Brazil
One of the largest universal public health systems, with a tightly controlled opioid regime and a recently formalized palliative care agenda.
9 domains reviewed · 9 high-confidence · 0 dated estimates · 9 material gaps
WHO region: Americas. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 9 of 9
- Hospice: 3 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 13
- Sources behind this dossier
- 19
- Newest source 2026
Lessons from Brazil
- Heavy prescribing formalities, physician and dentist-only prescribing and out-of-pocket costs coexist with low medical opioid use. Controls should be judged by their effect on patient access, not only diversion.232
- A ministry partnership linked hospital, outpatient and home services into local clusters and trained existing staff, a low-cost route to primary palliative care in a large public system.235
- A credential route by examination or residency, plus a national curriculum requirement, builds a training pipeline, but rollout depends on trained faculty.237,236
- Community health agents who already know every household can help primary care teams find people who need palliative care, as tested in a Rio Grande pilot.530
- Special prescription notifications, 30-day limits and prescriber registration can keep non-medical use low but have been criticized for restricting pain care, so rules need review against patient need.232
Palliative care
Is morphine available in Brazil?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
Medical opioid availability is a small fraction of high-income countries' and mid-level for Latin America. Pharmacy sales rose steeply from 2009 to 2015, mostly codeine, and dispensing concentrates in wealthier southern states. Many pediatric palliative services report difficulty obtaining opioids.232,233,234
How has access to morphine, not codeine, changed for palliative patients since 2018?
Help answer it:Search PubMedHow does Brazil regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
Access is classed as highly restricted. Prescribers need a duplicated special form plus a prescription notification, each covering a limited supply, and pharmacies log dispensing in a national controlled-substances system reported monthly to health authorities.232
When was the prescription notification regime last revised, and has anything eased?
Help answer it:Search PubMedWho can prescribe morphine in Brazil?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
Only physicians and dentists with a special local registration may prescribe scheduled opioids, and pharmacists may not accept emergency telephone prescriptions.232
Has prescribing authority been extended beyond physicians and dentists?
Help answer it:Search PubMedHow does palliative care reach patients in Brazil?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
Most people depend only on the public system, yet about half of palliative services are public and many sit in the Southeast. A first health resolution on palliative care came in 2018, and a 2020 to 2024 national program built primary palliative care in linked hospital, outpatient and home clusters.235,236,234
What national instrument followed the 2018 resolution, and how far is it implemented?
Help answer it:Search PubMedWho pays for palliative care in Brazil?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
The national program ran through a ministry partnership with philanthropic hospitals. Patients pay out of pocket for opioid prescriptions at a meaningful share of the minimum wage.235,232
How are palliative services reimbursed in the public system versus private plans?
Help answer it:Search PubMedHow are palliative care clinicians trained in Brazil?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
Palliative medicine became a recognized area of practice in 2011, earned by examination or registered residency, with two-year residencies from 2023. Palliative care entered the national medical curriculum in 2023. A regional survey lists Brazil among countries reporting it as a specialty.237,236,96
Is palliative medicine a specialty or an area of practice? The sources differ.
Help answer it:Search PubMedHow does Brazil prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
Brazil schedules strong opioids under ANVISA lists, limits prescribing to registered physicians and dentists, requires a special prescription notification covering up to 30 days, and records all dispensing in a national controlled substances system. Reviewers describe Brazil as highly restricted for opioid access, with rules criticized for neglecting pain care, while non-medical use stays far below North American levels.232
How widely available are methadone or buprenorphine treatment and take-home naloxone in Brazil's public health system?
Help answer it:Search PubMedHow do children get palliative care in Brazil?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
Among 272 Brazilian physicians treating children with cancer, 77.2% had access to pediatric palliative care experts, but only 10.3% said palliative care began at diagnosis. Top barriers were physician discomfort (89.0%), limited knowledge (88.6%) and lack of home-based services (83.8%).750
How many children with life-limiting conditions in Brazil receive specialist palliative care, and are oral morphine solutions available for children in public pharmacies?
Help answer it:Search PubMedHospice care in Brazil
How the hospice model works here, who can use it, who pays and who it reaches. Covered 3 of 4.
What does hospice care look like in Brazil?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
Recent PubMed literature describes hospice care as a service inside cancer centers, for example at one public quaternary cancer hospital in Sao Paulo. No national hospice model was described in the sources read.317
How many dedicated end-of-life hospice units exist in Brazil, who runs them, and do Brazilian authors use hospice and palliative care interchangeably?
Help answer it:Search PubMedWho can get hospice care in Brazil?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
What admission rules apply to hospice care in Brazil, and how late do patients arrive?
