Contracting for Primary Health Care in Brazil : The Cases of Bahia and Rio de Janeiro
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 implementati...
| Main Authors: | , , , , |
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| Language: | English en_US |
| Published: |
World Bank Group, Washington, DC
2014
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| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/en/2014/09/20278393/contracting-primary-health-care-brazil-cases-bahia-rio-de-janeiro http://hdl.handle.net/10986/20728 |
| Summary: | 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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