What innovators in Brazil can learn from the flexible, dynamic Indian subcontinent
About a week ago, a diverse group of partners gathered to exchange critical views and challenge old strategies regarding Brazilian healthcare.
Cohosted by my organization, ACCESS Health International, with Artemisia Social Businesses, AVINA Foundation and the Aspen Network of Development Entrepreneurs, the workshop included representatives from the healthcare field, as well as entrepreneurs, academia, investors and the government. We seek to create a network of health-focused people to share ideas and strategies with, and expand that network to workers outside of major areas such as São Paulo and Rio de Janeiro. Also, we sought to discuss what other countries such as India are doing in the health field and if program models operating elsewhere could be successful in Brazil.
I presented on innovative market-based health programs that have been identified in CHMI's mapping process. Explaining that health markets are the part of the health system where health care decisions are made by both consumers and providers of services, I stressed that health markets are increasingly important in many countries, since they take the place of or operate alongside government-sponsored public delivery.
Before they arrived, we had asked participants to consider three main questions:
- What changes would you like to see in the healthcare in Brazil over the next five years?
- Please cite the biggest challenges in healthcare today.
- Please cite examples of successful initiatives and programs you think should be replicated.
We kicked off brainstorming sessions by giving our answers to these questions. Then five groups discussed questions regarding healthcare and the bottom of the pyramid in Brazil:
* What types of innovations have contributed to increasing access to health care for the bottom of the pyramid? * What could be done to provide incentives for health enterprises in Brazil to target the bottom of the pyramid?
The participants agreed that the biggest challenges to healthcare in Brazil today were government regulation and access to information and education. Participants wrote down things like, "very complex system", "high centralization", and "lack of efficient systems".
Participants felt that regulations, such as constant need for a medical doctor’s presence in almost all situations, create a less streamlined, more complex and expensive system.
In addition, restrictions on the distribution of products like eyeglasses and medicines make innovations more difficult to implement. Often, advancements exist already, but are impractical in the Brazilian sphere, such the example of low cost American hearing aids that are hindered by high import taxes.
Despite the obstacle of regulation, participants came up with alternative solutions. One group compared the Brazilian system to that in India, and found that India has a more “dynamic and flexible” system, making some models of innovation unfeasible in Brazil. On the other hand, options like telemedicine would be very helpful as they would provide access to those unable to come to the hospital but would still allow for treatment within the vast regulations of the system, as opposed to small local clinics that are “unable to remain small”.
One group suggested that government healthcare programs were often the most innovative in Brazil, like, Systema Único de Saúde (SUS). Programs such as Nefrocare, Programa de Saúde da Familia – PSF and Hospital de Cancer de Barretos are all known for their effectiveness in their fields.
While more than 75% of Brazilians rely exclusively on the government's Unified Health System (UHS or Sistema Unico de Saude-SUS), private healthcare expenditures are increasing. The fact that the public system is so effective led participants to believe that perhaps it is key to involve the government in new initiatives, despite the potential for bureaucracy to smother. Participants said regulation was certainly needed to promote safe and effective practices within the healthcare field.
The second biggest challenge partners saw was the issue of access, both to education and information as well as healthcare in general. Many agreed that the problem was not quality of healthcare but rather the peoples’ ability to gain access to it. Programs such as Projeto Centro de Integração de Educação e Saúde (Cies - Center of Education and Health Integration) and Programa de Suade de Familia were just some of the solutions to the problem of access. Other challenges, such as the problem of financing care and the need for more preventative and promotive care, were also discussed within the workshop.
After the meeting, participants said they hoped that these conferences will be able to occur through out Brazil and not just in São Paulo.
I am organizing another event on the topic of universal healthcare on June 30, also in São Paulo. Vera Cordeiro, Fabio Bibancos, Roberto Kikawa, Edmour Saiani, Maria Ribeiro and Ricardo Tete will all speak on a variety of topics, including social inclusion, engaging professionals and treatment in public hospitals. As at the previous workshop, this event is meant to encourage people to engage in the public health dialogue through a unique set of voices. For more information, click here.