Brazil and National Health Care

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In the 1980’s there were huge changes in Brazil’s government.  There was a movement to increase access to healthcare and in 1988 a national health care system (SUS) was founded.  The concept created by SUS is to have a primary care clinic (referred to as Family Health Strategy, FHS) serve as the starting point of care.  The FHS team includes physicians, nurses, family health agents, and other positions.  The family health agents are members of the local community who are employed by the FHS to perform secretary services and follow the care of a number of families.  Dentists, dental assistants, and hygienists are a part of the oral health group within the FHS concept.

Prof. Dr. Roosevelt was kind enough to take us to a Family Health Strategy clinic in Bauru. Over 20 family health agents were employed at this clinic.  Currently there are only 2 FHS clinics in the city of Bauru, but other public health clinics exist.  The 2 FHS clinics in Bauru serve 6.8% of the population, and 31 FHS clinics are eventually planned to serve Bauru, a population of around 340,000.  We also had the chance to visit a secondary care FHS dental clinic, which provided more complex dental care compared to basic restorative and hygiene procedures performed at the primary FHS clinics.

According to Prof. Dr. Roosevelt the FHS is working well in smaller communities, but it has been difficult to implement in larger cities.  Health politics are concentrated at the federal level, but the delivery and management of the system is at the local level.  Funding for the FHS clinics come from the city, state, and national level.  Healthcare is free at all public clinics and hospitals in Brazil.

At FOB USP students take a public health class every semester of dental school.  Students are educated on the principals of community health, public policy in Brazil, health education, and epidemiology.  Public fluoridation of water in Brazil started in 1974, and fluoridation of dentrifice mandated in 1989.  In the city of Bauru, which is where FOB USP is located, they have reached almost 90% caries prevention in children based on DMFT values between 1976 and 2006.

Lauren Ehardt is a D3 who is going to miss suco de abacaxi com hortelã (pineapple juice with mint).