Intended for healthcare professionals


Brazil’s Family Health Programme

BMJ 2010; 341 doi: (Published 29 November 2010) Cite this as: BMJ 2010;341:c4945
  1. Matthew Harris, academic clinical fellow in public health1,
  2. Andy Haines, professor of public health and primary care2
  1. 1Kings College London, London WC2R 2LS, UK
  2. 2Department of Social and Environmental Health Research and Department of Nutrition and Public Health Intervention Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
  1. mattjharris{at}

A cost effective success that higher income countries could learn from

Healthcare reforms in Brazil began in 1988 as part of a broader sociopolitical movement at the end of nearly 20 years of military rule. The new constitution was underpinned by principles of budgetary and political decentralisation, community participation in local budget setting, and the acknowledgment that health and access to health care is a universal human right. This laid the foundation for the Sistema Único de Saúde, or Unified Health System, and began a nationwide shift from tertiary centre based health care to comprehensive primary health care, free at the point of use, funded by the taxpayer, and inspired by the Alma-Ata Declaration of 1978.

Over the past 15 years progress in Brazilian public health has been remarkable. Infant mortality has dropped from 48 per 1000 to 17 per 1000. In just the past five years, hospital admissions due to diabetes or stroke have decreased by 25%, the proportion of children under 5 years old who are underweight has fallen by 67%, over 75% of women now receive seven or more antenatal consultations, and diphtheria, tetanus, and pertussis (DTP) vaccine coverage in children less than 1 year old is greater than 95% in most municipalities. …

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