Presentation on theme: "Perspectives on the Health Sector: challenges and opportunities"— Presentation transcript:
1Perspectives on the Health Sector: challenges and opportunities José Gomes Temporão, MD, PhDFormer Minister of Health ( )South American Institute of Government in Health (Isags)
2THE PRESENTATION1-BACKGROUND 2- THE TRANSITIONS 3- HEALTH AND DEVELOPMENT 4-THE NEW SOUTH AMERICAN HEALTH CONTEXT
3Brazil - Economic and Institutional Scenario Macroeconomic stability (inflation, fiscal and monetary policies, etc.)Institutional strength (democracy, state organization)Stable growth trajectoryGDP growth: 7,5 %Long Term Perspective: sustainable growthPerspective: 5th position in world Economy
4Brazil: Social, Demographic and Health System Changes Substantive improvement in social inclusion and income distributionSocial assistance programsExpansion of middle classGINI index decrease: 9% from to 2009 (Ipeadata, 2010)Universal health system consolidation (Datasus, 2009)The primary “ Family health care program”: universal accessInfant mortality rate: the biggest decrease in the last 10 years worldwide - 5,2%/yearLife expectancy improvement (from 67 years in 1990 to 73 years in 2009)
5The New Middle Class and Mass Market 5The New Middle Class and Mass MarketDistribution by social class% of populationFonte: IBGEElaboração: Ministério da Fazenda5
6The Brazilian Health Reform and The SUS – Unified Health System
7Democratic Constitution 1980’s: After dictatorship’s end a new Democratic Constitution is proclaimedDemocratic ConstitutionNational (Unified) Health SystemFragmented systemHealth as Universal RightHealth as State dutyDecentralized to states and municipalitiesPublic/Private mixSocial participation at all levelsPrivate services for those who could affordSocial Security for sectors formally employedPublic health for endemics and epidemic hazards1988…1960197019801990200020107
8SUS – Unified Health System SUS Indicators75% of the Brazilian population depend on SUS6,000 hospitals64,000 primary care units30,000 family health care teams2,3 billion ambulatory appointments12 million hospital admissions9 million chemo- and radiotherapy procedures19 thousand transplants sponsored by SUS1 million CT scans and 160,000 Magnetic Ressonance8 million hemodialyses proceduresSUS CharacteristicsUniversality: SUS, as the Brazilian public system, provides healthcare for all, regardless of distinctions and restrictions;Unity: one system composed of decentralized unities managed by different governmental levels (Federal, State and Local/Municipal)
9NATIONAL HEALTH SYSTEM (SUS) More than 75% of the Brazilian population depends exclusively on SUS (150 million people) for its health needsThe other 25% has private coverture but uses also the SUS (transplants, high cost drugs, emergency care, vaccines, Aids etc)9
10Private System: Insurance Health Plans Revenue (Brazil, 2000 to 2009) Balança Comercial 2007 – Igual ao feito para a ÍndiaNote: revenue growth is also the result of improved collection of information by ANS, expressing only partly real growth.
