Integrated Care in the Community: The Case of the Programa Maior Cuidado (Older Adult Care Programme) in Belo Horizonte-Minas Gerais, BRA

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.

Long‐term care in India: Capacity, need and future

“…In 2020, the MoSJE launched the National Action Plan for Welfare of Senior Citizens, a policy document that outlines current schemes and future strategies along with their implementation plan and expected outcomes to provide financial security, food, health care, and a life of dignity to the elderly population (MoSJE, 2020). In June 2021, the MoSJE launched the “Senior Care Aging Growth Engine” project to fund and promote entrepreneurs and start‐ups to contribute toward the “Silver Economy”. Under this programme, the ministry will allocate 100 crores of rupees (INR) (approx.…”

“…14 million US dollars (USD)) to build capacity and care facilities for senior citizens. Further, the ministry plans to develop model senior care projects in partnership with the private sector, with appropriate regulations and standards, policy support, tax structure, subsidized financing and appropriate governance mechanisms (IBEF, 2021).…”

“…In comparison, on average the Member countries of the Organisation for Economic Co‐operation and Development spent 8.8 per cent of their GDP on health in 2019 (OECD, 2021). The share of private out‐of‐pocket health expenditure in the total health expenditure has dropped in recent years, but still accounts for around 50 per cent of total health spending (MoHFW, 2021). Of the 3.3 per cent of GDP spent on the total health expenditure in India, only 0.16 per cent is spent on rehabilitative and long‐term care services, which is quite low as compared to an average of 1.25 per cent in OECD Member countries (OECD, 2020).…”

“…Even after all these efforts, only around 20 per cent of the population is currently covered under some kind of health insurance, as there are both socioeconomic and systemic barriers to accessing health insurance (Kumar and Sarwal, 2021). Elders are often explicitly excluded by insurance companies due to their age and their pre‐existing conditions, such as diabetes, high blood pressure and history of cancer (Dey et al, 2012).…”

“…We estimated a 34 per cent cumulative increase in demand for long‐term care between 2021 and 2036 across the country, with individual states (as shown in Figure 3) experiencing an increase in the range of 0.9 per cent to 2.7 per cent. These figures highlight the potential magnitude of rising dependency and the need for long‐term care across all states in India.…”