Abstract
Chagas disease (CD) poses a major public health challenge for the Americas and non endemic regions around the world. This study discusses the legal framework surrounding access to healthcare for CD for Bolivian migrants living in São Paulo, Brazil. While recent guidelines stipulating care for CD exist, there is a lack of legal provisions to ensure they are regularly implemented. Bolivian migrants in SP have specific needs, including language differences and a high level of mobility. Interviews were conducted with ten participants representing public health institutions or organizations working with the Bolivian migrant community. Additionally, a review was conducted of legal, official, and health policy documents pertaining to rights of Bolivian migrants in SP. Although the right to healthcare is constitutionally guaranteed for all, in practice, immigrants, especially those without documentation, encounter barriers to initiating treatment for CD. Providing the primary health care system (SUS) card would not only improve access to healthcare for Bolivian migrants, but also provide a potential pathway toward regularization of status. The approval of clinical protocols and therapeutic guidelines for CD (2018) represents an opportunity to improve care for all Brazilians with CD. Programs with multidisciplinary teams should be developed taking into account the specific social and cultural needs of this population.
Highlights
Over six million people are infected with Trypanosoma cruzi, the parasite that causes Chagas disease (CD) [1,2,3]
The healthcare rights of Bolivians with CD living in São Paulo (SP) depend on three important frameworks: (1) their legal status in Brazil, as it pertains to accessing healthcare via the SUS; (2) policies and legal requirements regarding provision of testing and treatment for CD; and (3) capacity of the health system to provide care for Bolivians with CD
The legal and normative documents related to immigrants, collected during the research provided insight on how Brazilian legislation treats Bolivian immigrants regarding the right to health
Summary
Over six million people are infected with Trypanosoma cruzi, the parasite that causes Chagas disease (CD) [1,2,3]. There are substantial gaps in both research and development and public health infrastructure; effective new drugs for CD have not been developed in nearly 50 years, and less than one percent of people with the infection have received diagnosis and treatment in the Americas [4,5,6]. This leads to a considerable burden of morbidity and mortality, since, in the absence of timely identification and treatment, CD leads to serious, life-threatening complications (most often heart disease) in 30%–40% of those infected with T. cruzi. Brazil, where CD was originally discovered by Carlos Chagas in 1909, has the second-largest burden of the disease worldwide, with over 1.1 million people infected, and incurs the highest annual healthcare costs from CD, estimated at $129 million in 2013 (equivalent to $143 million in 2020) [1,9]
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