11Targeting equity BRAZIL: an unequal country that chose to build a universal health system This picture is “worth a thousand words”, as the saying goes. It is a graphic example of the social contrasts we face, where the upper classes coexist literally wall to wall with the less favored segments of our society.It is in this context of social and economics contrasts, as this picture well illustrates, which pose enormous challenges to the progress of our society, that Brazil was able to implant a universal Health System where all, no exceptions, have the right to integral and free care.1111
13The TransitionsEpidemiological – reduction of infectious diseases and increase of cronic and cardiovascular diseases.DemograficDiet TransitionTechnological(Cultural, organizational, economic)
14Trends in deaths patterns according to causes, Brazil 1930-2007
15Diabetes Mortality Rates 1996 - 2007 Legenda (Óbitos/100000) Schmidt MI, et al Lancet, 2011
16The Transitions Demografic – Increasing elderly population Epidemiological – reduction of infectious diseases and increase of cronic and cardiovascular diseases.Demografic – Increasing elderly populationDiet TransitionTechnological
17Ramos, Veras e Kalache, 1987 RSP Demographic Transition: a Secular Trend30 ANOS60 ANOS100 ANOS80 ANOS1750180018501900195020002050FecundidadeFecundidadeEUROPABRASILMortalidadeMortalidadeRamos, Veras e Kalache, 1987 RSP
18Ramos, Veras e Kalache, 1987 RSP 26.2195013.9197531.82000‘BOOM’ OF ELDERLYINBRASIL2025( millions of inhabitants 60 +)Ramos, Veras e Kalache, 1987 RSP
19The Transitions Diet Transition Epidemiological – reduction of infectious diseases and increase of cronic and cardiovascular diseases.Demografic – Increasing elderly populationDiet Transitionoverweight : de 12% (1975) para 43% (2008)obesity: de 3% (1975) para 13% (2008).Technological
20Height deficit in under 5 ys. according to family income, 1974/5-2006/7 34Poorest20
21Obesity and overweight – How long will take to be at the same level as USA today? MEN64.2%OBESITY +OVERWEIGHT: 12 YEARS!%27.1%OBESITY:16 YEARS!VIGITEL (http://portal.saude.gov.br/)BRFSS para EUANUPENS/USP
22The Transitions Technological Epidemiological – reduction of infectious diseases and increase of cronic and cardiovascular diseases.Demografic – Increasing elderly populationDiet Transition- overweight, obesityTechnological
243-Health and Development: General Perspective From Brasil
25Health and Development (The Duality of Health) Health as a citizenship condition and a proeminent area of development25
26The Duality of HealthArticulation of economic logic with health logicDevelopment of production base combined with health needsHealth Sector In BrasilAbout 8% GDP10% of qualified work of the country12 million direct and indirect jobsPlatform for new technological paradigms (fine chemicals, biotechnology, eletronics, nanotechnology, new materials, etc)26
27Perspective of demand explosion and a strong pressure on the productive base: a challenge and an opportunity
28BRAZIL: Health Industrial Complex (HIC) S T A TE..P R O M O T I ON+ R E G U L A TIOIndustrial SectorsChemical and BiotechnologyindustriesMechanic, Electronic and Materials IndustriesPharmaceuticalsAPIsVaccinesBlood ProductsDiagnostic ReagentsMechanical equipmentsElectronic equipmentsProthesis and orthosisMaterialsHealth ServicesDiagnosis andTherapeuticServicesHospitalsAmbulatoriesSource: Gadelha, 2003
29Informações Selecionadas Health within a Development Context: Panorama of the Pharmaceutical Productive Chain (1)Informações SelecionadasMaior base industrial da América LatinaMercado farmacêutico de US$ 20 billion (alta tx de crescimento)Posição no ranking: entre os 9 maiores mercados mundiaisEstrutura internacionalizada, porém com um significativo fortalecimento do capital nacional com base nos genéricosElevado dinamismo nas vendas de medicamentos no período recente (todos segmentos)Produção de vacinas com elevado dinamismo (PNI e produtores públicos): R$ 900 milhõesEstratégia nacional para Hemoderivados: HemobrásProdução de reagentes limitada e de baixo conteúdo tecnológicoEspecialização em atividades de menor conteúdo tecnológicoPapel destacado do Estado nas compras de todos segmentos
30Informações Selecionadas Health within a Development Context: Panorama of the Pharmaceutical Productive Chain (3)Indústria de Equipamentos e MateriaisInformações SelecionadasDinamismo do segmento no período recenteMercado em torno de R$ 8 bilhõesPredomínio de empresas de pequeno e médio porteEstrutura empresarial fragmentadaAfastamento da fronteira tecnológicaPerda de competitividade nos segmentos mais dinâmicosPapel destacado do Estado nas vendas do setor (50%)
31Health within a Development Context: Panorama of the Pharmaceutical Productive Chain (4) Reagents for Diagnosis Industry – Selected InformationMarket domain for the international leadersSpecialization of the local companies in activities of smaller technological contentPermanent commercial deficit even after the depreciationSignificant role of the government purchases (politics of blood and attendance in general)
