Abstract
Internationally, there is a large body of scientific evidence concerning the benefits of integrating health and social care to ensure that frail older people living in the community receive the assistance they need to maintain independence. In the Brazilian city of Belo Horizonte, located in the state of Minas Gerais, an integrated care intervention has been developed: the Programa Maior Cuidado – Older Adult Care Programme (PMC). This programme represents a pioneering example in Brazil of the provision of carers for highly vulnerable older people, through integrated action between public health and social service agencies. This paper draws on the first phase of a mixed method evaluation of PMC, including data from documentary sources, focus groups, empirical observation and expert workshops, to examine the processes that led to the establishment of programme. The origins of the PMC are discussed and its operational processes, with a particular emphasis on integrated activities and the roles of different actors. The paper situates PMC within comparable international experiences of integrated provision for older people and considers how it has been affected by unique context and challenging of a middle-income country.
Highlights
Rapid population ageing represents a significant challenge for most low and middle- income countries
All of the above have been exacerbated by the Covid-19 pandemic, which has hit Brazil hard, with the majority of deaths occurring among people aged 60 or more [9]
The carers only work during normal working hours, but the time spent varies according to the complexity of the case. They are hired through a contract between the municipality and a non-governmental Civil Society Organisation (Organização da Sociedade Civil – OSC in Portuguese), responsible for ensuring their training and qualifications, under the supervision of the Departments of Health and Social Assistance
Summary
Rapid population ageing represents a significant challenge for most low and middle- income countries. As in high-income countries, an ageing population requires policies to promote integrated health and social care, to support independent living at home and reduce unnecessary hospital admissions [2]. Numerous studies refer to the potential benefits of integrating health and social care, including more efficient use of health services and improved health outcomes for older people and their carers. These integrated interventions can take many forms, but mainly focus on collaboration between health and social assistance professionals, and with family carers [3, 4, 5]. All of the above have been exacerbated by the Covid-19 pandemic, which has hit Brazil hard, with the majority of deaths occurring among people aged 60 or more [9]
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