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Integrating health and social care is now a high priority for public health policy in high-income countries. It has received much less attention in low and middle-income country (LMIC) settings. There is particular value in assessing the potential to integrate care services for older adults, given the speed of population ageing in LMICs. The presentation provides findings of process and impact evaluations of novel local government initiatives to integrate care for older people in Brazil (drawing on a study co-funded by the UK MRC and CONFAP Brazil). Programa Maior Cuidado (PMC) was established in the Brazilian city of Belo Horizonte in 2011. It is jointly managed by the departments of health and of social assistance and involves close community-level collaboration between health posts and neighbourhood social service centres. A key element of PMC is the provision of paid trained lay carers to support family care for dependent older people in socially vulnerable families. We will present findings on the implementation process and operation of PMC, as well as its effects on the following outcomes of interest: reduced unnecessary hospitalisations, enhanced health status for older people and reduced care burden for family carers. Quasi-experimental analysis using spatial-based Propensity Score Matching shows promising results in terms of increasing planned attentions as well as access to rehabilitation services, which confirms the ability of the Program to improve interface with health services avoiding unplanned unnecessary attentions We will examine the implementation of similar interventions in other Brazilian cities, including Fortaleza and Contagem, and will study the role of national and international processes in dissemination, knowledge sharing and agenda-setting. Key messages The presentation provides findings of process and impact evaluations of novel local government initiatives to integrate care for older people in Brazil. Programme under evaluation lead to interesting outcomes of interest: reduced unnecessary hospitalisations, enhanced health status for older people and reduced care burden for family carers.

Integrating health and social care in Brazil