associated to flexible contents, will allow students to follow several short courses and therefore to qualify for different functions.

Aimed at expanding professional education, the Federal Government has obtained international financing for the amount of U$ 500 million. These funds will be invested in re-equipping public technical schools and in the establishment of a network of community professional schools, in partnership with municipalities, trade-union organisations and associations.

In absolute terms, during the last four years, enrolment in higher learning grew more than in the 14 previous years. Starting in 1995, 424 thousand new enrolments were recorded. In 1998, there were over 2.1 million students in higher learning, a 28% increase as compared to 1994. It is an impressive progress, if one considers that, from 1980 to 1993, the expansion of higher learning was of but 20.6%.

Growth was also significant in the post-graduation system. The number of students rose from 43 thousand, in 1994, to 53.9 thousand, five years later. Brazil produced a little over nine thousand master’s degrees a year; currently the figure surpasses 14.4 thousand. During the same period, the number of doctor’s degrees per year grew from less than 2.5 thousand to 4.7 thousand. It means that, in five years, the number of people obtaining doctor’s degrees every year nearly doubled. Scholarship granting for doctor’s degrees expands continuously: 5.867 scholarships were granted in 1994; four years later 8.009 scholarships were granted.

During the last five years, the Federal Government has invested R$ 100 million in libraries, computers and IT infrastructure for public universities. In addition, 300 million dollars will be invested, starting in 2000, by means of an international tender for the purchase of equipment for graduation laboratories and university hospitals.

The Federal Government has put together a full system of research and evaluation for all levels of Brazilian education, in only five years, by means of the National Institute for Educational Studies and Research - INEP. The research and the evaluation exams on the educational system have become indispensable instruments for planning and implementing the public policies of the Ministry of Education. Starting from their results, in addition to spending more, government is now spending better, and conditions have been created for relating the expansion of the educational system to quality, and not only to quantity.

The Federal Constitution of 1988 enshrined the full right of Brazilians to health care. The doctrine principles of universality, equity and integrity are thus the basis supporting all political and legal definitions of the Brazilian health system. Starting from these principles, there have emerged important initiatives for the shaping of the universal, equality-based and participatory model being built today.

The main expression of these principles has been the establishment of the Unified Health System - SUS. Among the main guidelines of this system, one may highlight: a) decentralisation, with a single direction in each sphere of government, the regional character of the network and the hierarchical character of services; b) the participation of society and the exercise of social control, by means of collegiate decision-making levels; c) the funding of services, of a highly public nature, by means of contributions and taxes excised by the federal, state and municipality levels and under the responsibility of the three levels of government.

In Brazil, the health-care model is going through a deep change in its philosophy of action. One tries to invert the logic that used to privilege the treatment of diseases in hospitals, focusing actions in the promotion of health, in order to prevent people from becoming ill. Programmes that have been created or upgraded since 1995 have become the instruments of this change.

People from the communities themselves are trained to disseminate information on basic health care, by means of the payment of one minimal wage a month. This programme is consolidated, thanks to the priority the Federal Government has attributed to it during the last two years. By means of house calls, the agents take the responsibility for providing guidance, identifying problems and following health-related procedures. These agents are already present in the lives of 65 million citizens.

The pre-emptive work of agents is added of the activities of the teams that work in this programme, made up of a physician, a nurse and a nurse-attendant and up to six health-care agents. Each team is in charge of serving an average of 860 families in the community where such team is based, developing health promotion, protection and recovery actions. It is a fundamental activity aimed at reducing the demand for hospital care.

Started in 1994, Programme Family Health assures care to circa 21 million people. From 328 teams, at the very beginning of the Programme, it had six thousand in 1999, operating in all regions of the country. During the same period, the number of municipalities served grew from only 55 to 2.000. In 1996, the budget for the two programmes was R$ 218 million. A year later it had risen to R$ 380 million, a 74.3% increase. For 2000, a new leap forward is forecast, this time the figure will be R$ 680 million.

The target of the Ministry of Health is to have 150 thousand community agents and 20 thousand Family-Health teams in 2002. Thus, half of the Brazilian population will be served and the option for the model of health promotion will be irreversible.

