# Equity in Health Policy for Persons With Disabilities in Brazil: Spatial Distribution of Specialised Rehabilitation Centres

## TL;DR

This study examines how Brazil's specialized rehabilitation centers are distributed and finds they are not placed where they are most needed.

## Contribution

The study reveals that economic factors, not disability prevalence, drive the placement of rehabilitation centers in Brazil.

## Key findings

- Only 32% of Brazil's health regions have specialized rehabilitation centers.
- CER implementation is linked to higher income, health spending, and GDP, not disability prevalence.
- The Northeast region has high rehabilitation needs but lacks sufficient centers.

## Abstract

To analyse the spatial distribution of Specialised Rehabilitation Centres (CERs) in Brazil, considering the prevalence of persons with disabilities (PWD), socioeconomic factors, and health financing.

An ecological study design was employed, using descriptive and Bayesian spatial regression analyses on data from 438 health regions in Brazil. The presence or absence of CERs in these regions was the main outcome. Covariates included PWD population, socioeconomic indicators, health service funding, and health system factors.

The study revealed that CERs are present in only 32% of health regions, with significant associations between CER implementation and factors such as monthly per capita household income, health expenditure per inhabitant, and regional GDP. Notably, the increase in PWD numbers did not directly correlate with CER implementation at the regional level.

The implementation of CERs is influenced by economic and health service factors, not just by the prevalence of PWD. To improve equity in access, it is essential to prioritise CER implementation in regions with higher rehabilitation needs and better utilise available data on disability demographics. Comprehensive, integrated care for PWD requires interdisciplinary and intersectoral actions.

Low coverage of CERs in Brazil: Only 34.9% of health regions have Specialised Rehabilitation Centres (CERs), with significant disparities in their distribution across the country.
Economic factors impact CER implementation: The study identified that CER implementation is positively associated with an increase in monthly per capita income, public health spending per inhabitant, and the GDP of the health region.
Disability prevalence is not sufficient to justify implementation: The higher concentration of persons with disabilities (PWD) in certain regions does not directly translate into greater CER implementation, highlighting the need to consider other factors for prioritisation.
Regional inequality in rehabilitation needs: The Northeast region has the highest concentration of rehabilitation needs, yet the availability of CERs remains insufficient, perpetuating disparities in access to health services for PWD.
Importance of qualified data for public policies: The study emphasizes the need for updated and accurate data on the PWD population to guide the implementation of more equitable and effective health policies.

Low coverage of CERs in Brazil: Only 34.9% of health regions have Specialised Rehabilitation Centres (CERs), with significant disparities in their distribution across the country.

Economic factors impact CER implementation: The study identified that CER implementation is positively associated with an increase in monthly per capita income, public health spending per inhabitant, and the GDP of the health region.

Disability prevalence is not sufficient to justify implementation: The higher concentration of persons with disabilities (PWD) in certain regions does not directly translate into greater CER implementation, highlighting the need to consider other factors for prioritisation.

Regional inequality in rehabilitation needs: The Northeast region has the highest concentration of rehabilitation needs, yet the availability of CERs remains insufficient, perpetuating disparities in access to health services for PWD.

Importance of qualified data for public policies: The study emphasizes the need for updated and accurate data on the PWD population to guide the implementation of more equitable and effective health policies.