BMJ 1995;310:1346-1347 (27 May)

Editorials

Primary care at last for Brazil?

Much training is needed

Brazil has one of the most unequal distributions of income in the world.1 Its health system is dominated by hospital care, and around 80% of hospital admissions paid for by public funds are to hospitals in the private sector.2 Because pay is so poor in the public sector many doctors are forced to have two or more appointments to earn a reasonable income. Although the country produces more doctors per capita than many other comparable middle income countries, most are "specialists" with limited training, and few want to work in primary care. Community nurses are also in short supply. There are only two sizeable programmes for training primary care doctors, both based in the southern city of Porto Alegre. These train about 50 doctors a year.

The Ministry of Health in Brasilia recognises the impossibility of developing a national health system without investing in primary care . . . [Full text of this article]


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