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Free Content Health sector reform in Brazil: impact on tuberculosis control [Country Case Report]

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This paper comments on the reform process of the health sector policies that took place after 1986 in Brazil, and its negative impact on the National Tuberculosis Control Programme (NTP). Decentralisation was followed by a slow transition from a vertical programme to an integrated programme. In 1990, the NTP was dismantled due to fiscal constraints, and in 1992, the NTP component was reorganised, with national and regional co-ordinators and subsequent increased support to state programmes. In 1996, the health sector reform continued its process, but this consisted mainly of cuts in health budgets and rapid decentralisation from federal level to unprepared states and municipalities, leading to the weakening of local tuberculosis control programmes. Only recently has government commitment been secured, with a new National Plan on Tuberculosis Control which includes the World Health Organization strategy for TB control—the implementation of the DOTS strategy (directly-observed treatment, short-course)—and efforts are being concentrated in 5500 municipalities. The programme has a centralised administration which supports decentralised implementation through out-patient clinics, and resources will be focused on local service delivery.
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Keywords: Brazil; DOTS; HIV; health sector reform; tuberculosis; tuberculosis control programme

Document Type: Miscellaneous

Affiliations: 1: Discipline of Pneumology, School of Medicine and University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil 2: National Co-ordinator of Lung Health, DGPES/SPS/Ministry of Health, Brasilia, Brazil

Publication date: 2000-07-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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