Health and social assistance systems in the challenge of reducing poverty - The case of Brazil

The study intends to describe and analyse the present situation of brazilian health and social assistance systems and discuss the constraints they are facing in order to contribute to the challenge of reducing poverty. Brazil shows a quite good performance in the fullfilment of Millennium goals defined by UN. This success  is related to the increasing of formal employment and minimum wages, as so as to huge cash transfer programs, specially the Bolsa Família, which is the biggest cash transfer program worldwide, covering more than 12 million poor families. However, it is well known that poverty is a complex phenomenon related not just to the lack of money and jobs, but also to social, individual and familiar conditions, which requires the guarantee of access to a wide range of social protection services, sustained through regular public policies.
After the authoritarian regime, Brazil approved a new Constitution (1988), which introduced the universalisation of acess to health and social assistance, among other social rights, to be guaranteed through national and descentralized public systems. The implementation of these inovative structures has widely changed the way health and social assistance were tradicionally treated in Brazil. Major changes were the inclusion of large segments of the population previously without access, the creation of  a national network of services (specially for primary health and social care), the incoporation of national, state and local government spheres on the formulation, implementation and delivery of services, and the creation of social participation mechanisms in almost all 5000 municipalities. On the other hand, economic and political constraints are bringing huge difficults to health and social assistance systems, with significant problems of access to and quality of services, lack of integration among services and low coverage. These problems may compromise the maintenance of the objectives of reducing poverty already achieved.