Brazil's more doctors programme and infant health outcomes: a longitudinal analysis.
Brazil's more doctors programme and infant health outcomes: a longitudinal analysis.
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DOI：
10.1186/s12960-021-00639-3
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发表时间：
2021-08-14
影响因子：
4.5
通讯作者：
Hone T
中科院分区：
文献类型：
--
作者：
Bexson C;Millett C;Santos LMP;de Sousa Soares R;de Oliveira FP;Hone T
提供足够数量的卫生人力资源对于有效和可获得的卫生服务至关重要。2013年至2018年期间，巴西卫生部实施了更多医生计划（PMM），以增加该国服务不足地区的初级保健医生供应。本研究调查了PMM和婴儿健康结果之间的关联，并评估了PMM影响的异质性是否因城市社会经济因素和健康指标而异。采用生态纵向（面板）研究设计，分析了2007年至2018年12年间5565个巴西城市的数据。采用纵向固定效应回归模型，比较接受PMM医生的城市与未接受PMM医生的城市的婴儿健康结果。PMM的影响进行了评估，总的和在城市分组。总体而言，PMM与婴儿或新生儿死亡率的变化没有显著相关性，但PMM与婴儿死亡率（IMR）的降低有关（-0.21; 95% CI：-0.38，-0.03），这些城市在该方案实施前的婴儿死亡率（IMR）最高（每1000例活产婴儿死亡25.2例）。PMM还与接受7次或更多次产前检查的孕妇比例增加有关，但仅在基线IMR较低的城市和PMM前非PMM医生和社区卫生工作者密度高的城市。在实施该方案之前婴儿死亡率最高的城市，实施PMM与婴儿死亡率降低有关。这表明PMM的有效性仅限于最需要的领域。改善公平提供保健人力资源的新方案应采用综合的目标确定办法，平衡保健需求和社会经济因素，以最大限度地发挥效力。在线版本包含补充材料，可通过10.1186/s12960-021-00639-3获取。
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 socio-economic factors and health indicators. An ecological longitudinal (panel) study design was employed to analyse data from 5565 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. On aggregate, the PMM was not significantly associated with changes in infant or neonatal mortality, but the PMM was associated with reductions in infant mortality rate (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 1000 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. 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 socio-economic factors to maximize effectiveness. The online version contains supplementary material available at 10.1186/s12960-021-00639-3.
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DOI：
10.1590/1413-81232015219.15472016
发表时间：
2016-09-01
期刊：
Ciência & Saúde Coletiva
影响因子：
--
作者：
Comes, Yamila;Trindade, Josélia de Souza;Santos, Leonor Maria Pacheco
通讯作者：
Santos, Leonor Maria Pacheco
影响因子：
2.8
作者：
Hone, Thomas;Powell-Jackson, Timothy;Millett, Christopher
通讯作者：
Millett, Christopher
影响因子：
15.8
作者：
Hone T;Saraceni V;Medina Coeli C;Trajman A;Rasella D;Millett C;Durovni B
通讯作者：
Durovni B
影响因子：
5.3
作者：
Carrillo, Bladimir;Feres, Jose
通讯作者：
Feres, Jose
影响因子：
6.9
作者：
Mattos, Enlinson;Mazetto, Debora
通讯作者：
Mazetto, Debora