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Contracting for primary health care in Brazil : the cases of Bahia and Rio de Janeiro (English)

This study presents two case studies, each on a current initiative of contracting for primary health services in Brazil, one for the state of Bahia, the other for the city of Rio de Janeiro. The two initiatives are not linked and their implementation has independently sprung from a search for more effective ways of delivering public primary health care. The two models differ considerably in context, needs, modalities, and outcomes. This paper identifies their strengths and weaknesses, initially by providing a background to universal primary health care in Brazil, paying particular attention to the family health strategy, the driver of the basic health care model. It then outlines the history of contracting for health care within Brazil, before analyzing the two studies. The state of Bahia sought to expand coverage of the family health strategy and increase the quality of services, but had difficulty in attracting and retaining qualified health professionals. Rigidities in the process of public hiring led to a number of isolated contracting initiatives at the municipal level and diverse, often unstable employment contracts. The state and municipalities decided to centralize the hiring of health professionals in order to offer stable positions with career plans and mobility within the state, and chose to create a state foundation, acting under private law to manage and oversee this process. Results have been mixed as lower than expected municipal involvement resulted in relatively high administrative costs and consequent default on municipal financial contributions. The state foundation is undergoing a governance reform and has now diversified beyond hiring for primary care. The municipality of Rio de Janeiro, which until recently relied on an expansive hospital network for health care delivery, sought in particular to expand primary health services. The public health networks suffered from inefficiency and poor quality, and it was therefore decided to contract privately owned and managed, not-for-profit, social organizations to provide primary care services. The move has succeeded in attracting considerable increases in funding for primary health and coverage has increased significantly. Performance initiatives, however, still need fine-tuning and reliable information systems must be implanted in order to evaluate the system.


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    Araujo,Edson Correia, Tricai Cavalini,Luciana, Girardi,Sabado Nicolau, Ireland, Megan, Lindelow,Magnus

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    Working Paper

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    Latin America & Caribbean,

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    Contracting for primary health care in Brazil : the cases of Bahia and Rio de Janeiro

  • Keywords

    Municipalities;primary care;primary health care;support to family;provision of health service;millennium development goal;primary health care services;delivery of health services;life expectancy at birth;primary health service;primary health facility;human resource management;primary care facilities;Health Care Delivery;economies of scale;quality of care;accountability for performance;primary care services;public health network;contracting for health;loss of income;Health Service Delivery;quality and efficiency;basic health care;public health risk;country case study;types of contract;gap in knowledge;forms of contract;public sector entity;Science and Technology;private sector management;contract model;maternal mortality ratio;share of revenue;Home Care Services;health care needs;efficiency and quality;public policy objective;extreme poverty line;areas of health;basic food basket;private sector governance;social security benefit;minister of health;information and communication;community health worker;methods of payment;expansion of coverage;public health system;secretary of health;equity of access;fundamental human right;social security contribution;formal sector worker;social security institutions;social security coverage;Universal Health Care;per capita basis;local government entity;public sector employment;transfer of responsibility;private sector entities;piece of legislation;private law;



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Araujo,Edson Correia Tricai Cavalini,Luciana Girardi,Sabado Nicolau Ireland, Megan Lindelow,Magnus

Contracting for primary health care in Brazil : the cases of Bahia and Rio de Janeiro (English). Health, nutrition, and population (HNP) discussion paper Washington, D.C. : World Bank Group.