Carl T. Brighton Carl T. Brighton WorkshopWorkshop

Musculoskeletal Trauma inMusculoskeletal Trauma inLow and MiddleLow and Middle

Income CountriesIncome CountriesAhmedabad – India 2007Ahmedabad – India 2007

Clinical Orthopaedics and Related ResearchClinical Orthopaedics and Related ResearchThe Association of Bone and Joint SurgeonsThe Association of Bone and Joint Surgeons

DELIVERY OF MS CAREDELIVERY OF MS CARE

CHALLENGES & CHALLENGES & SOLUTIONS IN SOLUTIONS IN

BRAZIL BRAZIL

Marcos MusafirMarcos Musafir

THE ROLE OF THE MEMBERS OF

AT THE SCENARIUM OF THE BRAZILIAN

HEALTH CARE SYSTEMMarcos Musafir

POPULATION: 180 MILLION 5.700 Cities

680 with more than 250.000 inh.1.800 with plain medical care

3.000 with family care teams only

HEALTH CARE SYSTEMHEALTH CARE SYSTEM PUBLIC : SUS PUBLIC : SUS TOTALLY FREE=Public HospitalsTOTALLY FREE=Public Hospitals EQUAL ACCESS (75% ONLY THIS)EQUAL ACCESS (75% ONLY THIS) GOOD IN PREVENTION (AIDS)GOOD IN PREVENTION (AIDS) POOR IN EMERGENCY/TRAUMAPOOR IN EMERGENCY/TRAUMA

PRIVATE: Companies or Direct PaymentPRIVATE: Companies or Direct Payment PAY FOR SERVICEPAY FOR SERVICE BETTER PRIVATE HOSPITALSBETTER PRIVATE HOSPITALS ONLY 25% OF THE POPULATION ONLY 25% OF THE POPULATION

Geographic Distribution Hospital / Beds (2005/6)

Region H.Públic of SUS

H. Private+ SUS

BedsPúb./Priv.

Per 1.000 inhabitants

NORTH 310 154 24.604 2,01

NORTHWEST

1.070 917 119.682 2,44

MIDDLE WEST

243 398 36.630 3,00

SOUTHEAST

421 1.189 186.968 2,67

SOUTH 173 1.080 73.707 3,06

TOTAL 2.217 3.738 441.591 6 %

HEALTH CARE SYSTEMHEALTH CARE SYSTEM MUSCULOSKELETAL MUSCULOSKELETAL

HEALTH & SCIENCEHEALTH & SCIENCE

MEDICAL DOCTORS TOTAL: 350.000 in BrazilMEDICAL DOCTORS TOTAL: 350.000 in Brazil MEDICAL SCHOOLS: 166 *MEDICAL SCHOOLS: 166 * ORTHOPAEDIC SURGEONS: ORTHOPAEDIC SURGEONS: SBOT : 9.631 / but in TRAUMA: 3.600SBOT : 9.631 / but in TRAUMA: 3.600 OFFICIAL RESIDENTS/3 years: 1.572OFFICIAL RESIDENTS/3 years: 1.572 NON MEMBERS: 3.200 and 2NON MEMBERS: 3.200 and 2ndnd care: 1.800* care: 1.800* RHEUMAT + PHYSIATRIC + GERIATRICS: 4.000RHEUMAT + PHYSIATRIC + GERIATRICS: 4.000

HEALTH CARE SYSTEMHEALTH CARE SYSTEM BARRIERS TO THE DELIVERY OF CAREBARRIERS TO THE DELIVERY OF CARE::

Administrative conscious is low, with the combination Administrative conscious is low, with the combination of bad spenditure plus star personality;of bad spenditure plus star personality; Reduced technical conditions = RISKS for MD;Reduced technical conditions = RISKS for MD; Monthly fee for specialists: average: US$3.000,00Monthly fee for specialists: average: US$3.000,00 Private practice: Much more $: Private practice: Much more $: (3 times more average);(3 times more average); Not a career as the military = No motivation;Not a career as the military = No motivation; Still number 1 for public confidence! on public research;Still number 1 for public confidence! on public research; Now increasing PRESSURE over politicians at National, Now increasing PRESSURE over politicians at National,

State and City levels of Governments;State and City levels of Governments;

PREVENTION STRATEGIESPREVENTION STRATEGIES THE 6 UN/WHO RECOMMENDATION GAVE THE 6 UN/WHO RECOMMENDATION GAVE

THE SCIENTIFIC AND POLITICAL SUPPORT THE SCIENTIFIC AND POLITICAL SUPPORT TO IMPROVE PREVENTION ON MSK TO IMPROVE PREVENTION ON MSK TRAUMA RELATED TO RTI & VIOLENCE;TRAUMA RELATED TO RTI & VIOLENCE;

ONE OF THE 10 PRIORITIES OF THE NEW ONE OF THE 10 PRIORITIES OF THE NEW MINISTER OF HEALTH – J. G. TEMPORAO;MINISTER OF HEALTH – J. G. TEMPORAO;

SUGGESTIONSSUGGESTIONS INTERNATIONAL RECOMMENDATIONS BY WHO INTERNATIONAL RECOMMENDATIONS BY WHO

AND PARTNERS TO CHANGE IT NOW;AND PARTNERS TO CHANGE IT NOW; BEST PRACTICES SHARED WORLDWIDE;BEST PRACTICES SHARED WORLDWIDE; STIMULATE STANDARDS OF CARE;STIMULATE STANDARDS OF CARE; MEDICAL EDUCATION ACCESS;MEDICAL EDUCATION ACCESS; TRAINED SURGEONS IN SKILLS: Safety First;TRAINED SURGEONS IN SKILLS: Safety First; AWARENESS IN THE POPULATION;AWARENESS IN THE POPULATION; INCENTIVE FOR DISTRIBUTION OF SURGEONS, INCENTIVE FOR DISTRIBUTION OF SURGEONS,

EQUIPMENTS AND MATERIALS;EQUIPMENTS AND MATERIALS; CHANGE FROM POLITICS WITH or IN HEALTH TO CHANGE FROM POLITICS WITH or IN HEALTH TO

HEALTH POLITICAL SERIOUS PRIORITIES. HEALTH POLITICAL SERIOUS PRIORITIES.

MUITO OBRIGADOMUITO OBRIGADO

Marcos MusafirMarcos Musafir