Programa Maior Cuidado: An Integrated Community-Based Intervention on Care for Older People

Abstract

This report presents an overview of a novel community-based intervention for older people living in deprived neighbourhoods in the Brazilian city of Belo Horizonte: Programa Maior Cuidado (PMC). Since 2011 PMC has been jointly run by the municipal Departments of Health and Social Assistance to support dependent older people living in vulnerable families. These families receive up to 20 hours of support a week from professional family care support workers. Health centres and social assistance posts hold joint monthly case reviews and work closely with family care support workers to anticipate and respond to new problems. Between 2011 and December 2022, 3,062 families had received support or were continuing to do so. Drawing on a set of qualitative and quantitative evaluations, we show that PMC operates effectively and appears to generate a range of positive effects. These effects include enhanced health and wellbeing of older people, reducing the stress and burden of family carers and improving the efficiency of outpatient and inpatient health service use. PMC also provides a valuable livelihood opportunity for the caregivers it employs. A cost analysis estimates that the monthly per capita cost of PMC in April 2023 was 916.2 reais (US$173), which is substantially less than alternative interventions. These positive evaluations have led Belo Horizonte municipality to extend the scheme and the Federal Ministry of Health to support similar pilots in new cities. Future evaluations of these pilot schemes will add to the available evidence about PMC and its potential suitability for other parts of Brazil and similar countries.