Neglected diseases in Brazil
"Addressing inequities and inequalities in the health of neglected populations"
Brazil, like many countries, has two distinct sets of health problems – the diseases of affluences and those of poverty, each with radically different demands in terms of policy, resources, and radically different in their visibility and ability to attract resources. The health services in Brazil have been decentralized since the 1990s and are largely managed by the 5,700 municipalities within the 27 states of the country. The Ministry of Health coordinates the whole system and funds 75% of the total budget. Neglected diseases are concentrated in the impoverished states of the North and North East. All the economic, health and social indicators are significantly poorer in this region. Within these areas there is also considerable geographic overlap of where neglected diseases occur lending themselves to adopting an integrated approach to tackle these diseases.
Efforts need to be intensified
Leprosy remains a public health problem in Brazil with national prevalence rates around 4 per 10,000 inhabitants. This is significantly higher than the WHO elimination target. The prevalence rates go up to 10 per 10,000 in the North and North East. The key obstacles to elimination are poor access to diagnosis and treatment as well as complex treatment guidelines. Various measures are underway to address these problems and intensify efforts to eliminate leprosy. Important policy decisions have been made to integrate leprosy services within primary health care services.
Although the total number of reported cases of visceral leishmaniasis has been declining in recent years, there remain areas of high transmission of the disease. Eco-epidemiological studies have been initiated to study the reemergence of the disease. Special funds are provided to municipalities to deal with the outbreaks.
In areas with high dengue incidence rates efforts are being made to improve surveillance, decentralize vector control as well as laboratory diagnosis. Controlling dengue involves a multi-sector agenda including garbage collection, access to water, etc.
Despite the steady decline in mortality rates from schistosomiasis in the Northeastern region, highly endemic areas remain. Considerable progress has been made towards interruption of transmission of Chagas disease.
The way ahead
Tackling neglected diseases requires a multiple disease approach within an integrated framework due to the substantial geographical overlay of affected areas. A close link also needs to be established between surveillance and control activities. Greater decentralization in terms of management, planning and implementation is needed together with centralization of activities such as setting standards, purchasing drugs, vaccines and insecticides. The overall aim is to integrate neglected diseases into primary health care, with close monitoring of inequalities.