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Reading: Transforming Together: a Pathfinder for Integrated Care in Brazil


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Transforming Together: a Pathfinder for Integrated Care in Brazil


Anne Hendry

IFIC Scotland, GB
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The International Centre for Integrated Care (IC4IC) and a team from Sao Paulo State Secretary of Health and Regional Department of Health (UCP) co-designed a pathfinder integrated care project in Litoral Norte, Brazil to establish a more integrated system across different levels of healthcare and with partners from social development, education, housing, sport, culture and the environment.

The project engaged and empowered leaders, professionals and managers from different disciplines and levels of care to collaborate as a network to improve population health.  Listening to patient, carer and family experience, studying care processes and pathways, and exploring relationships and interactions between different disciplines and sectors identified common themes, clarified roles and responsibilities, and co-created solutions. 

Capacity and capability for transformation were built through coaching for system leaders from different sectors, co-design of new ways of working and spread of learning by serial tests of change using a modified breakthrough collaborative approach.

From November 2018 to November 2019, five field visits engaged 1200 managers, leaders and professionals from healthcare, social development, education, culture, housing, sports, and community partners from four 4 municipalities (population 330,000), alongside professionals from State and Regional Departments of Health and Social Development. Field visits were followed by monthly online coaching sessions for UCP staff.

A regional network of champions have adopted and spread new ways of integrated working in primary care with NGOs and community partners to support wellbeing; integrated population health initiatives in low income housing; health promotion, mental health and suicide prevention initiatives reaching around 15,000 adolescents through 47 schools; Day of Care surveys in 4 hospitals and development of intermediate care services; and revision of ambulatory care pathways for 20 chronic conditions. 

Self assessed knowledge, competences and capability for integrated care improved at local, regional and central levels. Around 60% of respondents reported significant or very significant improvements and 40% reported at least modest improvements in system relationships.

The co-designed, collaborative approach has built peer support, resilience and delivered rapid changes despite a challenging and changing political landscape. Professionals from different sectors and levels of care are planning together and sharing information in a confident and organised way that has changed relationships between providers, improved coordination of care and delivered better health outcomes for citizens. The project co-designed an integrated and stepped care model to improve population health and enable more care closer to home by creating the conditions for different stakeholders to plan, reorganise and optimise care across a regional network.

Success factors are nurturing trusting relationships, empowering local leaders to be creative, equipping professionals with knowledge and tools to overcome difficulties, and co-creating new ways of working that enable place based people centred integrated care solutions.

Enhanced capability for integrated care has spread beyond the region as the UCP team sensitised two other Health in Action regions to the innovative approach. The Transforming Together approach is transferable to other states in Brazil and to LMI economies with a mix of private and public healthcare and municipal, state and federal systems. 

How to Cite: Hendry A. Transforming Together: a Pathfinder for Integrated Care in Brazil. International Journal of Integrated Care. 2021;21(S1):123. DOI:
Published on 01 Sep 2021.


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