Quality improvement initiatives in Brazil: a progress report.

BACKGROUND: In 1994 Brazil's Ministry of Health (MOH) introduced a program to provide a supporting environment for quality improvement (QI) initiatives. Yet the five-track QI strategy, which included moving toward outcome indicators, establishing a national accreditation program, emphasizing QI tools, establishing basic clinical guidelines, and enhancing community control, was discontinued in 1998, following the dismissal of the minister of health. The QI program retained only its accreditation activities. ACCREDITATION: The Consortium for Brazilian Accreditation (CBA) began in 1994 to establish an accreditation process compatible with international initiatives. Both the MOH and the CBA have developed standards for hospitals. The Brazilian Manual for the Accreditation of Hospitals is available on the Internet. The CBA has developed a set of standards by adapting the 1996 hospital standards from the Joint Commission on Accreditation of Healthcare Organizations. To developing CBA's role as an accrediting organization, administrative and technical supporting structures were created within the Cesgranrio Foundation and a Joint Commission for Accreditation was established. QUALITY MANAGEMENT INITIATIVES: A growing number of hospitals, clinical laboratories, blood banks, health plans, and other health care services and organizations are seeking International Organization for Standardization (Geneva) certification. Consulting firms in the field of quality management continue to increase the number of their clients in the health sector. CONCLUDING REMARKS: Current QI initiatives represent only a minority of health care services and organizations in the country. Strong efforts need to be made by both the private and public sectors to expand such initiatives throughout Brazil.

Health care reform and quality initiatives in Brazil.

BACKGROUND: The pursuit of equity in health care and universal entitlement to access of services, as health care reform concerns, were addressed at a Brazilian national health conference in 1986, in a new constitution in 1988, and in subsequent legislative and administrative actions. However, in the early 1990s, economic policies affected the federal government's ability to fund the necessary services. QUALITY IMPROVEMENT (QI): In 1994 the Ministry of Health introduced a formal QI program, whose main purpose was to disseminate a culture of QI among health care providers, payers, and users of health services. The minister of health then established a national commission on QI, which played an important role in making QI activities an important activity. A NATIONAL ACCREDITATION PROGRAM: Efforts to create an accreditation program began in 1986. Since 1994 work has proceeded on organization of a nongovernmental accreditation agency, development of national standards and procedures for the accreditation of health services, and dissemination of methods and procedures for health care quality management. QI PROGRAMS: Examples of QI programs that have been successfully implemented include those at the State of Rio de Janeiro Blood Center and the National Institute of Cancer. Since 1996, many national societies have begun to produce consensus statements and guidelines. Progress has also been made in consumer rights and protection. CONCLUSIONS: The public, health care professionals, providers, and the government are increasingly aware of the need to strengthen and develop QI initiatives for health care in Brazil. Awareness of the opportunities for improvements in health care which outcomes trigger should help contribute to their application.

[Strategies for the development of local health systems in the State of Rio de Janeiro, Brazil]. / Estratégias para a construção de sistemas locais de saúde no estado do Rio de Janeiro, Brasil.

The organization of health services has undergone large-scale changes since the beginning of the 1980s, as may be seen in the organization of local health systems, the introduction of integrated health actions, and the establishment of the unified and decentralized health system. These changes are aimed at municipalizing the services. In Rio de Janeiro, particularly in the Baixada Fluminense, the public and private network categories have ceased to exist, having been replaced by a single municipal network. Delay in the transfer of INAMPS services is impeding the formation of a fully unified network. Complete organization of the decentralized system demands the elimination of political and bureaucratic obstacles.