The government of Brazil is ready to start a long-awaited reform of its EMS sector, with an aim to raise the quality of services and better meet growing middle-class demands for quality healthcare, according to recent statements from senior officials with the Brazil Ministry of Health and industry analysts.
In recent years the calls of Brazilians for their government to invest more in healthcare and improve services in its EMS sector have significantly increased, which forced the government to act. One driver for this has been the rebound of the country’s economic situation, which has improved in recent years and led to the growth of the country’s middle class. According to various estimates, the number of people who have climbed out of extreme poverty in Brazil now exceeds 40 million. Most of them moved from farms to urban centers and thus expect more quality services in regard to healthcare, including EMS.
Another factor has been the growth of average life expectancy in Brazil from 66 years during the 1990s to about 74 at present. This growing population of seniors has also necessitated development of domestic healthcare.
The idea of reform became part of the pre-election promises of Brazilian President Jair Bolsonaro. While Brazil has the largest healthcare market in Latin America—the total value of which exceeds U.S. $100 billion and represents more than 10% of the country’s national GDP—its operations often have been highly inefficient and a subject of fierce criticism from analysts and even senior state officials.
Similar to other emerging nations, the current living standards in Brazil vary significantly depending on the region. For example, those in southern Brazil, where the major cities of Sao Paulo and Rio de Janeiro are located, tend to live better, healthier lives than those in the north. That also affects the EMS sector and quality of services provided within its scope.
As a rule, the availability of quality EMS in the richest regions of the country is usually better than that in the poorer parts.
At present Brazil has about 200 emergency call centers, covering more than 2,000 municipalities. While the number of such centers has significantly increased in recent years, they still cover only 75% of the population.
According to the ambitious plans of the Ministry of Health, that figure should reach 100% by 2022–23. By this time the government also hopes to solve the problem of personnel shortages, which remains another obstacle to development of the sector.
This is illustrated by recent statistics provided by the ministry and independent analysts that show the number of doctors employed in the EMS sector of the northeastern area of Maranhao is equivalent to only 0.58 doctors per 1,000 people. In comparison, this figure is estimated at 3.44 in Rio de Janeiro.
Several years ago former President Dilma Rousseff tried to address the challenge of personnel shortages in the country by inviting thousands of foreign doctors (primarily from Cuba) to work in the country’s healthcare sector, including EMS. Despite these efforts the problem remains pressing.
At present a significant number of physicians employed in Brazilian EMS come from different specialty backgrounds. Many have taken the job as a form of supplementary income or as a result of unsuccessful private practice. In addition, as more than 50% of medical school graduates in Brazil do not get residency positions, these new physicians with minimal clinical training often look for work in emergency departments.
An official spokesperson of Luiz Henrique Mandetta, the Brazilian Minister of Health, confirmed the lack of professional training in the domestic EMS industry. According to him, there is also a lack of coordination between the care units involved in providing emergency care in the country.
Another reason for the planned reform is the government’s need to deal with the increasing numbers of traffic accidents and violence (the amount of which has significantly increased in recent years), as well as the overcrowding of hospital emergency departments.
According to Mandetta, reform is an acute need, as most of the major legislative acts and standards regulating the Brazilian EMS sector were adopted at the beginning of the 2000s and by now are seriously outdated.
In fact, the Brazilian emergency medical service, which is locally called SAMU (serviço de atendimento móvel de urgência, or emergency mobile care service), was officially established in its current form in 2002 as a result of the adoption of “Portaria 2048,” a document that set forth some basic principles for the industry’s operations.
The industry is also regulated by the National Emergency Care Policy (Política Nacional de Atenção às Urgências), approved in 2003.
Medical aid can be freely requested by telephone from any location in the country by dialing the number 1-9-2 to reach an emergency call center.
The reform also involves increased construction of emergency care units throughout the country. At present more than 600 such facilities are under construction.
At the same time attention will be paid during the reform to the development of private-sector EMS providers, largely for transfers and subscription-based emergency care at home. The latter, however, will continue to be more typical for wealthier Southern regions of the country.
Finally, part of the government’s plan is to create conditions for the development of EMS on a national scale. This is mainly due to the fact that not all states consider emergency care a priority.
Eugene Gerden is an international freelance writer who specializes in coverage of the global firefighting, EMS, and rescue industries. He has worked for several industry titles and can be reached at email@example.com.