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Large reductions In amenable mortality associated with Brazil's primary care expansion and strong health governance

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Title: Large reductions In amenable mortality associated with Brazil's primary care expansion and strong health governance
Authors: Hone, T
Rasella, D
Barreto, M
Atun, R
Majeed, A
Millett, C
Item Type: Journal Article
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.
Issue Date: 1-Jan-2017
Date of Acceptance: 1-Jan-2017
URI: http://hdl.handle.net/10044/1/45336
DOI: https://dx.doi.org/10.1377/hlthaff.2016.0966
ISSN: 0278-2715
Publisher: Project HOPE
Start Page: 149
End Page: 158
Journal / Book Title: Health Affairs
Volume: 36
Issue: 1
Copyright Statement: ©2017 Project HOPE—The People-to-People Health Foundation, Inc.
Keywords: Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Health Policy & Services
INFANT-MORTALITY
PROGRAM
DECENTRALIZATION
EQUITY
IMPACT
MANAGEMENT
COVERAGE
DEATHS
SYSTEM
CITY
Brazil
International/global health studies
Primary Care
governance
mortality
1117 Public Health And Health Services
1402 Applied Economics
Publication Status: Published
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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