Dr Flavia Cavalcanti at the Bank of Incentive and Support for Breastfeeding in Petrolina, Brazil. Credit: Genna Naccache/Save the Children.

Dr Flavia Cavalcanti is a paediatrician in a neonatal centre in the north-eastern state of Pemembuco. “She says “I’ve been working as a paediatrician for about 19 years. I was always worried about children’s nutrition. For many years there were no social programmes in Brazil and the infant mortality rate was very high because of diarrhoea. Now I am involved in a programme that teaches medical staff and families about the importance of exclusive breastfeeding. Very quickly, we have been able to change people’s attitudes.

My neonatal unit also promotes ‘mae canguru’ (kangaroo mothercare) to help babies grow faster and healthier during the first crucial weeks. I believe it’s saved many premature babies’ lives. I feel great satisfaction working with premature babies and helping them overcome the difficulties they face. It’s more than a job”.

Neonatal mortality rate  (per 1,000 live births) (2011) 10
Under-five mortality rate (per 1,000 live births) (2011) 15
Maternal mortality ratio (per 100,000 live births) (2010) 56
Number of doctors, nurses and midwives per 10,000 people (2010) 31.4
Births attended by skilled personnel (2011) 98.9%
Total expenditure on health as a percentage of gross domestic product (2011) 8.9%
General government expenditure on health as a percentage of total expenditure on health (2011) 45.7%

Brazil recognized universal access to health care as a fundamental right in its Constitution of 1988 and created the Unified Health System (SUS), to provide free comprehensive care and essential medicines to all citizens. In parallel to the SUS, there is a private sub-system which covers predominantly those with capacity to buy private insurance or whose employer provides health coverage – resulting in a two-tiered system. Private expenditure, of which 58% is out-of-pocket, represents 55% of total health expenditure.

The nurse-to-physician ratio is 3.6, above the OECD average, and 36% of physicians are women. There is no national HRH long-term plan, but various strategies and investments address HRH needs, such as geographical disparities (density of physicians varies from 40.9 in the state of Rio de Janeiro to 7.1 in the state of Maranhão). In June 2013, the Ministry of Health launched “Mais Medicos” (More Doctors), a national and international recruitment program to fill in available positions in underserved regions at primary care level. Mechanisms for accreditation and regulation of the health workforce are in place.

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