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

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dc.creatorAraujo, Edson
dc.creatorCavalini, Luciana
dc.creatorGirardi, Sabado
dc.creatorIreland, Megan
dc.creatorLindelow, Magnus
dc.date2014-12-16T19:37:15Z
dc.date2014-12-16T19:37:15Z
dc.date2014-09
dc.date.accessioned2026-07-01T00:53:40Z
dc.descriptionThis 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.
dc.formatapplication/pdf
dc.formattext/plain
dc.identifierhttp://documents.worldbank.org/curated/en/2014/09/20278393/contracting-primary-health-care-brazil-cases-bahia-rio-de-janeiro
dc.identifierhttps://hdl.handle.net/10986/20728
dc.identifierhttps://doi.org/10.1596/20728
dc.identifier.urihttp://hdl.handle.net/123456789/412584
dc.languageEnglish
dc.languageen_US
dc.publisherWorld Bank Group, Washington, DC
dc.relationHealth, nutrition, and population (HNP) discussion paper;
dc.rightsCC BY 3.0 IGO
dc.rightshttp://creativecommons.org/licenses/by/3.0/igo/
dc.subjectADMINISTRATIVE COSTS
dc.subjectADMINISTRATIVE RULES
dc.subjectAGED
dc.subjectAMBULATORY SERVICES
dc.subjectANTENATAL CARE
dc.subjectBASIC HEALTH CARE
dc.subjectBIRTH CONTROL
dc.subjectBLOCK GRANTS
dc.subjectBULLETIN
dc.subjectCARE PERFORMANCE
dc.subjectCHRONIC DISEASE
dc.subjectCITIES
dc.subjectCIVIL SOCIETY ORGANIZATIONS
dc.subjectCLINICS
dc.subjectCOMMUNITY HEALTH
dc.subjectCOMPLICATIONS
dc.subjectCONTRACTUAL ARRANGEMENTS
dc.subjectDEATHS
dc.subjectDECENTRALIZATION
dc.subjectDELIVERY OF HEALTH SERVICES
dc.subjectDEVELOPING COUNTRIES
dc.subjectDIABETES
dc.subjectDISEASES
dc.subjectDRUGS
dc.subjectECONOMIC INEQUALITY
dc.subjectECONOMIC POLICY
dc.subjectECONOMICS
dc.subjectECONOMIES OF SCALE
dc.subjectEMERGENCY CARE
dc.subjectEMERGENCY ROOMS
dc.subjectEMPLOYMENT
dc.subjectEQUIPMENT
dc.subjectESSENTIAL MEDICINES
dc.subjectFAMILIES
dc.subjectFAMILY HEALTH
dc.subjectFINANCIAL CONTRIBUTIONS
dc.subjectFINANCIAL INCENTIVES
dc.subjectFINANCIAL RESOURCES
dc.subjectGOVERNMENT CAPACITY
dc.subjectHEALTH AFFAIRS
dc.subjectHEALTH CARE DELIVERY
dc.subjectHEALTH CARE FACILITIES
dc.subjectHEALTH CARE NEEDS
dc.subjectHEALTH CARE PROVISION
dc.subjectHEALTH CARE WORKERS
dc.subjectHEALTH CLINICS
dc.subjectHEALTH COVERAGE
dc.subjectHEALTH EDUCATION
dc.subjectHEALTH FACILITIES
dc.subjectHEALTH INDICATORS
dc.subjectHEALTH INEQUALITIES
dc.subjectHEALTH INFORMATION
dc.subjectHEALTH INFORMATION SYSTEM
dc.subjectHEALTH INFORMATION SYSTEMS
dc.subjectHEALTH INFRASTRUCTURE
dc.subjectHEALTH ORGANIZATION
dc.subjectHEALTH PLANNING
dc.subjectHEALTH POLICY
dc.subjectHEALTH PROFESSIONALS
dc.subjectHEALTH PROFESSIONS
dc.subjectHEALTH PROMOTION
dc.subjectHEALTH PROVIDERS
dc.subjectHEALTH RISKS
dc.subjectHEALTH SECTOR
dc.subjectHEALTH SERVICE
dc.subjectHEALTH SERVICE DELIVERY
dc.subjectHEALTH SERVICES
dc.subjectHEALTH SPENDING
dc.subjectHEALTH STRATEGY
dc.subjectHEALTH SYSTEM
dc.subjectHEALTH SYSTEM PERFORMANCE
