Brazil's unified health system: the first 30 years and prospects for the future.

In 1988, the Brazilian Constitution defined health as a universal right and a state responsibility. Progress towards universal health coverage in Brazil has been achieved through a unified health system (Sistema Único de Saúde [SUS]), created in 1990. With successes and setbacks in the implementation of health programmes and the organisation of its health system, Brazil has achieved nearly universal access to health-care services for the population. The trajectory of the development and expansion of the SUS offers valuable lessons on how to scale universal health coverage in a highly unequal country with relatively low resources allocated to health-care services by the government compared with that in middle-income and high-income countries. Analysis of the past 30 years since the inception of the SUS shows that innovations extend beyond the development of new models of care and highlights the importance of establishing political, legal, organisational, and management-related structures, with clearly defined roles for both the federal and local governments in the governance, planning, financing, and provision of health-care services. The expansion of the SUS has allowed Brazil to rapidly address the changing health needs of the population, with dramatic upscaling of health service coverage in just three decades. However, despite its successes, analysis of future scenarios suggests the urgent need to address lingering geographical inequalities, insufficient funding, and suboptimal private sector-public sector collaboration. Fiscal policies implemented in 2016 ushered in austerity measures that, alongside the new environmental, educational, and health policies of the Brazilian government, could reverse the hard-earned achievements of the SUS and threaten its sustainability and ability to fulfil its constitutional mandate of providing health care for all.

Access to child care services in the Northeast and in the South Regions of Brazil / Acesso ao atendimento de puericultura nas Regiões Nordeste e Sul do Brasil

Abstract Objectives: to estimate the incomplete follow-up on child care services and the associated factors in the municipalities in the Northeast and in the South of Brazil. Methods: a population-based cross-sectional study with 7,915 children. The incomplete follow-up on child care regarded the absence of at least one of the seven advocated care services. The Poisson regression was used for crude and adjusted analysis. Results: the prevalence of the incomplete follow-up child care was 53.6% (CI95%= 52.5-54.7) in the Northeast and 28.3% (CI95%= 27.3-29.3) in the South, therefore 91% was greater in the Northeast (PR=1.91; CI95%= 1.73-2.11). Protector effect was observed: in the muni-cipalities with 30 to 49 thousand inhabitants in the Northeast (PR= 0.72; CI95%= 0.64-0.82) and 100 to 999 thousand inhabitants in the South (PR=0.69; CI95%= 0.57-0.84); the South has the greatest income quartile (RP=0.77; CI95%= 0.63-0.95) and has six or more prenatal consultations (PR=0.83; CI95%= 0.75-0.92) in the Northeast and (PR=0.65; CI95%= 0.53-0.79) in the South. Social classes D and E showed risks (PR=1.41; CI95%= 1.19-1.67) in the Northeast and (PR=1.67; CI95%= 1.37-2.03) in the South. Conclusions: children in the Northeast are more likely not to have a complete child care follow-up, implying that the user does not come to be attended or finds difficulties to have access to the health services.

Resumo Objetivos: estimar o acompanhamento incompleto de puericultura e os fatores associados, em municípios do Nordeste e Sul do Brasil. Métodos: estudo transversal, de base populacional, realizado com 7.915 crianças. Considerou-se acompanhamento incompleto da puericultura a ausência em pelo menos um dos sete atendimentos preconizados. Utilizou-se Regressão de Poisson para análise bruta e ajustada. Resultados: a prevalência do acompanhamento incompleto da puericultura foi de 53,6% (IC95%= 52,5-54,7) no Nordeste e de 28,3% (IC95%= 27,3-29,3) no Sul, sendo 91% maior no Nordeste (RP=1,91; IC95% 1,73-2,11). Efeito protetor foi observado: em municípios com 30 a 49 mil habitantes no Nordeste (RP= 0,72; IC95%= 0,64-0,82) e 100 a 999 mil habitantes no Sul (RP=0,69; IC95% 0,57-0,84); pertencer ao maior quartil de renda per capita no Sul (RP=0,77; IC95% 0,63-0,95) e fazer seis ou mais consultas de pré-natal (RP=0,83; IC95%=0,75-0,92) Nordeste e (RP=0,65; IC95%= 0,53-0,79) Sul. Pertencer às classes D e E evidenciou risco no Nordeste (RP=1,41; IC95%= 1,19-1,67) e no Sul (RP=1,67; IC95%=1,37-2,03). Conclusões: as crianças no Nordeste estão mais sujeitas a não seguir o acompanhamento completo de puericultura, sugerindo que o usuário não comparece ou encontra dificuldades nos acesso aos serviços de saúde.

Saúde Móvel: novas perspectivas para a oferta de serviços em saúde / Mobile health: new perspectives for healthcare provision / Salud Móvil: nuevas perspectivas para la prestación de servicios de salud

OBJETIVO: revisar e discutir as novas perspectivas para a oferta de serviços em saúde decorrentes do desenvolvimento da saúde móvel e dos dispositivos vestíveis inteligentes. MÉTODOS: foi realizada revisão não sistemática da literatura para identificar artigos completos, cujos títulos destacassem o termo 'mHealth' e/ou 'Smart wearable', publicados nos últimos 15 anos. RESULTADOS: foram identificadas 467 publicações em periódicos indexados ao portal da Capes, 75 delas levadas em consideração pela análise; foram consolidadas evidências quanto às novas possibilidades decorrentes da disseminação da saúde móvel, aglutinadas segundo as categorias 'monitoramento de condições de saúde', 'transmissão de informações e análises de dados' e 'diagnóstico e terapêutica'. CONCLUSÃO: os trabalhos revisados sugerem que a oferta de serviços de saúde sofrerá alterações ao longo dos próximos anos, no que tange às categorias analisadas, o que exigirá um esforço de adaptação por parte dos profissionais de saúde, acadêmicos e usuários.

OBJECTIVE: to review and discuss new perspectives for healthcare provision resulting from the development of mobile health and intelligent wearable devices. METHODS: an unsystematic literature review was conducted to identify complete articles published in the last 15 years with titles highlighting the term 'mHealth' and/or 'Smart wearable'. RESULTS: 467 publications were identified in journals indexed on the CAPES portal, of which 75 were considered for analysis; evidence was then consolidated as to new possibilities arising from the spread of mobile health, grouped into the following categories: 'health status monitoring', 'information transmission and data analysis', and 'diagnosis and therapy'. CONCLUSION: the studies reviewed suggest that healthcare provision will change over the coming years with regard to the categories analyzed. This will require adaptation on the part of health professionals, academics and service users.

OBJETIVOS: revisar y discutir las nuevas perspectivas para la prestación de servicios de salud resultantes del desarrollo de la salud móvil (mHealth) y los dispositivos portátiles inteligentes. MÉTODOS: revisión narrativa, no sistemática, de la literatura para identificar artículos completos, cuyos títulos destacasen el termino 'mHealth' y/o 'Smart wearable', publicados en los últimos 15 años. RESULTADOS: se identificaron 467 publicaciones de revistas indexadas por el portal Capes de las cuales 75 fueron consideradas; así se consolidaron las evidencias sobre las nuevas posibilidades que surgen de la propagación de la salud móvil, vinculadas a las categorías 'monitoreo del estado de salud', 'transmisión de información y análisis de datos', y 'diagnóstico y terapéutica'. CONCLUSIÓN: los estudios analizados sugieren que la oferta de servicios de salud va a cambiar en los próximos años, con respecto a las categorías analizadas, lo que requerirá un esfuerzo de adaptación por parte de los profesionales de salud, académicos y usuarios.