Large Reductions In Amenable Mortality Associated With Brazil’s Primary Care Expansion And Strong Health Governance

Abstract

Strong health governance is key to universal health coverage. However, the relationship between governance and health system performance is underexplored. We investigated whether expansion of the Brazilian Estratégia de Saúde da Família (ESF; family health strategy), a community-based primary care program, reduced amenable mortality (mortality avoidable with timely and effective health care) and whether this association varied by municipal health governance. Fixed-effects longitudinal regression models were used to identify the relationship between ESF coverage and amenable mortality rates in 1,622 municipalities in Brazil over the period 2000-12. Municipal health governance was measured using indicators from a public administration survey, and the resulting scores were used in interactions. Overall, increasing ESF coverage from 0 percent to 100 percent was associated with a reduction of 6.8 percent in rates of amenable mortality, compared with no increase in ESF coverage. The reductions were 11.0 percent for municipalities with the highest governance scores and 4.3 percent for those with the lowest scores. These findings suggest that strengthening local health governance may be vital for improving health services effectiveness and health outcomes in decentralized health systems.

Association between expansion of primary healthcare and racial inequalities in mortality amenable to primary care in Brazil: A national longitudinal analysis

“…This precluded any potential analysis with SRRs for ACSC groups. Fifth, we used mortality from ACSCs as our outcome measure rather than the more broadly defined concept of healthcare-amenable mortality [30,46]). This was principally to focus on conditions that have been defined as amenable to PHC within the Brazilian context and to exclude those that may be strongly influenced by hospital-based care.…”

“…Policy-makers should note that in Brazil, where sharp inequalities persist and an ambition to achieve UHC has been boldly pursued over the last 20 years, the equity-promoting associations of PHC are evident [30]. The strong positive relationship between PHC and reduced racial inequalities in mortality provides impetus for a renewed government commitment to the ESF.…”

“…Longitudinal (panel data) regression models were employed using routinely collected municipal-level data, which have been widely applied to evaluate the ESF previously [4,20,22,27–30]. These models estimated associations between ESF coverage and mortality from ACSCs among black/ pardo and white populations over time, whilst controlling for other confounding factors.…”

Why is breast cancer early detection important?

“…They will be our helping hands. The study led by researchers at Imperial College London, in collaboration with the data integration center at Fiocruz (CIDACS), found that a better level of governance and greater health coverage in primary care in Brazilian municipalities are associated with reduced mortality 19 . And the FHS may be the beginning of our long-awaited organized screening; • develop the feeling of nonconformity in mastologists who are in their "castle of knowledge" and to stop passively "accepting" the so common advanced stage lesions.…”

Implementation strategies for the guidelines for the early detection of breast cancer in Brazil

“…Adherence to the programs is associated with public motivation and awareness. The low awareness rate in most developing countries is alarming and interventions to raise public awareness are needed 27 .…”