Efficiency of public spending on primary health care: analysis of São Paulo’s cities

Abstract

Objective: To analyze the efficiency of São Paulo’s cities with spending on the Primary Health Care sub-function in the year of 2018 and its association with geographic location, population size, wealth generated in the city (GDP – Gross Domestic Product) and budget expenditures with this public policy.
 Methodology: Exploratory descriptive and explanatory study with São Paulo’s cities in six similar cluster whit combine population and GDP. It uses the settled expense as input, the Number of FHS (Family Health Strategy) Teams, FHS’s Coverage Percentage, Number of Basic Health Units (BHU) and Percentage of Live Births of mothers who performed more than 7 doctor's appointments in the prenatal period as an output. The efficiency level of each city is shown on georeferenced maps. Pearson's correlation is used to estimate the levels of associations between quantitative variables.
 Results: 102 cities have a maximum level of efficiency, distributed between the six groups. Cities with a lower number of inhabitants and GDP tend to be more inefficient. Efficiency has a low correlation with population size, GDP or health public spending. The cities with the lowest levels of efficiency are neighbors of São Paulo (Metropolitan Region) or small cities scattered throughout the state’s territory.
 Theoretical Contributions: The research identifies that the management (formulation, implementation and evaluation) of the primary health care policy must consider different programs that focus on its location in the cities’ territory, population and wealth. There are references to the benchmarks for good practices in managing Primary Health Care policies.