Disability inclusion in the Brazilian health system: results of a health system assessment

Background: People with disabilities face more barriers accessing healthcare and, on average, experience worse health outcomes. Strengthening health access for people with disabilities requires coordinated action across the health system. The Missing Billion Inclusive Health System Framework is a new tool to support policy makers assess levels of disability inclusion within health systems. In this study we use the framework within the Unified Health System in Brazil. We consider the relevance and feasibility of the indicators, as part of further testing and refining the framework. Methods: Information sources, used to complete the assessment, included Brazilian laws and policies, publically available data, published literature and interviews with people with disabilities and service providers. A workshop with stakeholders was held to co-develop key recommendations. Findings: Overall, the framework was comprehensive and feasible to complete. It highlighted key strengths in terms of disability inclusion in the Brazilian health system as well as gaps and leverage points for action. Interpretation: The Missing Billions framework can identify progress and opportunities to strengthen disability inclusion in health systems. In Brazil, key promotive factors include supportive policies, leadership and financing structures. There are also opportunities for strengthening data and evidence, healthcare worker training on disability and health service accessibility. Actions must be centered on, and informed by, people with disabilities.