Help answer it:Search PubMedWho pays for hospice care in Brazil?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
At one public quaternary cancer hospital in Sao Paulo, hospice care was costed as part of the public hospital's own spending and made up 29.5% of palliative care costs for 2985 patients who died in 2010 to 2013. Single-site data; national payment rules for hospice under the SUS were not described.317
Does the SUS or private health insurance reimburse hospice stays nationally, and what share is paid by charities or families?
Help answer it:Search PubMedHow many people reach hospice in Brazil?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
Across 32 private cancer centers in 2022, patients in an outpatient palliative care program had more home or hospice deaths than other patients (19.6% vs 10.4%). Home and hospice deaths were reported together, and the study was run by the private network that offers the program.318
What share of Brazilian decedents die in a hospice, and how does access differ between SUS and private patients, regions, and non-cancer conditions?
Help answer it:Search PubMedWhat fills the gap in Brazil
How people get care outside formal services: families, faith communities, volunteers, health workers, healers, other medicines and charity. Described, not scored.
- Family caregiving
In interviews with family members and primary care professionals in municipalities far from large centers, living the final moments with family at home was valued. The study found serious discontinuity of care for people dying at home in the public system.533
Subnational evidence- Faith communities
Family caregivers of people with advanced cancer describe faith in God as giving them strength to cope with caregiving. In one survey of 50 family members, positive spiritual or religious coping was very high in 76%, and the authors report these resources were mostly ignored by the care team. In two favelas, prayer and connection with God were sources of comfort while organized religious attendance was mostly low.534,535,536
Subnational evidence- Volunteers and compassionate communities
A compassionate community project in Rio Grande enrolled family carers in monthly meetings called Comunidade Cuidador alongside primary care teams, running 8 training programmes in 2015 with an average of 10 carers. A compassionate community in two favelas also supports patients receiving palliative care and their caregivers. Both reports come from the programs' own teams or partners.531,536
Subnational evidenceSelf-reported- Community health workers and home-based care
In a Rio Grande pilot, a Family Health Strategy team with 6 community health agents used the agents' knowledge of local households to identify people needing palliative care, finding 51 patients in the first round. National survey data show about 70% of households with a person needing home care received home visits, with fewer visits where social vulnerability was higher.530,532
Mixed scope
Sources cited here
- 232Maia LO, Daldegan-Bueno D, Fischer B.
Opioid use, regulation, and harms in Brazil: a comprehensive narrative overview of available data and indicators. Substance Abuse Treatment, Prevention, and Policy 2021;16(1):12. Low availability versus high-income countries, mid-level in Latin America; codeine dominant; morphine and codeine on the essential list; special form, prescription notification and supply limits; physician and dentist prescribing only; out-of-pocket prescription cost. Abstract and full text read.
- 233Krawczyk N, Greene MC, Zorzanelli R, et al.
Rising Trends of Prescription Opioid Sales in Contemporary Brazil, 2009-2015. American Journal of Public Health 2018;108(5):666-668. Pharmacy opioid sales rose steeply, mostly codeine. Abstract read.
- 234Ferreira EAL, Saito L, Sarracini MR, et al.
Pediatric palliative care in Brazil: reflections on end of life based on geographic mapping. Research in Health Services and Regions 2024;3(1):18. Services unevenly distributed; many report difficulty accessing opioids. Abstract read.
- 235D'Alessandro MPS, Hoffmann LB, de Souza HL, et al.
Description of a National Initiative to Train and Implement Processes of Primary Palliative Care in the Public Health System in Brazil. Palliative Medicine Reports 2025;6(1):116-121. Most people depend on the public system but about half of services are public; first health resolution on palliative care in 2018; 2020 to 2024 national program in hospital, outpatient and home clusters under a ministry partnership with philanthropic hospitals. Abstract and full text read.
- 236Tramonte MS, Carvalho ACP, Pinheiro MS, et al.
A needs assessment of palliative care education in neurology residency programs in Brazil. Arquivos de Neuro-Psiquiatria 2025;83(8):1-7. Palliative care recognized as public health policy with incomplete implementation; in the national medical curriculum from 2023. Abstract and full text read.
- 237Carvalho RT, Correa TL.
Palliative Medicine: 10 years as an area of medical practice in Brazil. Revista da Associacao Medica Brasileira 2022;68(12):1607-1610. Recognized as an area of practice in 2011; title by examination or registered residency; two-year residencies from 2023. Full text read.
- 96Pastrana T, De Lima L, Stoltenberg M, Peters H.
