Palliative Care Network in Brazil

Abstract

Brazil is a country with great diversity and distinct realities, so there is a proportional challenge and complexity in offering a unified and integrated system which is accessible, of quality, and effective. Population aging and the increased incidence of chronic-degenerative noncommunicable diseases (NCDs) increase the need for palliative care (PC); however, public policies still need to be implemented so that this care encompasses adequate funding, professional training, and guaranteed medication. The first national policy for PC was recently proposed, providing guidelines for the organization of PC, emphasizing the importance of integration between the different levels of care and services in the Brazilian health system (SUS). Nevertheless, the challenges of this policy include the training of professionals, communication in the network, the absence of integrated health information systems, and effective mechanisms to finance this new modality of care.All this complexity includes social plurality, more than one level of multidisciplinary and multiprofessional care, which receives resources from various sources and presents structural and technological inequality [4].The organization of health has isolated levels that do not communicate with each other. Primary healthcare (PHC) is not related to secondary care, and none of them are related to tertiary care [1]. Thus, the lack of communication between healthcare levels prevents comprehensive care [6].Comprehensiveness is part of the guidelines of the Unified Health System (SUS). It is a guiding concept of care that aims at treating each individual with respect, in his/her totality, valuing his/her needs and characteristics [7].The healthcare networks (HCN) emerge within this context, mainly to interconnect the care levels and to integrate care itself [4].The concept of HCN proposes a polyarchy, i.e., democratic, person-centered structure where health services communicate at all levels, and no level is more or less important than the other. It allows comprehensive care with promotional, preventive, curative, caregiving, rehabilitative, and palliative interventions. Thus, it offers a humanized and quality service to the population [8].The Administrative Rule 4279, of December 30, 2010, regulates HCNs. It establishes guidelines for the organization of HCNs within the scope of the SUS. The networking system was necessary for a better health policy, a new structure based on the covenants for health, life, and in defense of the SUS, which assume responsibility for the regionalization and the health situation of Brazil and for strengthening the policy, principles, and guidelines of the SUS. PHC is the major coordinator of care, the gateway and communication center between users and health professionals. It distributes and redistributes assistance for all levels of healthcare horizontally, according to the needs. This explains the concept of networks [5].The basic elements for the development of networks are well-defined population, based on registers performed on prim...