32HIC 2009 – Evolution of Brazilian Health Trade Balance: General Overview (values in US$ Billions, updated by USA Inflation)32
33HIC 2009 - Brazilian Health Trade Deficit by Sector 33
34Health, Innovation and Development: policy perspectives Institutionalization of an integrated policy
35Productive Development Policy (PDP-2008) Mobilization Programmes in Strategic AreasHealth Industrial ComplexInformation andCommunicationTechnologiesNuclear EnergyDefenseIndustrial ComplexNanotechnologyBiotechnologyProgrammes to Consolidate and Expand LeadershipAeronauticsComplexPetroleum,Natural Gas andPetro chemistryBio ethanolMiningSteelCellulose andPaperMeatProgrammes to Strengthen CompetitivityAutomobileComplexCapital GoodsTextileWoods andFurnitureHygiene,Perfumeryand CosmeticsCivil ConstructionServices ComplexNaval Industry andCabotageLeathers, FootwearandArtifactsAgro industryBiodieselPlasticsOTHER35
36PDP: The Context - Public Policies Programme of Growth Acceleration (PAC): in expansion and oriented to overcoming structural bottlenecksPlan of Science, Technology and Innovation: programmes oriented to the promotion of scientific and technological development and innovation in the countryPlan for the Development of Education: quality investments applied to overcoming the greatest restriction to long-term development – training of the Brazilian people“Mais Saúde”*: directly responds to immediate needs and builds on future capacity in the field of public health in BrazilStructural and convergent projects are currently under way in Brazil*Plus Health
37HIC: Actions and Measures (1) Use of the statepurchasing powerto stimulate domesticproductionRevision of regulation for governmental purchasesPre-qualification, competitive isonomy, taxes waving and orders ofstrategic products for health innovationGovernmental Purchases- US$ 7,5 billion/year between 2008 and 2011Financial supportfor increasedproduction capacityNew Profarma: Supporting Programmes for the Development of the Health Industrial ComplexObjective: to increase the competitiveness of the HIC, by means of disseminating innovative activities and increasing the production of devices, materials, medicines and related products, contributing to the international insertion of national firmsResources: US$ 2 billion between 2008 and 2012Budgetary Resources of the Ministry of Health:- US$ 582 million between 2008 and 2011
38HIC: Actions and Measures (2) Expansion of availableresources for R&Din strategic areasResearch and Technological Development in Health Priority and the Establishment of National Centres of Toxicology and Clinical and Pre-Clinical Research (at least two networks)- US$ 700 million between 2008 and 2013New Profarma: Sub-Programme Innovation- Objective: to support projects of firms, the construction and consolidation of infrastructure for health innovation, as well as the internalization of competences and R&D&I activities in BrazilFUNTEC – Technological Fund: Non-reimbursable resourcesStrategic Areas 2008: Health, Renewable energies and EnvironmentActive Principles and Medicines for Neglected Diseases; drugs that use of the technique of recombining DNA; construction of infrastructure for health innovation that includes bioteries, pre-clinical and clinical research
39HIC: Strategic Areas for R&D&I Productive and Scientific-Technological Challenges12Domestic production ofhemoderivatives(factors 8 and 9, albumineand globulines)Development of Vaccinesfor the National ImmunizationProgramme34Production of devices andmaterials used in healthas a response tothe National Health PolicyReactives and DiagnosticDevices for Blood Controlbased on ModernsBiotechnologiesRegulatorylandmark56Production of medicines andactive principles forpharmochemicalsProduction ofBiotechnologicalProducts for Health
40Health R&D – The MoH’s Role (2) Some relevant projects in courseNational Network on Cell Therapy (RNTC).National Network on Clinical Research (RNPC).National Network on Health Technology Assessment HTA (REBRATS).National Cohort on Adult’s Health – CV diseases, diabetes, mental conditions (ELSA).National Cancer Research Network.Research on Neglected Diseases (~ 460 projects on Chagas Disease, Malaria, Leishmaniasis, Schistosomiasis, etc.) .
41The Brazilian Policy for the Health Industrial Complex: recent trends Articulation between health, industrial and S&T policyIntergovernmental Group involving 15 ministries and agenciesProduction Development Partnership20 public-private partnership to produce strategic productsUse of the public purchase power to stimulate innovation in healthRegulatory System Evolution
42Executive Group of the Health Industrial Complex - GECIS WG TributaryexemptionWG TransversalActionsWG government purchaseWG Biopharmaceutical regulationArticulation Forum:22 represents of the civil society, and from the entrepreneur sector.Participants:MS (coordinator), MCT, MDIC, MPOG, MF, MRE, Casa Civil, ANVISA, FIOCRUZ, FINEP, BNDES, INMETRO, INPI and ABDI.
