Integration of genetic services into the Single Health System in Brazil
Brazil faces multiple challenges to improve and expand genetic services, because of its enormous territory, sociocultural inequities and major basic health problems. The majority of the population is served by the public Single Health System (‘Sistema Único de Saúde’, SUS), created in conformity with the provisions of the 1988 Federal Constitution, to ensure universal and equal access for promoting, protecting and recovering the health of all citizens fairly. It has a municipal basis whose management is under the state administration, with the support of the Federal Ministry of Health (MH). Recognizing the marked regional inequalities as well as the rising demand for genetic services, the MH instituted the Working Group on Clinical Genetics in 2004. It is constituted by representatives from the MH, the Brazilian Society of Clinical Genetics, the Brazilian Society of Genetics, and from medical genetic services. Its major aims are to make proposals for implementing a national policy for health care in clinical genetics and for inserting the specialty in the SUS. The main actions include recognition of the most frequent birth defects and genetic diseases and development of regionalized, hierarchical and ethical genetic health programs for these conditions, emphasizing genetic services of low complexity properly integrated with secondary and tertiary reference centres. Guidelines are been established in order to standardize regional services considering diagnosis confirmation, treatment, follow-up, family orientation and genetic counselling for specific conditions as mental retardation, Down syndrome, congenital anomalies, genital ambiguity and inborn errors of metabolism, besides genetic counselling for genetic diseases in general. Even though a challenging task, this MH initiative represents the most significant effort toward an effective integration of clinical genetics in the SUS providing appropriate genetic services to the Brazilian population as a whole.