Understanding drivers of domestic public expenditure on reproductive, maternal, neonatal and child health in Peru at district level: an ecological study

BMC Health Services Research

Gianfranco Flores-Cordova¹  Maria Rivera-Ch¹  Carlos A. Huayanay-Espinoza¹  Luis Huicho¹  Peter Berman²  Eddy R. Segura³  Jessica Niño de Guzman⁴  Patricia Hernandez⁵  Howard S. Friedman⁶ 

[1] Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia;Department of Global Health and Population, Harvard T.H. Chan School of Public Health;Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas;Ministerio de Economía y Finanzas;Netherlands Interdisciplinary Demographic Institute;United Nations Population Fund;

关键词: Health expenditure;    Reproductive health;    Maternal health;    Neonatal health;    Child health;   

DOI  :  10.1186/s12913-018-3649-x

来源: DOAJ

【 摘 要 】

Abstract Background Peru has increased substantially its domestic public expenditure in maternal and child health. Peruvian departments are heterogeneous in contextual and geographic factors, underlining the importance of disaggregated expenditure analysis up to the district level. We aimed to assess possible district level factors influencing public expenditure on reproductive, maternal, neonatal and child health (RMNCH) in Peru. Methods We performed an ecological study in 24 departments, with specific RMNCH expenditure indicators as outcomes, and covariates of different hierarchical dimensions as predictors. To account for the influence of variables included in the different dimensions over time and across departments, we chose a stepwise multilevel mixed-effects regression model, with department-year as the unit of analysis. Results Public expenditure increased in all departments, particularly for maternal-neonatal and child health activities, with a different pace across departments. The multilevel analysis did not reveal consistently influential factors, except for previous year expenditure on reproductive and maternal-neonatal health. Our findings may be explained by a combination of inertial expenditure, a results-based budgeting approach to increase expenditure efficiency and effectiveness, and by a mixed-effects decentralization process. Sample size, interactions and collinearity cannot be ruled out completely. Conclusions Public district-level RMNCH expenditure has increased remarkably in Peru. Evidence on underlying factors influencing such trends warrants further research, most likely through a combination of quantitative and qualitative approaches.

【 授权许可】

Unknown