UC Berkeley

Background: Health systems around the world have historically been oriented toward acute care, but over the past century chronic diseases have become the leading causes of death globally. It has been estimated that 80% of the burden of chronic diseases occur in low and middle-income countries. However, there is a gap in the scientific literature regarding how these countries are addressing their burgeoning chronic disease burden, how chronic disease management models inform public health system organizations, and how health sector reform efforts intersect with chronic disease and its management. Purpose: The current work aims to address this specific gap by examining the public health system responses to HIV/AIDS and type 2 diabetes in the middle-income countries of Mexico and Brazil. Methodology: After reviewing existing models of chronic disease care and health systems, a new model was developed to examine the public health system responses to chronic diseases. The model was used to guide a literature review on health sector reform, HIV/AIDS, and diabetes in Mexico and Brazil. Quantitative and qualitative secondary data was supplemented by information gathered through qualitative interviews with experts in both countries from federal government, state/municipal government, non-governmental organizations, and academia working in the area of HIV/AIDS or diabetes. Data were analyzed according to the proposed model, and case studies were developed. Findings: The proposed model examines financing and expenditures, policy (including prevention), service delivery, medical products, self-management support, workforce, and health information technology. The study revealed the need to incorporate community involvement into the model and a number of additional indicators. A centralized procurement and health information system to monitor and control dispensation of medications, similar to Brazil's system for antiretroviral medications, would likely reduce long term costs and improve patient care in Mexico and elsewhere. Utilization of a primary care approach using multidisciplinary health teams may be the best mechanism to improve overall processes for chronic care and health outcomes. A civil rights, social justice approach employed by the citizenry to engage governments was critical in Brazil and Mexico to garner support for services and resources to combat HIV/AIDS and stimulate health sector reform.