The challenge
Brazil needed to reorganise primary health care so that it reached families across the whole country.
The case
Since 1994 Brazil's Family Health Program has organised primary care around teams of doctors, nurses, community health agents and oral health professionals, each responsible for following up the families living in a defined area. A study of 771 municipalities from 1996 to 2004, controlling for social and economic changes, found infant mortality fell 13% where program coverage was incipient, 16% where it was intermediate, and 22% where it was consolidated, meaning at least 70% of the population was covered for four years or more. Effects were greatest in the poorest municipalities. A later study of 1,622 municipalities linked consolidated coverage to lower deaths from heart and cerebrovascular disease.
Why it worked
Bringing a regular primary care team to every family reached the communities with the worst health first and may have narrowed inequalities. These are observational studies, though they control for many other changes and found no effect on accident deaths, used as a check.
Sources
- Aquino, R., de Oliveira, N. F., & Barreto, M. L. (2009). Impact of the Family Health Program on infant mortality in Brazilian municipalities. American Journal of Public Health, 99(1), 87–93.
- Rasella, D., Harhay, M. O., Pamponet, M. L., Aquino, R., & Barreto, M. L. (2014). Impact of primary health care on mortality from heart and cerebrovascular diseases in Brazil: a nationwide analysis of longitudinal data. BMJ, 349, g4014.
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