While 70 percent of Brazilians seek health care in the public sector, those who can afford it opt for private services. And who can blame them? A WHO editorial points to notorious overcrowding—“long queues… beds spilling into corridors”—as well as “out-dated equipment.” While the famous Sistema Único de Saúde (SUS) has provided virtually universal access to primary care, it has not excelled at delivering specialized medicine, an increasingly acute need with the nation’s growing burden of chronic disease.
In 2008, a physician named Roberto Kikawa introduced a significant innovation to deliver prompt, privately-run specialty care in collaboration with the public sector. His initiative, Projeto CIES, parks mobile clinics with specialized equipment and highly trained teams near public hospitals. CIES contracts with city governments or private companies to cover all treatment at full cost. By reducing the wait for tests and providing quicker results, CIES allows patients to start treatment faster.
CIES mobile health facilities are flexible enough to offer a surprisingly wide range of comprehensive care on wheels. The “health wagon,” a truck opening out to nearly 1100 square feet, can serve 250 people in a single day at an average cost of $10 each. Dr. Kikawa, a gastroenterologist, started CIES in the outskirts of São Paulo. Since then, the project has expanded to 28 cities in five states, serving more than 100,000 outpatients in its five years of operation.
I spoke with Dr. Kikawa about this innovative initiative.
Rose Reis: How long do patients typically wait to get specialty care in Brazil?
Roberto Kikawa: Access to specialized medicine is very poor, especially in small towns and rural areas. Patients often have to wait more than six months for an appointment with a specialist.
RR: Describe your mobile facilities.
RK: We have one “health wagon,” in which we can do four simultaneous exams at the same time. We operate the wagon with four nurses, three doctors and four other staff members: receptionists, attendants and assistants. This facility provides up to ten specialty services, from gastroenterology to cardiology and minor surgery.
Our smaller facility is the health box. Twenty-five feet long and eight feet wide, this container-like structure opens and doubles in size so we can see two patients at once. We staff this facility with two doctors, two nurses, and two administrative staff members. We can tow it from a truck or carry it on a river by catamaran or raft, since it was designed to serve people living in banks along the Upper Amazon. We can offer four specialties at a maximum in this facility. [Editor’s note: In addition, CIES notes that this facility is ideally suited to attending patients during Olympic events or World Cup matches.)
We also have a Health Van designed to transport equipment for digital radiology exams and ultrasound/echocardiography equipment. The van complements Brazil’s Family Health Program, which brings preventive care into communities.
RR: Where in Brazil have you set up the health wagon recently?
RK: This past year, we were in three different regions of São José dos Campos [a city of about 636,000 near São Paulo]. Our services were delivered through a partnership with the local administration. People were referred to us by the public hospital after they did a primary consultation. It was as if we were working for the public system.
RR: How do you approach policymakers to develop new contracts?
RK: They often hear about us, but it’s still a challenge to explain how we can help them solve the problem of offering good specialized health care to patients, and how much more efficient we are. In the contracts, we agree on a value per exam or procedure including equipment and logistics—the patients don’t pay.
RR: What kind of companies have contracted CIES to serve their communities?
RK: We have worked with companies including Hospital São Camilo, ThyssenKrupp, Metalfrio Solutions, Engemet, and EcoRodovias to offer our services to surrounding communities or employees.
RR: How much do you charge?
RK: Services are free to patients, but our contracts include a defined price for each type of procedure: an audiometry (hearing) exam costs R$ 6, around $3 USD; gastroenterology consultations cost R$ 14, around $7 USD; ergometric (cardiac stress) tests with electrocardiographics costs R$ 106, around $53 USD.
RR: Do you have any plans to expand?
RK: We’ve attracted attention from more than 50 cities in Brazil and have immediate plans to expand in Brazil to serve people in North and Northeast Brazil.
In addition, we were recently invited by a company to replicate our model in Peru. We are trying to start a franchising business model, in which our social enterprise, Fleximedical, sells mobile health facilities and training to other enterprises.