Expanding the primary health care workforce through contracting with nongovernmental entities: the cases of Bahia and Rio de Janeiro
Expanding the primary health care workforce through contracting with nongovernmental entities: the cases of Bahia and Rio de Janeiro
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DOI：
10.1186/s12960-016-0101-3
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发表时间：
2016-02-18
影响因子：
4.5
通讯作者：
Lindelow, Magnus
中科院分区：
文献类型：
--
作者：
Ireland, Megan;Cavalini, Luciana;Lindelow, Magnus
背景资料：巴西在吸引保健专业人员（特别是医生和护士）到初级保健一级以及农村和偏远地区工作方面遇到了困难。这项研究提出了两个案例研究，每一个在巴西的初级保健服务承包目前的倡议：一个为巴伊亚州和里约热内卢市的其他。这两种模式在背景、需求、模式和结果方面有很大不同。本文并不试图评估的举措，但以确定其优势和弱点。方法：分析的基础上产生的指标巴西卫生保健信息系统，文献和其他文件的审查，和关键的线人访谈。就巴伊亚而言，州和市政府决定设立一个国家基金会，一个根据私法行事的新的公共机构实体，集中雇用保健专业人员，以便提供有职业规划和在国内流动的稳定职位。结果好坏参半，因为市政参与程度低于预期，导致行政成本相对较高，从而导致市政财政缴款违约。在里约热内卢，市政府选择与非营利社会组织签订合同，以推动扩大该市的初级卫生保健。这种方法已经成功地扩大了覆盖面，但成本和性能的证据是weak.Conclusions：这两种情况下强调，改善成本和性能数据将是至关重要的有意义的比较评估在初级保健的交付安排。尽管每种模式的体制和执行安排不同，难以进行比较，但分析为巴西和其他地方外包初级保健专业人员提供了重要的经验教训。
Background: Brazil has experienced difficulties in attracting health professionals (especially doctors and nurses) to practice at the primary health care (PHC) level and in rural and remote areas. This study presents two case studies, each a current initiative in contracting for primary health services in Brazil: one for the state of Bahia and the other for the city of Rio de Janeiro. The two models differ considerably in context, needs, modalities, and outcomes. This article does not attempt to evaluate the initiatives but to identify their strengths and weaknesses.Methods: Analysis was based on indicators produced by the Brazilian health care information systems, a review of literature and other documentation, and key informant interviews.Results: In the case of Bahia, the state and municipalities decided to create a State Foundation, a new institutional public entity acting under private law that centralizes the hiring of health professionals in order to offer stable positions with career plans and mobility within the state. Results have been mixed as a lower than expected municipal involvement resulted in relatively high administrative costs and consequent default on municipal financial contributions. In the case of Rio de Janeiro, the municipality opted to contract not-for-profit Social Organizations as it made a push to expand access to primary health care in the city. The approach has been successful in expanding coverage, but evidence on cost and performance is weak.Conclusions: Both cases highlight that improvements in cost and performance data will be critical for meaningful comparative evaluation of delivery arrangements in primary care. Despite the different institutional and implementation arrangements of each model, which make comparison difficult, the analysis provides important lessons for contracting out health professionals for PHC within Brazil and elsewhere.