What is the relative impact of primary health care quality and conditional cash transfer program in child mortality?

• Published in: Canadian journal of public health Vol. 110; no. 6; pp. 756 - 767
• Main Authors: Vieira-Meyer, Anya Pimentel Gomes Fernandes, de Araújo Dias, Maria Socorro, Vasconcelos, Maristela Ines Osawa, Rouberte, Emilia Soares Chaves, de Almeida, Ana Mattos Brito, de Albuquerque Pinheiro, Themis Xavier, de Lima Saintrain, Maria Vieira, de Fatima Antero Sousa Machado, Maria, Dufault, Suzanne, Reynolds, Sarah Ann, Fernald, Lia
• Format: Journal Article
• Language: English
• Published: Cham Springer Science + Business Media 01-12-2019; Springer International Publishing; Springer Nature B.V
• Subjects: Brazil - epidemiology; Child; Child mortality; Child Mortality - trends; Clinical outcomes; Dependent variables; Exploration; Health care; Human capital; Humans; Independent variables; Medicine; Medicine & Public Health; Mortality; Municipalities; Population number; Primary care; Primary Health Care - standards; Process variables; Program Evaluation; Public Assistance - statistics & numerical data; Public Health; Quality control; Quality of care; Quality of Health Care - statistics & numerical data; QUANTITATIVE RESEARCH; Regression analysis; Regression models; Shrinkage; Transfer of funds; Variables; Brazil; Programme de transferts monétaires conditionnels; Qualité des soins de santé; Primary health care; Quality of health care; Mortalité infantile; Child mortality; Conditional cash transfer program; Soins de santé primaires
• ISSN: 0008-4263; 1920-7476
• DOI: 10.17269/s41997-019-00246-9

Objective
Evaluate how coverage and quality of primary health care (PHC) and a conditional cash transfer (CCT) program associate with child mortality in Brazil.
Methods
Multivariate linear regression models and least absolute shrinkage and selection estimator (LASSO) were utilized with the municipal level child mortality rate as the key dependent variable. PHC quality with PHC and CCT coverage were the independent variables. The quality of the Brazilian PHC was assessed using the Brazilian National Program for Access and Quality Improvement in PHC data. PHC and CCT coverage were calculated based on Brazilian official databases. Human developmental index (HDI), municipality size, and country region were used as control variables. A total of 3441 municipalities were evaluated.
Results
We found that ESF (Estratégia Saúde da Família) quality variables PLANNING [Family Health Team Planning activities], CITYSUPPORT [municipality support for Family Health Strategy activities], EXAMS [exams offered and priority groups seen by the family health team], and PRENATAL [prenatal care and exams provided by the family health team], as well as HDI, percentage of PHC coverage, percentage of CCT coverage, and population size have significant and negative relationships with 1-year-old child mortality. LASSO regression results confirmed these associations. Quality is an important element of effective social service provision.
Conclusion
This exploration represents one of the first investigations into the role of PHC system quality, and how it is related to health outcomes, while also considering PHC and conditional cash transfer program coverage. Quality of PHC, measured by work process variables, plays an important role in child mortality. Efforts on PHC quality and coverage, as well as on CCT program coverage, are important to child mortality reduction. Therefore, this is an important finding to other PHC public health services.