2. Carl T. Brighton Workshop Musculoskeletal Trauma in Low and Middle Income Countries Ahmedabad – India 2007 Clinical Orthopaedics and Related Research The Association of Bone and Joint Surgeons

3. DELIVERY OF MS CARE CHALLENGES & SOLUTIONS IN BRAZIL Marcos Musafir

4. THE ROLE OF THE MEMBERS OF AT THE SCENARIUM OF THE BRAZILIAN HEALTH CARE SYSTEM Marcos Musafir

5. POPULATION: 180 MILLION 5.700 Cities 680 with more than 250.000 inh. 1.800 with plain medical care 3.000 with family care teams only

6. HEALTH CARE SYSTEM PUBLIC : SUS PUBLIC : SUS TOTALLY FREE=Public Hospitals TOTALLY FREE=Public Hospitals EQUAL ACCESS (75% ONLY THIS) EQUAL ACCESS (75% ONLY THIS) GOOD IN PREVENTION (AIDS) GOOD IN PREVENTION (AIDS) POOR IN EMERGENCY/TRAUMA POOR IN EMERGENCY/TRAUMA PRIVATE: Companies or Direct Payment PRIVATE: Companies or Direct Payment PAY FOR SERVICE PAY FOR SERVICE BETTER PRIVATE HOSPITALS BETTER PRIVATE HOSPITALS ONLY 25% OF THE POPULATION ONLY 25% OF THE POPULATION

7. Geographic Distribution Hospital / Beds (2005/6) RegionH.Públic of SUS H. Private + SUS Beds Púb./Priv. Per 1.000 inhabitants NORTH31015424.6042,01 NORTH WEST 1.070917119.6822,44 MIDDLE WEST 24339836.6303,00 SOUTH EAST 4211.189186.9682,67 SOUTH1731.08073.7073,06 TOTAL2.2173.738441.591 6 %

8. HEALTH CARE SYSTEM MUSCULOSKELETAL MUSCULOSKELETAL HEALTH & SCIENCE MEDICAL DOCTORS TOTAL: 350.000 in Brazil MEDICAL DOCTORS TOTAL: 350.000 in Brazil MEDICAL SCHOOLS: 166 * MEDICAL SCHOOLS: 166 * ORTHOPAEDIC SURGEONS: ORTHOPAEDIC SURGEONS: SBOT : 9.631 / but in TRAUMA: 3.600 SBOT : 9.631 / but in TRAUMA: 3.600 OFFICIAL RESIDENTS/3 years: 1.572 OFFICIAL RESIDENTS/3 years: 1.572 NON MEMBERS: 3.200 and 2 nd care: 1.800* NON MEMBERS: 3.200 and 2 nd care: 1.800* RHEUMAT + PHYSIATRIC + GERIATRICS: 4.000 RHEUMAT + PHYSIATRIC + GERIATRICS: 4.000

9. HEALTH CARE SYSTEM BARRIERS TO THE DELIVERY OF CARE : BARRIERS TO THE DELIVERY OF CARE : Administrative conscious is low, with the combination Administrative conscious is low, with the combination of bad spenditure plus star personality; of bad spenditure plus star personality; Reduced technical conditions = RISKS for MD; Reduced technical conditions = RISKS for MD; Monthly fee for specialists: average: US$3.000,00 Monthly fee for specialists: average: US$3.000,00 Private practice: Much more $: (3 times more average); Private practice: Much more $: (3 times more average); Not a career as the military = No motivation; Not a career as the military = No motivation; Still number 1 for public confidence! on public research; Still number 1 for public confidence! on public research; Now increasing PRESSURE over politicians at National, State and City levels of Governments; Now increasing PRESSURE over politicians at National, State and City levels of Governments;

10. PREVENTION STRATEGIES THE 6 UN/WHO RECOMMENDATION GAVE THE SCIENTIFIC AND POLITICAL SUPPORT TO IMPROVE PREVENTION ON MSK TRAUMA RELATED TO RTI & VIOLENCE; THE 6 UN/WHO RECOMMENDATION GAVE THE SCIENTIFIC AND POLITICAL SUPPORT TO IMPROVE PREVENTION ON MSK TRAUMA RELATED TO RTI & VIOLENCE; ONE OF THE 10 PRIORITIES OF THE NEW MINISTER OF HEALTH – J. G. TEMPORAO; ONE OF THE 10 PRIORITIES OF THE NEW MINISTER OF HEALTH – J. G. TEMPORAO;

11. SUGGESTIONS INTERNATIONAL RECOMMENDATIONS BY WHO AND PARTNERS TO CHANGE IT NOW; INTERNATIONAL RECOMMENDATIONS BY WHO AND PARTNERS TO CHANGE IT NOW; BEST PRACTICES SHARED WORLDWIDE; BEST PRACTICES SHARED WORLDWIDE; STIMULATE STANDARDS OF CARE; STIMULATE STANDARDS OF CARE; MEDICAL EDUCATION ACCESS; MEDICAL EDUCATION ACCESS; TRAINED SURGEONS IN SKILLS: Safety First; TRAINED SURGEONS IN SKILLS: Safety First; AWARENESS IN THE POPULATION; AWARENESS IN THE POPULATION; INCENTIVE FOR DISTRIBUTION OF SURGEONS, EQUIPMENTS AND MATERIALS; INCENTIVE FOR DISTRIBUTION OF SURGEONS, EQUIPMENTS AND MATERIALS; CHANGE FROM POLITICS WITH or IN HEALTH TO HEALTH POLITICAL SERIOUS PRIORITIES. CHANGE FROM POLITICS WITH or IN HEALTH TO HEALTH POLITICAL SERIOUS PRIORITIES.

12. MUITO OBRIGADO MUITO OBRIGADO Marcos Musafir Marcos Musafir