PHA-Exchange> PHC in Brasil

[Claudio]

Dear all,

Thanks for the very interesting and useful Alma Ata anniversary pack (to follow shortly in the pha-exchange). My compliments and thanks to all those, whose hard work has gone in making it available.

I am just back from a visit to Bahia state in Brazil. As you may know, it is for last few years that Brazil has been making a very big structural change - delegating powers to the municipalities, including the power to decide and use resources for health care according to the needs of each municipality. At the same time, there are two national level programmes, which are being adapted and implemented at municiple level - PACS (community health agents programme) for rural areas and PSF (Family health programme) mainly for urban areas.

During my visit, I spoke to lot of persons and organisations working at community level and I was struck by their enthusiasm for what they see as a very positive step for reaching Health for All initiative. The decentralisation process has its share of problems, including the very medical vision of health and health services in some municipalities and the progress to decentralisation (or municipalization, as they call it) has been slow and problematic. Still it does seem to be an attempt to put into practice some of the principles of Alma Ata at a very large scale and with the potential to affect millions of persons.

At the same time, the position taken by Brazilian government and Brazilian health professionals on some recent issues, especially related to drug-related policies, has been courageous and counter-current.

Often the initiatives in countries where English is not the main language, remain ignored by majority of world. I wonder, if there are any serious international papers analysing what is happening in Brazil and if PHM should play an active role in learning more about it in a critical manner. The next PHA in Porto Alegre in July 2004 can be an excellent opportunity to do so. 

Sunil
AIFO, Bologna, Italy

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