43The Brazilian Policy for the Health Industrial Complex: recent trends Articulation between health, industrial and S&T policyIntergovernmental Group involving 15 ministries and agenciesConvergence of incentives (investment, market, innovation)Production Development Partnership30 public-private partnership to produce strategic productsUse of the public purchase power to stimulate innovation in healthRegulatory System EvolutionArrange a good balance between health access and innovation
44Public and Private Development Partnership (PPDPs) NINE PARTNERSHIP AGREEMENTS WEREALREADY ESTABLISHED INVOLVING :9 public companies;20 private companies ;Local development and production of 28 active principles (API`s).The public purchases with these API’s currently reach aroundR$ 1,5 billion per year.After full implementation, these partnerships will be able to save an estimated amount of R$ 390 million per year.
46The Brazilian Policy for the Health Industrial Complex: recent trends Articulation between health, industrial and S&T policyIntergovernmental Group involving 15 ministries and agenciesConvergence of incentives (investment, market, innovation)Production Development Partnership20 public-private partnership to produce strategic productsUse of the public purchase power to stimulate innovation in healthRegulatory System Evolution
47Industrial Policy – MoH (2) Reforming the Health Regulatory Framework.Building a special status for the health government purchasings (“Buy Brazilian” Act for the health products).Improving the purchasing processes in the health public sector (quality guarantee).Improving the Sanitary Surveillance regulations, together with ANVISA
48A New Agenda of Cooperation in The New National Context From simple trade and production relationship to:Benefits in terms of universal accessInvestment in higher technological products and processCooperative R&D in BrazilPartnership with local private and public producersEnhancement of trade balance results
49Main innitiatives to expand rational access to medicines and vaccines in Brazil. Pharmaceutical Assistance Programs (strategic and high costs medicines)Popular Pharmacies Program.Generic Drugs Consumption Program.The National Immunization Program.
50Expenditure in Medicines – Ministry of Health Budget 24/03/2017Expenditure in Medicines – Ministry of Health Budget(%)Source: SCTIE/MS50
51Health and Development in Brazil Political Context For the first time, Brasil has na industrial policy in health, to strengthen its pharmaceutical industry, having production capacity and reduce its dependence on this area51
52Health as a Window of Opportunity Dimension of the national market (SUS and Private Sector) and high demandExistence in Brazil of a productive tradition (the most developed in Latin America)Scientific structure and human resourcesA well structured sanitary regulatory system organized on a national basisMacroeconomic stability (investment grade)Projected Industrial GDP growth (yearly): 5% (2008/11)Reduction of income inequalities (high market impact)Priority of Health Economic-Industrial Complex within national policy52
534- The Growing Importance of Health in the Globalization Context Health as a central issue in the international relations:South-south cooperationLatin AmericaPortuguese-Speaking African CountriesHaitiThe Union of South American Nations (UNASUR)
54Global Health: The South American Institute of Government Global Health: The South American Institute of Government in Health (Isags)
55Governance for HealthISAGS is a public, intergovernmental entity within the South American Health Council of the Union of South American Nations (UNASUR); with permanent headquarters in Rio de Janeiro
56Governance for HealthIts activities will be closely articulated with the Ministries of Health of UNASUR countries in:knowledge management and generating innovation in policy and governance for health,offering the best available practices and evidence to guide health management;developing leadership on systems, services, organizations and programs on health-related areas,providing technical support to government institutions in the health sector.
57NetworkingISAGS will collaborate with other institutions of national, regional and global scope.South America Network of National Institutes of Health (RINS);South America Network of National Public Health Schools (REGS);South America Network of Technical Health Schools (RETS);South America Network of Workshops on International Relations in Health (ORIS);Latin-America Network of National Institutes of Cancer (RINC).
58The Unasur Strategic Agenda Health Quinquennial PlanHealth Surveillance and Response;Universal Health Systems;Universal Access to Drugs;Health Promotion and Action on Social Determinants of Health;Human Resources for Health.
59Cooperação Sul-Sul e CIS Saúde e DesenvolvimentoCooperação não pode olhar apenas para a oferta de insumos, tecnologiasCompreensão mais ampla do processo de desenvolvimento das sociedades e como a saúde se insere neleInclui a gestão de tecnologias, desenvolvimento e inovação, visando a redução da dependencia