Established in January, 1998, the Basic Care Threshold has put in place a new system for funding basic health efforts, which has fostered the decentralisation of such services and eliminated the possibility of political discrimination in the apportionment of funds with municipalities. The local governments of the 5.507 Brazilian municipalities now count on an automatic mechanism for the transfer of appropriations for basic-care activities: general practitioner’s consultations, pre-natal tests, oral hygiene, family planning, vaccination and all activities carried out by health agents in their communities.

After PAB was put in place, it was possible to control the practice of client-based relations, still present in the Brazilian political culture. The Municipality Health Fund is monthly supplied with resources from the Ministry of Health, without the intervention of any local authority.

In addition to ensuring a minimal expenditure of R$ 10.00 per inhabitant/year, PAB has represented an additional input of R$ 270 million a year for 1.941 municipalities, where 40 million people live, and which used to spend only R$ 3,33 per inhabitant/year. The funds, therefore, have trebled in those poorer municipalities. Overall, the Programme transfers to municipalities R$ 1.6 billion per year.

In a single day, every year, circa 20 million children are vaccinated in Brazil, against several types of diseases, among which poliomyelitis. In the period from 1996 to 1999, the funds meant for vaccination campaigns have nearly doubled - from R$ 145.1 million to R$ 270 million - which allowed the authorities to increase the coverage and to apply new vaccines for the pre-emption of other diseases, such as the flu, pneumonia, German measles and measles, hepatitis B, meningitis, diphtheria and tetanus.

During the last two years, free vaccination against the flu has extended to all people over the age of 65. Each year nine million elderly people are vaccinated, which is reducing hospital admittance for people in this age group due to respiratory afflictions during the winter months.

In order to fight infantile mortality, in 1996 a programme was created that concentrates actions of vaccination, sanitation, nutrition, women’s health care and child health care, as well as the implementation of the Community Agent and Family Health programmes. Thus, Brazil has obtained its best result in the domain of health, which was the reduction of infantile mortality among children under the age of one. From 1989 to 1998, the rate of mortality decreased from 50.9 to 36.1 per one thousand born alive - a 29.1% drop in nine years.

This programme provides, free of charge, the most utilised medicines in health dispensaries. The programme used to serve a population of 35 million people, in municipalities having less than 21 thousand inhabitants, but it has been extended to all municipalities. With the transfer of federal resources, the state and municipality funds purchase and distribute 40 types of medicine, selected according to the local reality. This is an example of the strategy of providing universal health services that also has a positive impact over income distribution.

With the Transplant Act, enacted in 1997, which regulated mechanisms for the protection of donors and of recipients, the number of transplants grew in Brazil. There were 3.711 operations in 1997; 4.053 in 1998 and 4.708 last year. The Central for Notification, Capture and Distribution of Organs, established in 15 Brazilian states, enabled the system of single state lists to be put in place and standardised the criteria for the selection of recipients of each organ. In addition to the public network, all private hospitals are now also controlled by the national system.

Cardiovascular diseases represent a serious public-health problem in Brazil, with 250 thousand casualties a year, 28% of all deaths recorded in the country and 17% of hospital admissions within the Single Health System. High blood pressure affects 20% of the adult population - 15 million people - and diabetes causes hospital admission of over one hundred thousand people a year.

To control such diseases, the Set of Actions for the Multi-factor Reduction of Non-transmissible Diseases was created as a strategy intended to reduce in a significant manner the incidence of these diseases by 2003.

Brazil is singled out by the World Health Organisation as an example, because it maintains one of the best programmes for the pre-emption of AIDS in the world. It is the only country to provide free of charge, to people infected the medicines that delay the progress of HIV. The cost is high and growing - circa R$ 487 million in 1999 - but the initiative of Government ensures better living conditions for HIV-positive individuals, as well as a longer lease of life and less hospital admittance.

In Brazil, for over three decades, companies providing health plans and insurance operated within a market practically without rules, although it involved circa 40 million users. Now, a piece of legislation clearly defines the obligations and rights of companies and those of the insured. Provisional registrations of 2.234 products and of 250 operators of health plans and insurance have been cancelled. In order to regulate the industry, the National Supplementary Health Agency was created, a body made up of representatives of the Ministries of Health, Finance, Justice, Planning and the General Secretariat of the Presidency of the Republic.

