# Description of a National Initiative to Train and Implement Processes of Primary Palliative Care in the Public Health System in Brazil

## TL;DR

This paper describes Brazil's first national initiative to implement palliative care training and services in public health, tailored to local needs and resources.

## Contribution

The project introduced a scalable, low-cost model for integrating palliative care into Brazil's public health system through customized regional approaches.

## Key findings

- The program was structured around three pillars and five stages, adapting to local realities without overburdening health services.
- Remote activities and reduced visits enabled cost-effective scaling across Brazil's vast territory.
- Engaging local health professionals improved intervention effectiveness and addressed work overload challenges.

## Abstract

To describe the first national project in Brazil to systematically bring palliative care (PC) knowledge and practices to public health services.

Descriptive case study of “Palliative Care Program in the SUS—hospital care, specialized outpatient care and home care,” based on three main pillars and carried out in five stages.

The program took place from 2020 to 2024. Part of its fundamental design was the customization of PC initiatives to be implemented in the health care services based on the local reality of each region and its available resources. The target services were clusters of three public or philanthropic health care services comprising one hospital, one specialized outpatient clinic, and one home care service that allowed for the continual care of the patients.

Considering the Brazilian territorial extension and the complexity of the public health system, the project was innovative in adding competence and management processes in PC without burdening the services. Remote activities and reduced visits made the project low-cost, allowing it to be scaled up and viable even in a country of continental proportions.

The field teams had the opportunity to listen to the health professionals of the public system, who were struggling with work overloads and a population in dire PC needs, giving them a voice and enabling the adjustment of the project’s interventions based on their reality. These ongoing and timely adjustments at the same time engaged local leaders and improved the interventions sought.