Contracting for Primary Health Care in Brazil : The Cases of Bahia and Rio de Janeiro

Araujo, Edson ; Cavalini, Luciana ; Girardi, Sabado ; Ireland, Megan ; Lindelow, Magnus

World Bank Group, Washington, DC

关键词: ADMINISTRATIVE COSTS;    ADMINISTRATIVE RULES;    AGED;    AMBULATORY SERVICES;    ANTENATAL CARE;   

RP-ID  :  91322

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

This study presents two case studies,each on a current initiative of contracting for primaryhealth services in Brazil, one for the state of Bahia, theother for the city of Rio de Janeiro. The two initiativesare not linked and their implementation has independentlysprung from a search for more effective ways of deliveringpublic primary health care. The two models differconsiderably in context, needs, modalities, and outcomes.This paper identifies their strengths and weaknesses,initially by providing a background to universal primaryhealth care in Brazil, paying particular attention to thefamily health strategy, the driver of the basic health caremodel. It then outlines the history of contracting forhealth care within Brazil, before analyzing the two studies.The state of Bahia sought to expand coverage of the familyhealth strategy and increase the quality of services, buthad difficulty in attracting and retaining qualified healthprofessionals. Rigidities in the process of public hiringled to a number of isolated contracting initiatives at themunicipal level and diverse, often unstable employmentcontracts. The state and municipalities decided tocentralize the hiring of health professionals in order tooffer stable positions with career plans and mobility withinthe state, and chose to create a state foundation, actingunder private law to manage and oversee this process.Results have been mixed as lower than expected municipalinvolvement resulted in relatively high administrative costsand consequent default on municipal financial contributions.The state foundation is undergoing a governance reform andhas now diversified beyond hiring for primary care. Themunicipality of Rio de Janeiro, which until recently reliedon an expansive hospital network for health care delivery,sought in particular to expand primary health services. Thepublic health networks suffered from inefficiency and poorquality, and it was therefore decided to contract privatelyowned and managed, not-for-profit, social organizations toprovide primary care services. The move has succeeded inattracting considerable increases in funding for primaryhealth and coverage has increased significantly. Performanceinitiatives, however, still need fine-tuning and reliableinformation systems must be implanted in order to evaluatethe system.