Since the beginning of 2000, the packing of medicines in Brazil have to bear a seal certifying the origin and the quality of drugs for sale in pharmacies or made available in hospitals. Government has also ensured an increase in inspection activities on the origin of medicines by means of the control of the issuance of invoices, a measure that has already had positive effects in the reduction of fraud.

The first generic medicines reached the Brazilian market in January 2000, less than a year after the creation of the legislation regulating their production. The chief goal was to reduce the prices of medicines, non-accessible to nearly half the Brazilian population. The measure has worked. Generic medicines are being sold at prices between 30 and 55% cheaper than the brand-name corresponding drugs having the same therapeutic properties and the same characteristics in terms of absorption by the human organism. In order to further force down the prices of medicines, the Single Health System, which accounts for 20% of the Brazilian pharmaceutical market, is giving priority to generic medicines in its procurement.

Parallel to these institutional measures, the National Agency for Sanitary Surveillance was created, a body aimed at, inter alia, ensuring the quality of products meant for human consumption and at preventing transmissible diseases from entering the country through airports, ports and borders.

There has been a remarkable decrease in the participation of transmissible diseases in the profile of mortality in Brazil. The occurrence of a large set of transmissible diseases for which there are already in existence effective means of control, such as vaccines, presents a drastic reduction trend. Such is the case of diphtheria, tetanus and whooping cough. Poliomyelitis, a disease that used to affect over one thousand children a year in the early 1980s, has been totally eradicated in Brazil in 1989. The existence of the disease in other continents and the risk of importing the virus justify, however, the maintenance of mass-vaccination strategies to protect Brazilian children.

Measles, a transmissible, contagious disease, that used to affect two to three million children in the 1970s, has experienced a visible reduction in the period from 1980 to 1999. A surge, that occurred in 1997 and caused one death, was controlled in the following years. The Chagas Disease, endemic in Brazil, has also been under control for several decades now, as well as leprosy, which has diminished from 16.4 cases per ten thousand inhabitants, in 1985, to 4.3 cases in 1998, bringing Brazil close to the target established by the World Health Organisation of eliminating the disease as a public-health problem.

Malaria and tuberculosis present a status of persistence and still require the reinforcing of new strategies to fight them. After having shown an important reduction, in the 1970s and in the 1980s, tuberculosis has stabilised at the threshold of 90 to 100 thousand cases a year. Malaria, on the contrary, has reduced to less than 100 thousand cases a year, during the same period, but returned to the average of circa 500 thousand cases a year, 70% of which concentrated in the Amazon Region.

A third group of diseases translates the worldwide phenomenon of emergence and re-emergence of transmissible diseases, with the emergence of AIDS, in the early 1980s. In the case of Brazil, there has also been the re-introduction of cholera, coming from Peru, in 1991, and an epidemic of dengue, which became, in the late 1990s, a public-health priority, continent-wide, after having been eradicated in several American countries in the 1950s and in the 1960s. Cholera had its epidemic peak in 1993, but the endeavours of the health system have reduced over ten fold its incidence in the following years, and now the disease is completely under control.

Visceral Leishmaniosis, a disease for which more effective forms of pre-emption have not been found yet, presents a cyclical behaviour, with an increase in the number of cases in average periods of five years. Wild yellow fever, even if it presents an annual number of cases below those of the majority of countries that share the Amazon Basin with Brazil, is the target of permanent attention, in order to protect the Brazilian population that lives in endemic areas of the Amazon Region and of the Centre-West. Since April 1998, vaccination against yellow fever has been intensified in those regions, in order to complete the coverage of all inhabitants. Over 22 million people have been vaccinated in 1999 and 2000.

In Brazil, the significant participation of the private sector and the State’s status as a purchaser of hospital services require the formulation of innovating public policies and of forms of social control apt to prevent the rationality of economic efficiency and of profitability from prevailing over the logic of social rights.

Publications

Summary

Commitment 7