Transcript Establishing a Canada-Brazil Telehealth Partnership

This presentation has been
prepared by:
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Infotelmed Communications Inc www.infotelmed.ca
LCE Communications reg
www.LCE.ca
with the collaboration of the
Edumed Institute, Campinas,
State of Sao Paulo, Brazil
www.edumed.net
LCE
LCE Communications
Montreal . Canada
Infotelmed and LCE
But Brazil, like Canada, has
health care challenges:
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Luiz, can you fill in some challenges here, these are just examples:
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For telemedicine to be useful, the most important statistic is health care facilities and
personnel - in 1996 (latest WHO stats) there were 127 physicians per 100 000 pop – I
couldn’t find a more recent statistic. In Canada in 1998 we had 185 physicians per 100 000.
But most of these doctors are located in cities and not where rural and remote populations
are. How are these remote people served?
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How many hospital beds per population compared, say to the US or Canada.
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How similar is the geographic dispersion of the people. Canada is like Australia –in 2001 we
had 3.3 persons per sq km but of course that gets really thin in a place like Nunavut meaning some people are really far away from a doctor or a hospital which is also true in
Brazil?
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What are the main diseases – among indigenous people for instance. What do they die from?
Do you have any stats for them?
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How do poor people pay for their health care since so little is spent from public monies for the
poor and how many are there
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How healthy is the average Brazilian – you can estimate this through the infant mortality rates
and the life expectancy rates – but no need to overdo it
The above listed stats would be for some proposal to CIDA
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Demographics, Brazil 2002
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8,511,965 sq km (slightly smaller than the USA)
Largest country in South America; shares common
boundaries with every South American country
except Chile and Ecuador
14,691 km land boundaries, 7,491 km coast line
182,032,604 inhabitants, median age 27 yrs, 17.67
births/1,000 population, 6.13 deaths/1,000
population. Growth 1.15% per year.
86% literacy. 30% of the Brazilian population has less
than 8 years studies, 27% less than 4 years
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Population Distribution
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A country very similar to Canada: vast
expanses at North and Midwest, with
densities of less than 1 per sq.km.; highest
concentration along coastline and capitals
(Rio de Janeiro: 291 inhab/sq.km
Average: 17 inhabitants per sq.km., 76%
urban, 24% rural.
5,656 counties, 89% have less than 50,000
inhabitants, 65% less than 20,000.
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Distribution of Wealth
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National average: 29% below poverty
level. Minimum wage is US$ 80. About
40% of working force gets this.
Varies from 12 to 19% in the richest
Southern states, can be as high as 59%
in the poorest Northeast states
The income of the 20% richest is 27
times the income of the 20% poorest
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Health Status
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Life expectancy at birth: male: 67.16 years
female: 75.3 years
Infant mortality (less than 1 yr age): national
average is 10 per 1,000 born alive. In the
Northeast is thrice (18) that of the South (6).
Deaths due to infectious and parasitary
diseases is now less than 5,5% of all causes,
chronic and degenerative diseases account
for 57% to 65%.
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Aboriginal Population
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Populated the area 30,000 years ago. Neolithic level,
much inferior to North American natives
Thought to have reached 8 million inhabitants at the
time of Discovery;
Now less than 600,000. Large part has been
accultured but stands among the poor of the poorest
in the country. Have special civil “protected” status,
large Indian reservations in the North. Primitive and
even undiscovered nations still exist
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Aboriginal Health
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There is a National Indian Health Service under the
National Health Foundation;
A hierarchical public health service has been set up
and is under construction, using family health
concepts, barefoot community health agents
(recruited among natives) and primare care;
Disease profile is still much related to poverty and to
low immune defenses, such as tuberculosis, dengue,
malaria and other tropical diseases, diarrhea,
undernutrition, respiratory diseases, etc. AIDS and
chronic diseases due to change of nutrition and of
habits, alcoholism are in the rise
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Healthcare Professionals 2002
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360,000 physicians (208 per 100,000)
170,000 dentists (96 per 100,000)
90,000 registered nurses (52 per 100,000)
500,000 nurse assistants (289 per 100,000)
170,000 other allied health
TOTAL ca. 1,290,000 professionals
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Large Regional Disparities
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65 to 554 physicians per 100,000 (regions)
Highest density 1,000 physicians per 100,000
North and Northeast with less physicians,
South and Southeast with more
State of São Paulo alone has 95,000
physicians (26,5%)
160 largest counties have 93% of physicians,
the 7% remaining are in 3,400 counties
2,400 counties (43%) have less than 10
resident physicians, 2,100 counties (38%)
have no resident
physicians
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Healthcare Resources 2002
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6,000 hospitals with 450,000 beds
2.05 to 3.33 beds per 1,000 inhabitants
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Health Care Systems
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Three largely separate systems:
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The Unified Health System (SUS) is public, at
municipal, state and country levels, free for all
citizens. Paid by public budget. Covers about 75%
of the population;
The private health plan system, covers 23% of the
population, includes medical insurance, medical
cooperatives, self-management health plans,
community health plans. Paid by contributions
from the beneficiaries
Private medical care, covers 2% of the population,
self-paid.
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Status of Health Care System
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Private medicine and public university-based tertiary care ranks
among the best in the world, particularly in certain areas such
as AIDS/HIV and infectious diseases, cardiology and cardiac
surgery, oncology, plastic and reconstructive surgery,
immunology, etc.
Public health is mostly in a sorry state, due to the low level of
wages for healthcare professionals, low per capita investment
and excessive political and burocratic interferences
However, it is improving steadfastly in efficiency and coverage,
due to IT investments, education and training, managerial
reform, societal external control, etc.
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Telehealth Status
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Still in the beginning. Large and rich private hospitals
and excellence centers in public universities were the
pioneers
Telehealth remains largely unadopted by the public
health sector, but a few succesful experiments are
underway. Interest is growing very fast, though
The potential is enormous due to many factors (size
of the country, inequality of distribution of resources
and of quality of service, etc.)
There are no large stakeholders, keyplayers or
distribution network for products. Field is open,
particularly for satellite-based initiatives
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Opportunities for Canadian telehealth
(TH) expertise and products
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For a proposal to Industry Canada or International trade the most important
stats you have provided plus maybe a little more information on the state of
Brazil ’s hospital and health care system – how advanced, how modern etc.
Is there a distribution network for any telehealth products that we are going to
introduce ?
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