Primary care at last for Brazil?

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6991.1346 (Published 27 May 1995) Cite this as: BMJ 1995;310:1346
  1. Andrew Haines,
  2. Elizabeth Wartchow,
  3. Airton Stein,
  4. Eliana Mattos Dourado,
  5. Jon Pollock,
  6. Barbara Stilwell
  1. Professor of primary health care University College London Medical School, Whittington Hospital, London N19 5NF
  2. Community general practitioner Community Health Service, Conceicao Hospital, Porto Alegre, Brazil
  3. President Brazilian Association of Community General Practitioners, Porto Alegre, Brazil
  4. Coordinator Family Health Programme, Ministry of Health, Brasilia, Brazil
  5. Research fellow Institute of Child Health, University of Bristol, Bristol BS2 8BJ
  6. Principal lecturer Institute of Advanced Nursing Education, Royal College of Nursing, London W1M 0AB

    Much training is needed

    Brazil has one of the most unequal distributions of income in the world.1 Its health system is dominated by hospital care, and around 80% of hospital admissions paid for by public funds are to hospitals in the private sector.2 Because pay is so poor in the public sector many doctors are forced to have two or more appointments to earn a reasonable income. Although the country produces more doctors per capita than many other comparable middle income countries, most are “specialists” with limited training, and few want to work in primary care. Community nurses are also in short supply. There are only two sizeable programmes for training primary care doctors, both based in the southern city of Porto Alegre. These train about 50 doctors a year.

    The Ministry of Health in Brasilia recognises the impossibility of developing a national health system without investing in primary care and is creating a family health programme. This programme intended to establish 2500 primary care teams nationwide in the first year.3 It was proposed that nearly half would be in the impoverished north east. Nine …

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