• Spending overview
• Policy overview
• Diseases overview

Spending overview

Despite improvements in the past two decades, Brazil's health indicators compare poorly with other major economies in the region. Life expectancy is lower than in Mexico, Argentina, Venezuela and Chile, and the infant mortality rate is the highest among these countries. This reflects Brazil's wide health inequalities between the country's rich and poor, and between the urban south and rural north.

Macroeconomic instability during the 1990s caused healthcare spending measured as a share of GDP to fluctuate between a low of 5.5% and a high of 7%. Since 2000 health spending has stabilised at 8% of GDP, which is slightly higher than the average for Latin America. In US-dollar terms, spending per head on pharmaceuticals remains low, at around one-half of the levels recorded in Mexico and less than 5% of the levels recorded in the US. Tight public finances, coupled with a weaker economy in 2009 will constrain growth of both public and private spending on healthcare in the short term, but spending will pick up in 2011-13 as GDP grows by around 4% per year.

Policy overview

Efforts to improve the standard of public healthcare provision have been hindered by fiscal constraints, but the federal system has allowed scope for innovations at the local level, with some regions having developed successful healthcare initiatives, despite limited resources. Initiatives include the creation of healthcare consortia, which pool the resources of several neighbouring municipalities. Multinational institutions, including the World Bank and the UN Educational, Scientific and Cultural Organisation (UNESCO), have provided some support, although as a middle-income country, Brazil is not a major recipient of multilateral assistance as a percentage of total healthcare spending.

Brazil's government plans to continue investing in the expansion of the Programa de Saúde Familiar (PSF, family healthcare programme), reaffirming that the PSF formed the cornerstone of its strategy to improve basic healthcare. Some of the funds will be allocated to the development of human resources; currently, a shortage of trained medical personnel is slowing the programme's expansion into the bigger municipalities.

The public healthcare sector is currently undergoing a modernisation process, in which foreign partners are participating as suppliers of equipment and providers of services. Along with the decentralisation of control, the Ministry of Health has been shifting the emphasis from treatment to prevention, by means of family healthcare programmes that prioritise maternity and infant care services, and HIV/AIDS education programmes. This involves a fundamental change in the way doctors are trained, as most of the country's around 250,000 doctors are specialists, rather than the family doctors required to build a preventive system. Multilateral lenders have provided support for healthcare reforms and other special programmes.

The strategy for expanding public-sector health coverage is centred on the PSF, launched in 1994. The programme aims to establish primary care facilities for families in all of Brazil's 5,560 municipalities. The aim is to have one "family health team" comprising a doctor, a nurse and support staff, for every 4,500 inhabitants. By 2005 over 80% of municipalities had been reached. However, since these consisted mostly of small rural municipalities, this covered 35% of the population, according to recent estimates. The government has also developed a national policy for the elderly, to provide free access to drugs and medical attention.

Diseases overview

Deaths by communicable diseases have been falling, but death rates for "lifestyle" illnesses such as heart disease and diabetes have been creeping up. According to data from the World Health Organisation (WHO), around 1% of the Brazilian adult population (aged 15 and over) was living with AIDS in 2005. This reflects marked improvements in the past five years. It puts Brazil on a par with the Latin America average and well below the world average. Investment in urban sanitation is expected to have a positive impact on infant mortality and life expectancy indicators during the forecast period.