Brazil’s more doctors programme and infant health outcomes: a longitudinal analysis
File(s)
Published version
Author(s)
Bexson, C
Millett, C
Pacheco Santos, Leonor Maria
de Sousa Soares, Ricardo
Proenço de Oliveira, Felipe
Type
Journal Article
Abstract
Background
Providing sufficient numbers of human resources for health is essential for effective and accessible health services. Between 2013 and 2018, the Brazilian Ministry of Health implemented the Programa Mais Médicos (PMM) (More Doctors Programme) to increase the supply of primary care doctors in underserved areas of the country. This study investigated the association between PMM and infant health outcomes and assessed if heterogeneity in the impact of PMM varied by municipal socioeconomic factors and health indicators.
Methods
An ecological longitudinal (panel) study design was employed to analyse data from 5,565 Brazilian municipalities over a 12-year period between 2007 and 2018. A differences-in-differences approach was implemented using longitudinal fixed effect regression models to compare infant health outcomes in municipalities receiving a PMM doctor with those that did not receive a PMM doctor. The impact of PMM was assessed on aggregate and in municipality subgroups.
Results
On aggregate, the PMM was not significantly associated with changes in infant or neonatal mortality, but the PMM was associated with reductions in IMR (of -0.21; 95% CI: -0.38,-0.03) in municipalities with highest IMR prior to the programme’s implementation (where IMR >25.2 infant deaths per 1,000 live births). The PMM was also associated with an increase in the proportion of expectant mothers receiving seven or more prenatal care visits but only in municipalities with a lower IMR at baseline and high density of non-PMM doctors and community health workers before the PMM.
Conclusions
The PMM was associated with reduced infant mortality in municipalities with the highest infant mortality rate prior to the programme. This suggests effectiveness of the PMM was limited only to the areas of greatest need. New programmes to improve the equitable provision of human resources for health should employ comprehensive targeting approaches balancing health needs and socioeconomic factors to maximize effectiveness.
Providing sufficient numbers of human resources for health is essential for effective and accessible health services. Between 2013 and 2018, the Brazilian Ministry of Health implemented the Programa Mais Médicos (PMM) (More Doctors Programme) to increase the supply of primary care doctors in underserved areas of the country. This study investigated the association between PMM and infant health outcomes and assessed if heterogeneity in the impact of PMM varied by municipal socioeconomic factors and health indicators.
Methods
An ecological longitudinal (panel) study design was employed to analyse data from 5,565 Brazilian municipalities over a 12-year period between 2007 and 2018. A differences-in-differences approach was implemented using longitudinal fixed effect regression models to compare infant health outcomes in municipalities receiving a PMM doctor with those that did not receive a PMM doctor. The impact of PMM was assessed on aggregate and in municipality subgroups.
Results
On aggregate, the PMM was not significantly associated with changes in infant or neonatal mortality, but the PMM was associated with reductions in IMR (of -0.21; 95% CI: -0.38,-0.03) in municipalities with highest IMR prior to the programme’s implementation (where IMR >25.2 infant deaths per 1,000 live births). The PMM was also associated with an increase in the proportion of expectant mothers receiving seven or more prenatal care visits but only in municipalities with a lower IMR at baseline and high density of non-PMM doctors and community health workers before the PMM.
Conclusions
The PMM was associated with reduced infant mortality in municipalities with the highest infant mortality rate prior to the programme. This suggests effectiveness of the PMM was limited only to the areas of greatest need. New programmes to improve the equitable provision of human resources for health should employ comprehensive targeting approaches balancing health needs and socioeconomic factors to maximize effectiveness.
Date Issued
2021-08-14
Date Acceptance
2021-08-04
Citation
Human Resources for Health, 2021, 19 (97), pp.1-10
ISSN
1478-4491
Publisher
BioMed Central
Start Page
1
End Page
10
Journal / Book Title
Human Resources for Health
Volume
19
Issue
97
Copyright Statement
© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or
other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this
licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco
mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or
other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this
licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco
mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
License URL
Sponsor
Medical Research Council (MRC)
Identifier
https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-021-00639-3
Grant Number
MR/R022887/1
Subjects
Science & Technology
Social Sciences
Life Sciences & Biomedicine
Health Policy & Services
Industrial Relations & Labor
Health Care Sciences & Services
Business & Economics
Human resources for health
Brazil
Infant health
Maternal
newborn and child health
Primary care
Doctors
PRIMARY-CARE
FAMILY
IMPLEMENTATION
MORTALITY
COVERAGE
IMPACT
Brazil
Doctors
Human resources for health
Infant health
Maternal
Primary care
newborn and child health
1110 Nursing
Health Policy & Services
Publication Status
Published
Date Publish Online
2021-08-14