2005 Award Winner
Winners:
Secretaria Municipal de Saude, Rio de Janeiro, Brazil
2005
Publication:
The Public Management and Citizenship Programme in Brazil
Organization:
The Public Management and Citizenship Programme in Brazil
Jurisdiction:
Brazil

The National Health Service (SUS) is a public health plan that aims for universal and equal healthcare and treatment for all Brazilian citizens. This is ambitious considering the country’s highly unequal socio-economic situation. The city of Rio de Janeiro, with a population of over 6 million, has suffered for years from a serious crisis in public health. One of the greatest challenges faced by Rio de Janeiro and other large urban centers is the limited reach of health programs and difficulties in supplying medication. One solution found by the Municipal Department of Public Health, in 2002, was the Medication at Home Project, a joint initiative of the Hypertension and Diabetes Program and the Municipal Department of Health to provide medicine regularly to chronic sufferers of diabetes and hypertension.

To give an example of the Project’s methodology: if a patient goes to an appointment at the local health clinic and signs up to take part in the Hypertension and Diabetes Program, the attending doctor will then type up an electronic prescription, specifying type and frequency of medication. This information is stored on the Department of Health computer network. The doctor then sets a follow-up appointment. Next, the patient’s data is sent to a company in charge of distributing medication. The patient receives the pertinent medication at home until the date of the next appointment. If the patient does not come to this appointment, the supply of medication is interrupted until the patient reports for a check-up.

In July 2005, the Hypertension and Diabetes Program treated over 400,000 patients. Besides regular doctor appointments, the Program offered support appointments with specialists from other areas, such as nutrition, social assistance, and psychology, and carries out individual and group educational activities. Although the administrative center of the Medication at Home Project is at the Department of Health, it operates in conjunction with the Hypertension and Diabetes Program. The project takes place at 112 health clinics throughout the municipality. Each health clinic has a computer linked to the central network and a system operator responsible for the Medication at Home Project.

The supply of medication to patient’s homes is available only to hypertensive and diabetic patients who are in a maintenance phase of treatment, with established medication and dosage. Those who are still in the first stage of treatment, without clinical stability, and who have not yet shown commitment to Program routines and activities must still collect their medication at the health clinic pharmacy.

Doctors taking part in hypertension and diabetes care at the first units, who implemented the Medication at Home Project have found the system so trustworthy that they are now leaving longer spaces between check-ups for patients who are in the “maintenance phase” of treatment. In health clinics with 24-hour emergency attendance, emergency hypertension cases have dropped by over 50%. The year 2004 brought further expansion for the Medication at Home Project, which is now linked to the Family Health Program and carried out by the community health agents.

The city of Rio de Janeiro has over a million inhabitants living in slums, shanty towns, and risk areas. Within this context, the main challenge continues to be promoting universal and equal access to the system by all users, wherever they live. In risk distribution areas, the Project has established partnerships with community associations and churches. This strategy of using alternative addresses for delivering medication works well to overcome the challenges of homelessness and migration. To ensure that medication sent to clients is not being redistributed elsewhere, innovators have also instituted measures to educate patients, both when signing up for the Project and during group sessions, about the dangers of sharing medicine.

The Medication at Home Project is a strategy which can be applied to any other program dealing with chronic disease and which has a large impact on management of health programs. After the project was set up, health clinics began to gather new data which allows control and evaluation of policies, forming a base for future policies aimed at the needs of the population.

Lessons:

  • The Project improves access to health care by supplying medication at home for registered diabetes and hypertension patients who are in a stable phase of treatment, helping broaden the reach of public health services.
  • By setting up a system which is organized and easier to control, patients of chronic disease can leave longer intervals between routine appointments, benefiting doctors who have more time to see new patients.
  • By offering a series of additional services for diabetes and hypertension patients, such as nutritional advice and focus group sessions, and by involving community groups and community health agents in distributing medication, a support system is built up around chronic disease patients.
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