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Hoje, em 5.346 municípios brasileiros (96% do total), os primeiros sintomas de qualquer doença põem para funcionar uma cadeia de cuidados que tem seu primeiro elo nos 257,9 mil agentes comunitários, integrantes das 34.715 equipes de Saúde da Família que contam também com médicos e enfermeiros. O programa tornou-se o pilar da reorganização da Atenção Básica. Ficaram na literatura ou nas fotografias de arquivo dos jornais as imagens do passado, com crianças famintas, esvaindo-se em diarreias mortais, sem que a mãe pudesse ou soubesse o que fazer.
Quando Lula foi eleito em 2002, menos de 32% dos brasileiros eram atendidos por equipes de Saúde da Família. Em setembro de 2013, a cobertura havia ultrapassado 56% da população. Em 2011, o PSF mudou de nome e deixou de ser chamado “programa”. Para defini-lo como uma política permanente, considerada pelo Ministério da Saúde como algo definitivo e essencial para as políticas públicas, passou a ser chamado “Estratégia Saúde da Família”.
For those who were unable to afford the services of a private dentist, the only semblance of the country's oral health policy was the indiscriminate use of forceps, the feared pliers used for pulling teeth.
For more complex cases or to restore the smiles of millions of Brazilians who had their teeth pulled — particularly the elderly — 1,013 Dental Specialty Centers were created. Moreover, since 2010, 1,650 laboratories are doing something unprecedented in the history of public health in the country: they produced over 4 million dentures. They were delivered free of charge to people whose mouths had been mutilated in the past.
Thanks to the program, Brazil is now part of the group of countries with low incidence of tooth decay, according to the World Health Organization (WHO). Moreover, through the Smile Brazil program’s prevention, basic treatment, specialized care, surgeries, root canal treatment and rehabilitation of oral health, some 400,000 fewer teeth were extracted at least a year!
• Program to rescue the self-esteem of the population
The investment in the renovation of physical facilities where the Family Health program professionals work offers an idea of the importance of the strategy for the government: by the end of Dilma’s term of office, R$ 15 billion will have been invested to improve the structure of the basic units.
In 2013 this totaled R$ 3.1 billion, money that increased the number of "health clinics," as they are best known by the population, from 31,226 in 2011 to 39,959 by the end of 2013, of which 757 were built in what are considered “poor” areas. In the units that are being or have been expanded, there will be more space for the professionals to run therapeutic group activities with the elderly, diabetics, people with hypertension and pregnant women.
Physicians, educators, community health agents, teachers, parents and nurses work together to prevent disease and promote the health of children, teens and youths enrolled in public schools.
Since 2007, this program involves, in an unprecedented way, the Ministries of Health and Education. At school, the professionals conduct early diagnosis of chronic diseases, control of tooth decay, detection of vision problems and identify the nutritional status of students. Some 80,400 schools, daycare centers and kindergartens, with a majority of Bolsa Família students, are part of the program, which serves children and youths in 4,864 municipalities. The expansion of the School Health program for kindergartens and daycare centers is integrated with the Affectionate Brazil program, which was designed to ensure comprehensive care for children and youth by strengthening policies related to health and education.
• How the program works:
One year before Lula’s first election in 2001, the law of psychiatric reform condemned the old psychiatric hospitals from which patients were discharged — when they were discharged — with consequences worse than their diseases. It was up to the Lula and Dilma governments to create the new structures to serve the mentally ill in a humane and responsive way in order to integrate them into the family and society.
Since then, the budget allocated to mental health has tripled, jumping from R$ 620 million to R$ 2 billion. Consequently, the number of Community Psychosocial Health Service Centers (Caps) has reached 2,067 facilities in December 2013, nearly five times more than the 424 existing in 2002. Created at the end of the 1980s, the Caps involve the community and the family in treatment of the mentally ill so they can once again lead normal lives. As this is not always easy to accomplish, since 2003 the families of 4,245 Brazilians who for several years lived isolated in hospitals now receive financial aid, currently R$ 412.00 [per month].
Indigenous health ceased to be one of the actions of the National Health Foundation (Funasa) to become the exclusive focus of an office created in 2010 by the Ministry of Health. The main objective is to offer a holistic health care service through the SUS to Brazil’s Indian population. The government primarily invests in improving the sanitary conditions for waste management and water supply in the villages. As a result of these efforts, infant mortality among indigenous populations has been declining steadily since 2005. In 2009, it was 41.9 deaths per 1,000 live births, compared with 74.6 in 2000.