Internationally, there is a large body of scientific evidence concerning the benefits of integrating health and social care to ensure that frail older people living in the community receive the assistance they need to maintain independence. This programme represents a pioneering example in Brazil of the provision of carers for highly vulnerable older people, through integrated action between public health and social service agencies. This paper draws on the first phase of a mixed method evaluation of PMC, including data from documentary sources, focus groups, empirical observation and expert workshops, to examine the processes that led to the establishment of programme.
The origins of the PMC are discussed and its operational processes, with a particular emphasis on integrated activities and the roles of different actors. The paper situates PMC within comparable international experiences of integrated provision for older people and considers how it has been affected by unique context and challenging of a middle-income country.
Rapid population ageing represents a significant challenge for most low and middle- income countries. As in high-income countries, an ageing population requires policies to promote integrated health and social care, to support independent living at home and reduce unnecessary hospital admissions [ 2 ].
Numerous studies refer to the potential benefits of integrating health and social care, including more efficient use of health services and improved health outcomes for older people and their carers. These integrated interventions can take many forms, but mainly focus on collaboration between health and social assistance professionals, and with family carers [ 3 , 4 , 5 ].
Over the next 25 years, the share of people aged 70 or older will treble, to reach Brazil is ageing in a context of deep economic crisis, and profound social and gender inequality, all of which present challenges to public policies.
