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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

VIEWPOINT: Don’t Neglect Brazil

The country offers fertile ground for pilot initiatives that can benefit the world at large.

In recent years, it has become increasingly difficult to find international non-governmental partners and donors willing to work in Brazil. From a purely economic point of view, this is logical given that Brazil has the seventh largest economy in the world and a high tax burden from which to address social needs.

When comparing whether to support a smaller country in Africa or Asia or a continental behemoth like Brazil, organizations must make rational choices about the allocation of scarce resources. Large-scale international events, such as the 2014 FIFA World Cup and the 2016 Summer Olympic Games in Rio de Janeiro, lend even more credence to international perceptions that Brazil needs little external support to tackle basic public health problems.

When discussing Hansen’s disease or other Neglected Tropical Diseases (NTDs), however, few countries bear the burden that Brazil does. Despite a strong and decentralized public health system, nearly 90% of all new cases of Hansen’s disease in the Western Hemisphere are Brazilian.

Few organizations that deal with leprosy and other NTDs maintain a presence in Brazil.

With only 20% of the hemisphere’s population, it also has virtually all cases of schistosomiasis and visceral leishmaniasis as well as the majority of trachoma, leptospirosis, dengue fever, malaria and Chagas disease. There are even pockets of onchocerciasis and lymphatic filariasis that still need attention. Nevertheless, few organizations that deal with leprosy and other NTDs maintain a presence in the country, and donors rarely include it as a priority nation.

INCOME INEQUALITY

Along with the geographical and climatic factors that favor these diseases, there is also the factor of inequality that skews any discussion on Brazil. Despite an improving GINI coefficient*, there are still only four countries with a more inequitable distribution of income in the world.

Nearly 11% of the total population — 22 million people — live on less than $2 per day, and these are the ones disproportionately affected by diseases of poverty. Although each disease has unique pockets of high-burden areas throughout the country, there is a greater risk for those living in the impoverished northeast, the Amazon River basin and in communities of indigenous peoples that dot the national landscape.

POTENTIAL IMPACT

Regardless of the regional and economic disparities that contribute to a major disease burden akin to Asia and Africa, most aid organizations see only the middle-income, BRICS reality of Brazil. However, even if one discards the possibility of direct interventions and social development projects, there are still a number of important opportunities for international NGOs, universities and donors to have an impact for the world at large:

  • Brazil offers a unique combination of multiple tropical diseases and a number of highly skilled researchers. This has led to a number of joint research projects over the years, especially with large universities in the south and southeast. However, the range of committed researchers and scientists goes well beyond the federal public universities and allows for engaging studies closer to the endemic leprosy and NTD areas. The combination of institutional capacity and persons in need of new health tools and services makes it a very attractive national partner;
  • The variety of NTDs and high level of regional and urban poverty allow for cross-cutting initiatives that take a holistic view of the individuals affected. Netherlands Leprosy Relief and other ILEP/NNN** members have been working on approaches to work transversally for improved social inclusion, quality of life and access to services;
  • Brazil offers fertile ground for pilot initiatives and testing of new diagnostic tools and vaccines that could be scaled up within Brazil and expanded to other countries in need. While it may be possible to outsource the rollout phases to the Brazilian government, support for innovative strategies is often welcomed locally even as an initial testing ground.

Despite the crushing need of direct support in many regions and communities of Brazil, there is not likely to be a large-scale return of international NGOs and donors to the public health arena.

However, the country offers important conditions for the development of new approaches, research, training courses and technical tools that can benefit its own population affected by Hansen’s disease and other NTDs as well as those in many other countries across the world.

Few organizations that deal with leprosy and other NTDs maintain a presence in Brazil.

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AUTHOR: Duane Hinders

Duane Hinders is Country Representative, Netherlands Leprosy Relief, Brazil.

FOOTNOTES

* An economic measure of income inequality.

** International Federation of Anti-Leprosy Organizations/Neglected Tropical Diseases Non-governmental Development Organizations Network