Can anyone compare the public health systems of India and Brazil?

[DINGO Joe]

I kind of assumed that they were both comparable or maybe even India had a better system because they make so much pharmaceuticals, but the recent Covid surges led me to read a little more and it seems like Brazil spends much more and has a vastly stronger medical infrastructure than India with India having a private medical system and a sharp drop off after that with rural care virtually non-existent. 

I also get the impression that while there is an undercount of COVID deaths in Brazil it's nothing like the lack of data in India.

Any color posters can provide would be appreciated.

[Red Velvet]

I can’t speak for India because I don’t know much. So I will talk about Brazil.

Brazil has an average/good medical infrastructure but it depends on government investment. And it’s not just how much you spend that matters, but HOW you do it.

In Brazil we have a mixed health system, with investment from public and private spheres. In the public sphere, there is the Sistema Único de Saúde (SUS), the universal healthcare system accessible to all the population and visitors in the country.

The main importance of SUS is accessibility and the penetration it has in all segments of a giant country with continental proportions. Upper classes naturally use more the private system because it’s seen as less crowded and sometimes better but the point of SUS is attending all society and to include lower income segments that, if it weren’t for it, wouldn’t get any medical care at all. And that’s extremely important.

The vaccination campaigns in particular are historically very successful and seen as a global reference because of the high volume of people that are vaccinated in a relative short amount of time. That since the national vaccination program was installed in 1973 and many diseases were eradicated in the country, most symbolic one being polio in the 80s.

Personally, I practically never had to paid for a vaccine, maybe only few exceptions as a baby and a small child. That’s how much of a reference the Brazilian vaccination programs are seen by the population. Every time I needed one I went to the public system. I also often use the SUS whenever there are some quick practical exams to do, like X-rays or even HIV tests. But whenever there is a big emergency I opt for the private one to save time and general more quality. Which isn’t to say the public system is bad, doctors are qualified but there you have to share the attention with more people and sometimes under a more limited local infrastructure.

COVID-19 vaccines appear to be lagging but that’s because of the failure of current Brazilian suicide government in buying vaccines in advance. Brazilian system is capable of vaccinating millions of people in a day with its infrastructure and has done it before.

The biggest problem in regards dealing with COVID-19 imo was the president stimulating anti-safety measures. There wasn’t a lockdown in Brazil and people were also stimulated by science denialism to go out and participate in agglomerations. It was perfect for the spread of the virus.

The Bolsonaro supporters trying to invade hospitals to try to prove the disease didn’t exist and was only a conspiracy also didn’t help. Covid was treated as a politicized topic in the country and if you defended good practice measures you were accused of being opposition wanting to sabotage the Bolsonaro government.

There was also tons of disorganization from the federal government, they basically chose to ignore the disease mostly. Which created a vacuum of leadership that was never completely fulfilled. Governors tried to do that job and fulfill that role, especially the São Paulo state one, called João Doria.

If it wasn’t for Joao Doria, Brazil wouldn’t have vaccinated 85% of the people that already were, because he’s the one who brought the vaccine that is being widely used in here, from China. Same one Bolsonaro always vilified to serve his master Trump and said it was trash. And even if he also didn’t buy many other ones to arrive early.

Bolsonaro is basically an antivaxxer, he openly tried to stimulate people to not believe in vaccines. He chose to not vaccinate himself for COVID-19 yet and the ministers who work for him had to vaccinate themselves in secret because they didn’t want him to discover.

The president strategy was promoting placebo to the population. He spent lots of money on chloroquine because it’s a cheap medicine so he can buy tons of it and convince a large share of people that it’s enough to save them, preventing anger against him to intensify while arguing he tried to do something.

So it’s not really of much use to have a prepared system, both public and private, when its being sabotaged from the inside and money is being put into stuff like chloroquine by the federal government instead of useful stuff.

The pandemic unfortunately happened in Brazil during the worst possible time, with the worst president the country had in all its history.

The reaction should’ve been better, considering the health infrastructure Brazil has. It wouldn’t be in levels of Chile but closer to it.

I always assumed Brazil system is significantly better than the India one but I am not too informed about India system to say for sure.

[CumbrianLefty]

The pandemic unfortunately happened in Brazil during the worst possible time, with the worst president the country had in all its history.

Maybe *the* most important thing in your very comprehensive overview.

[buritobr]

I agree to what Red Velvet told.

Adding some information: the SUS is not very good, but it is not very bad. The 30% of the population who have upper income have private health insurance because they want a better and less overcrowded service. But according to opinion polls, people who use the SUS (poor people) have a more positive view on it, than people who don't use the SUS (middle class and rich people). Upper income people usually have a prejudiced view that the SUS is worse than it really is.
The share of the GDP used to healthcare in Brazil is similar to this share in rich countries, but since the GDP per capita in Brazil is 1/4 of the GDP per capita of rich countries, the per capita spending in health is 1/4. Of course, the SUS cannot have the same quality of the public healthcare system of Sweden.
Actually, even people who have private insurance also use SUS services because the evaluation of the food of the restaurants according to the health norms is made by the SUS. The vaccine programs are conducted by the SUS. If you crash a BMW in Brazil, even if you have a private insurance but you are not able to speak after the accident, the ambulance will take you to a hospital where the emergency service is conducted by the SUS.
The SUS is usually not bad for emergencies (car accidents, shots) and for organ transplant (acutally, private organ transplant is forbidden). The biggest problem of the SUS is the long waiting time to schedule an appointment with specialist doctors.
The SUS is kept by the 3 levels of government (federal, state, municipality). Different states and municipalities have different levels of quality.