Expansion of Integrated Care in Brazil: the experience of reorganizing the healthcare network in Santana de Parnaíba.
Authors: Verissimo Larissa , Hendry Anne , Jacob Lia Maristela , Castillejo Joan , Andrew Mandy , Stein Viktoria , Misorelli José Carlos 
Published: January 2024

During 2018/2019, the State Department of Health of São Paulo in partnership with the International Center for Integrated Care delivered an integrated care pilot project- Transforming Together. The aim was to co-design and deliver a more integrated system in the North Coast Region and to build the capability of key players in the region and state to sustain the change. The demonstrator project generated knowledge transfer in 2020/2021 through an InterAmerican Development Bank webinar and publications to encourage other municipalities to develop integrated care networks. With their acquired knowledge and experience, a team of local consultants have spread the change methodology to another region.
In 2022 a new integrated care project was launched in Santana de Parnaíba-SP, a municipality in the metropolitan region of São Paulo with around 145,000 inhabitants, an HDI of 0.814 and GDP per capita of 12.500 dollars. Primary and secondary care services are already strong, referring patients to the regional network only for tertiary services, and a new hospital is scheduled to open in 2023. The project aims to fully integrate this hospital within the healthcare network and with other sectors.
The work plan, co-designed with the municipality, has three workstreams aligned to provision of services and care for the population: a diagnostic phase; technical support for managers; and a ‘train the trainers’ educational programme to build workforce competencies for integrated care. For the diagnostic phase, municipal services were visited, health and social care service data was analyzed and a novel Day of Care Survey applied to understand the current hospital inpatient profile. Workshops with managers from different sectors explored the concepts of integrated care, supported them to map local care pathways and to self assess the maturity of their network using the Scirocco self-assessment instrument. After agreeing the educational programme outline and selecting participants, learning cycles began in July 2022. Six thematic sessions focus on: Integrated Care and Innovation; Management and Assistance Models; Leadership; Participatory Policies; Effective Work Processes; and Governance. The sessions include masterclasses by international experts via videoconference.

By November 2022, more than 100 health and social care workers have participated. They have had the opportunity to deepen their knowledge on integrated care, strengthen relationships with colleagues from other services/sectors, understanding the importance of working together between all the actors involved in the care of a person to improve their health and well-being. Managers have a growing understanding of how to tackle the main barriers to people centered integrated care, and how working together across sectors is still deficient. Scirocco tool scores reflected knowledge, certainty and readiness for integrated care.
This initiative highlights how implementation can be transferred successfully from one context to another.
By using international expertise to build local knowledge and leadership, we have demonstrated a methodology that builds capability for integrated care in the Brazilian system and a support programme that is transferable to different regions in São Paulo state. Scale up of the Transforming Together integrated approach across all states is necessary to strengthen the Brazilian public health system.