DESK REVIEWS | What is the process for deciding how much funding is available for long-term care service provision?

DESK REVIEW | What is the process for deciding how much funding is available for long-term care service provision?

There are several laws informing the planning of allocation and expenditure of public resources for the entire health (SUS) and social care (SUAS) systems which, together, finance the LTC services provided to older people in Brazil (Brasil, 2011). SUS has several participatory forums at federal, state, and municipality levels, which help inform the healthcare strategy nationally. These occur at different points in time along the year and are secured by different laws. As Brazil does not have a unified LTC system, and it is unclear which services are classified as being LTC, it is difficult to estimate how and how much of the total amount is allocated to LTC specifically every month/year. Further, for the financing of public/philanthropic LTC institutions, in addition to the budget coming from the public system financed mostly through taxation, the budget may come from the older person/family funds, older people’s pensions, philanthropy, donations, and others, all of which are varied (Freire et al., 2012; Watanabe, 2018). In the private LTC institutions, the main source of financing is through individual payment (e.g. pension, family funding) (Freire et al., 2012).


Brasil, no. L12435 (2011).

Freire, F. de S., Mendonça, L. H. de, & Costa, A. de J. B. (2012). Sustentabilidade econômica das instituições de longa permanência para idosos. Saúde em Debate, 36(95), 533–543.

Watanabe, H. (2018). Instituições de Longa Permanência conveniadas com o MDS.

The allocation of funds is decided through the annual financial statement, commonly known as the Union Budget. The Union budget is announced in Parliament by the minister of finance. Both the finance bill and the appropriation bill are passed by the Lok Sabha before the annual announcement. In 2019–2020, the health budget was increased to support the requirements of the rural health mission and to initiate the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana health scheme (AB-PMJAY).

For other programmes, such as the National Programme for Palliative care, declared in 2012, a model Personal Independence Payment (PIP) framework with operational and financial guidelines has been designed. Based on a model PIP (Project Implementation Plans), the states/UTs may prepare their proposals related to palliative care and seek financial support from the National Health Mission. Palliative Care is part of the ‘Mission Flexipool’ under the National Health Mission (NHM) and no separate budget has been allocated for the implementation of the programme (MoHFW, 2019b). However, large gaps in the implementation of this programme have been reported with only about 2% of the proposed budget being sanctioned to a small number of states (Rajagopal, 2017).


Ministry of Health and Family Welfare. (2019b). National Programme for Palliative care (NPPC): National Health Mission.

Rajagopal Vallath Nandini, M., Mathews Rajashree, L. K., & Watson, M. (2017). An Indian Primer of Palliative Care For medical students and doctors. Available from

Local governments receive an allocated budget (effective for one year) on an annual basis. Local governments submit their financial plan to the Regional House of Representatives six months before the beginning of the new financial year for approval. The process is monitored by the Ministry of Home Affairs (Proses Penyusunan APBD, 2016).


Proses Penyusunan APBD. (2016). Media Riset, Diklat, Dan Konsultan Lembaga Kajian Nasional Kementerian Dalam Negeri.

The process of allocation in all sectors including LTC is determined by the ministry of health based on cost-effective and efficient programmes (Ministry of Health, 2016b).


Ministry of Health. (2016b). National and county health budget analysis FY 2016/17. Nairobi, Kenya.

As previously mentioned, while DIF and INAPAM define the budget annually allocated to the few institutions they have, their overall budget has to be approved by the Ministry of Finance.