Palliative medicine specialization in Latin America: a comparative analysis. Journal of Pain and Symptom Management 2021;62(5):960-967. DOI 10.1016/j.jpainsymman.2021.04.014. Abstract read. Mexico is among the Latin American countries reporting palliative medicine as a medical specialty.
- 751Vigna PM, de Castro I, Fumis RRL
Spirituality alleviates the burden on family members caring for patients receiving palliative care exclusively. BMC Palliat Care 2020;19(1):77. Cross-sectional study of 178 family caregivers at one private tertiary teaching hospital in São Paulo; single site, private sector. Abstract read.
- 752Delalibera M, Coelho A, Frade P, et al.
Caregiving and bereavement in palliative care: A cross-cultural study between Brazil and Portugal. Transcult Psychiatry 2020;57(3):445-454. Prospective convenience samples of palliative care family caregivers in Brazil (60 at baseline, 35 in bereavement) and Portugal; small samples. Abstract read.
- 750McNeil MJ, Godfrey A, Loggetto P, et al.
Physician Perceptions of and Barriers to Pediatric Palliative Care for Children With Cancer in Brazil. JCO Glob Oncol 2023;9:e2300057. Survey of 272 physicians treating children with cancer at participating Brazilian institutions in 2022; institution-based convenience sample. Abstract read.
- 317Rozman LM, Campolina AG, Lopez RM, et al.
Palliative cancer care: costs in a Brazilian quaternary hospital. BMJ Support Palliat Care 2019;12(e2):e211-e218. Retrospective cost study of 2985 adults who died 2010 to 2013 after palliative care visits and/or hospice care at one public quaternary cancer hospital in Sao Paulo; single site, hospital perspective. Abstract read.
- 318Gomes SA, Silva DNM, Sorice F, et al.
Outpatient Palliative Care Program: Impact on Home Death Rate in Brazil. Cancers (Basel) 2024;16(7). Retrospective study of 1980 cancer deaths in 2022 across 32 private cancer centers; home and hospice deaths are reported together; all authors are affiliated with the private network that runs the program (self-evaluation). Abstract read.
- 530Corrêa SR, Mazuko C, Almeida M, et al.
OA59 Developing an innovative model of palliative care in the community in brazil. BMJ Support Palliat Care 2015;5 Suppl 1:A19. Conference abstract describing a Family Health Strategy pilot in one area of Rio Grande (3000 persons) where community health agents helped identify patients needing palliative care; written by the project team (self-report). Abstract read.
- 533Queiroz AH, Pontes RJ, e Souza ÂM, et al.
[Perception of family members and health professionals on end of life care within the scope of primary health care]. Cien Saude Colet 2013;18(9):2615-23. Qualitative interviews with 7 family members and 5 professionals about dying at home in the public system in municipalities distant from large centers; small sample. Abstract read.
- 534Paiva BS, Carvalho AL, Lucchetti G, et al.
"Oh, yeah, I'm getting closer to god": spirituality and religiousness of family caregivers of cancer patients undergoing palliative care. Support Care Cancer 2015;23(8):2383-9. Qualitative study of 30 family caregivers of people with advanced cancer in palliative care in Brazil. Abstract read.
- 535August H, Esperandio MRG
Spiritual Resources of Family Members of Patients in Palliative Care in Brazil. J Health Care Chaplain 2021;28(4):555-565. Survey of 50 family members of palliative care patients using religiosity and spiritual coping scales. Abstract read.
- 536Souza MT, Stipp MAC, Mesquita MGDR, et al.
The Spiritual Dimension of Palliative Care Patients and Their Caregivers in a Compassionate Community in Two Brazilian Favelas: A Mixed-Methods Study. J Relig Health 2026. Mixed-methods study of 29 patients and caregivers in a compassionate community in two favelas; small, single-program sample. Abstract read.
- 531Corrêa S
Proposal of a New Public Health End of Life approach for Brazil: how the Project EstaraoSeuLado-Primary Palliative Care is working and how it can help. Ann Palliat Med 2018;7(Suppl 1):AB009. Conference abstract on a compassionate community project in Rio Grande that ran monthly carer meetings with primary care teams; written by the project lead, who advocates national adoption (self-evaluation). Abstract read.
- 532Linhares RDS, Thumé E, Carrett MLV, et al.
Locomotion difficulty and need for home care: a cross-sectional study. Rev Saude Publica 2025;59:e35. National primary care user survey (PMAQ cycle III, 2017 to 2018) on home visits to households with a person needing home care; covers mobility-limited people generally, not only those at end of life. Abstract read.