A situational analysis of rehabilitation policy and systems in Brazil

Multiple health system components, supported by good policy, are needed for the provision of quality rehabilitation care. This study used the Missing Billion Health System Framework to structure a situational analysis of publicly funded rehabilitation services within the Unified Health System in Brazil, focusing on: governance, leadership, health financing, data and evidence, autonomy and awareness, affordability, human resources, health facilities, and assistive technology. We reviewed online policy documents, Health Information System data and published literature and conducted semi-structured interviews with 87 people with disabilities and 57 health and rehabilitation providers in São Paulo, Santos, Brasília, and Arcoverde. The situational analysis showed that the Brazilian policy framework is broadly supportive of rehabilitation provision, and a defined leadership structure assists rehabilitation provision at the national, state, and municipality level. However, there are challenges to rehabilitation service provision including insufficient funding and service availability, and inadequate numbers of rehabilitation professionals, with variation by cadre and region. For service users with disabilities, key challenges to accessing rehabilitation include high costs of transport, communication and information barriers, and long wait times. Available data indicate high-need and low coverage for rehabilitation, although there is a gap in reliable data on service need. In conclusion, this situational analysis highlighted rehabilitation programme and policy strengths in Brazil that could be replicated in other settings, such as the supportive policy and leadership structure. However, there are gaps to be addressed, including geographic inequalities in the availability of rehabilitation professionals and barriers to access for service users.