Public health system developed over past few years in state of Rio de Janeiro, Brazil  is definitely one of the better models of primary health care available anywhere. It was indeed a great opportunity to visit family health clinic in urban area and also in slums which is being known as favelas in Rio.

                   

The first thing which you will notice is their commitment towards providing a hygienic environment, well cleaned clinic without much noise and chaos even in the health centre locate in favelas which is the most congested and densely populated area of Rio de Janeiro.







 These health clinics have HIS which stores all the data of patient electronically. 
These clinics are equipped with X ray machine, USG and laboratory which collects all the samples and sends it to a central laboratory.



At the entry you will find a health worker with “may I help” sign. Their duty is to guide everyone towards appropriate place of their need.
As some people only come to collect report, others for investigations, dressing, vaccination or for taking drugs. For these purposes they don't need consultation with doctors and are being managed efficiently at entrance itself. It reduces time and crowd in the clinic.
Next you will find a big map which is google map snapshot of the catchment area of that clinic. This is equally divided based on total number of families in 7-12 groups. Each group is being taken care by team which consists of 1 doctor mostly family physician, 1 nurse, 1 technical nurse, and 5 community health workers. Out of 5 community workers 3 goes out to community and remaining 2 works in clinic daily and they rotate among themselves. Each community Worker has been assigned families out of their area for which they are responsible. Doctor has to spent 40 hrs per week in the clinic and out of this 4 hrs in the community. During the visit, doctor has to see those patients who couldn't come to hospital for various reasons.

Public health care is completely free. All the investigations, drugs, consultation are free. Every 2-3months dental kit with tooth brush and paste are provided free of cost.


For every 2 team 1 dentist is there to look after oral hygiene.
Consultation with specialists from ENT, Ophthalmology, Paediatrics etc are also provided only on reference of their family physicians. These specialist visit these hospital on a weekly schedule.
Each patient has got their health book where all the consultation made are written. They have also got a health app in their mobile to schedule their consultation etc. Whenever they visit the clinic they have to go to their respective team registration area from where they will be given necessary directions.
Each team has got their own team office and consultation area. In the team office you will find data of individuals assigned to each community worker. On an average each team has to look after 2000 individuals. On a big chart You will find picture of Doctor, nurses and technical nurses and below there are 6 groups with picture of respective community worker. In each group there is space for 296 families. By the side of each Family there are 6 Colour coded boxes which is To be filled by community worker. Important data which is to be entered according to colour code in the boxes are age less than 1 year, age 1-5 year, tuberculosis, pregnancy, HTN/DM, HA.


These all details are also available electronically through their HIS. Same goes for vaccination they track all the children in their area electronically and monitor them for vaccination.

 This not only eliminates any form of error but makes healthcare more accessible to the population. Community participation is also there as they are receiving good quality service at affordable price. Affordable because they have to only pay taxes to the govt and in turn get free healthcare.
There are so many things we can learn from their health system, First is the politival commitment of health secretary of Rio towards building a strong public health system which is entirely based on principles of primary health care that are affordable, available, accessible and appropriate. Hygiene and cleanliness can never be achieved only by good administration but also requires community participation and commitment towards keeping it clean.
I would also like to mention few things which are different there like abortion which is illegal, although they promote contraception and condoms are available for free from their health centres. Have a look at this graffiti (anyway in Rio u will find lots and lots of graffiti all around). "FAÇA SEXO SEGURO USE CAMISINHA" which means make safe sex use condoms.
There are many cases reported of early pregnancy in age group of 11-15 years. Only in cases of anencephaly or intrauterine death abortion is recommended.
So would like to thank the health secretary and his team for explaining us everything.