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Story Publication logo July 30, 2012

Free Healthcare: Betting on Brazil


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Two transitioning economies, similar development challenges, vastly different population size and...

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The constant stream of patients to the out-patient clinic at the Hospital das Clinicas in Sao Paulo. Image by Rema Nagarajan. Brazil, 2012.

Should the state provide healthcare? Could healthcare be a fundamental right? In the US, such questions can dominate an entire presidential campaign, split the country, and yet see no resolution. In India, it is the stuff of dreams—utopian, impractical.

In many Latin American countries, however, especially in Brazil, this question is settled. Health is a fundamental right granted by the Brazilian constitution of 1988. The debate is over. In the span of two decades, that resolution seems to have evolved into a conviction—an assertion of people's rights.

Across the board, from the common man to senior government officials, it is taken for granted that it is the government's responsibility to provide healthcare and that it is the people's basic right to have access to universal, equitable and comprehensive healthcare. The debate in Brazil today is not so much about if, but about how. Not about whether healthcare is the responsibility of the state, or, whether it is a fundamental right, but about how to efficiently and effectively provide public healthcare.

Take the instance of Prof José Otávio Costa Auler, Vice-Dean in charge of the Faculty of Medicine to which the largest hospital in South America, the Hospital das Clinicas is attached. Regarding patients' complaints of delays in accessing healthcare in the hospital, he talks of the need to enhance the budget and to regulate the flow of patients from all over to reduce the load on the hospital. He doesn't even suggest user fees to raise money, or consider it impossible to provide services free of cost. "The budget is not enough to maintain standards. We need to extend the services and organize patient flow so that people don't have to wait for long hours," says Prof Auler.

Ask Paulo Teixeira, the former director of the National STD/AIDS Program of the Health Ministry, if it is practical for the government to try and provide the expensive drugs needed to treat every single AIDS patient, and he points out that it was not hypothetical anymore as Brazil has proved it can be done. "After 20 years of anti-retrovirals (ARVs) we know it is not a problem. The constitution mandated treatment for all and so we found a way to do it," says Teixeira.

In a similar vein, Dr. Armando de Negri, president of the International Society for Equity in Health says, "When we pursue the idea that we have to provide everything, then we shift the agenda and ask ourselves how to make it cheaper and accessible and find a way to do it. In the case of ARV drugs for AIDS, the mandate to provide for all who need it, brought about the debate about patents and intellectual property."

The refrain seems to be that if the state really wanted, it could provide healthcare for all. Opposing views have wilted from lack of popular support. Few countries, least of all developing ones the size of Brazil, have attempted to deliver absolutely free healthcare for all its citizens. It remains to be seen if Brazil, with its far from perfect public health system, will actually pull it off with its unwavering commitment and show us the way.


navy halftone illustration of a female doctor with her arms crossed


Health Inequities

Health Inequities

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