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

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 to assess levels of disability inclusion within health systems.

This study uses the Missing Billion framework in Brazil to i) contribute to the further testing and development of the framework and ii) assess the level of disability inclusion within the Unified Health System.

Information sources used to complete the assessment included Brazilian laws and policies, publicly available data, published literature, literature reviews and interviews with people with disabilities and service providers in São Paulo, Santos, Brasília and Arcoverde. A workshop with stakeholders was held to co-develop key recommendations.

Overall, the Missing Billion 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.

The Missing Billion 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.