dc.subjectHEALTH SYSTEM REFORM
dc.subjectHEALTH SYSTEMS
dc.subjectHEALTH WORKERS
dc.subjectHEALTHY LIFE
dc.subjectHOME CARE
dc.subjectHOSPITAL
dc.subjectHOSPITAL MANAGEMENT
dc.subjectHOSPITAL SECTOR
dc.subjectHOSPITAL SERVICES
dc.subjectHOSPITAL SYSTEM
dc.subjectHOSPITALS
dc.subjectHUMAN RESOURCE MANAGEMENT
dc.subjectHUMAN RESOURCES
dc.subjectHUMAN RIGHT
dc.subjectHYPERTENSION
dc.subjectILLNESS
dc.subjectINCOME
dc.subjectINCOME COUNTRIES
dc.subjectINCOME INEQUALITY
dc.subjectINFANT
dc.subjectINFANT MORTALITY
dc.subjectINFORMATION ASYMMETRY
dc.subjectINTEGRATION
dc.subjectINTERNATIONAL ORGANIZATIONS
dc.subjectIUD
dc.subjectLABOR MARKET
dc.subjectLABORATORIES
dc.subjectLARGE POPULATIONS
dc.subjectLAWS
dc.subjectLEPROSY
dc.subjectLIFE EXPECTANCY
dc.subjectLIFE EXPECTANCY AT BIRTH
dc.subjectLIVE BIRTHS
dc.subjectLOCAL GOVERNMENTS
dc.subjectLOW BIRTH WEIGHT
dc.subjectMANAGEMENT OF HEALTH
dc.subjectMANAGEMENT OF PATIENTS
dc.subjectMATERNAL MORTALITY
dc.subjectMATERNAL MORTALITY RATIO
dc.subjectMEDICAL CARE
dc.subjectMEDICAL DOCTORS
dc.subjectMEDICAL EDUCATION
dc.subjectMEDICAL PROCEDURES
dc.subjectMEDICAL RESIDENTS
dc.subjectMEDICAL SCHOOL
dc.subjectMEDICAL STAFF
dc.subjectMEDICINES
dc.subjectMILLENNIUM DEVELOPMENT GOAL
dc.subjectMINISTRY OF HEALTH
dc.subjectMORBIDITY
dc.subjectMORTALITY
dc.subjectNATIONAL LEVEL
dc.subjectNONGOVERNMENTAL ORGANIZATIONS
dc.subjectNURSE
dc.subjectNURSES
dc.subjectNUTRITION
dc.subjectORAL HEALTH
dc.subjectOUTREACH ACTIVITIES
dc.subjectPATIENT
dc.subjectPATIENTS
dc.subjectPHYSICIAN
dc.subjectPOCKET PAYMENTS
dc.subjectPOLICY DECISIONS
dc.subjectPOLICY MAKERS
dc.subjectPOLITICAL DECISION
dc.subjectPOOR QUALITY CARE
dc.subjectPOPULATION DENSITY
dc.subjectPREGNANCY
dc.subjectPREGNANT WOMEN
dc.subjectPRENATAL CARE
dc.subjectPRIMARY CARE
dc.subjectPRIMARY HEALTH CARE
dc.subjectPRIMARY HEALTH CARE FACILITIES
dc.subjectPRIMARY HEALTH CARE SERVICES
dc.subjectPRIMARY HEALTH FACILITIES
dc.subjectPRIMARY HEALTH SERVICES
dc.subjectPRIMARY HEALTH SYSTEM
dc.subjectPRIVATE SECTOR
dc.subjectPROGRESS
dc.subjectPROVISION OF CARE
dc.subjectPROVISION OF HEALTH SERVICES
dc.subjectPUBLIC ADMINISTRATION
dc.subjectPUBLIC CONTRACT
dc.subjectPUBLIC HEALTH
dc.subjectPUBLIC HEALTH SYSTEM
dc.subjectPUBLIC POLICY
dc.subjectPUBLIC SECTOR
dc.subjectPUBLIC SERVICES
dc.subjectQUALITY IMPROVEMENT
dc.subjectQUALITY OF CARE
dc.subjectQUALITY OF SERVICES
dc.subjectRESPECT
dc.subjectSCHOOL HEALTH
dc.subjectSECRETARY OF HEALTH
dc.subjectSERVICE PROVIDERS
dc.subjectSERVICE PROVISION
dc.subjectSOCIAL ACTION
dc.subjectSOCIAL PARTICIPATION
dc.subjectSOCIAL SECURITY
dc.subjectSOCIAL SECURITY BENEFITS
dc.subjectSOCIAL SERVICES
dc.subjectSOCIOECONOMIC DEVELOPMENT
dc.subjectSTATE POLICY
dc.subjectSTATE UNIVERSITY
dc.subjectSTRATEGIC PRIORITIES
dc.subjectSUSTAINABLE DEVELOPMENT
dc.subjectTUBERCULOSIS
dc.subjectUNIVERSAL ACCESS
dc.subjectUNIVERSITIES
dc.subjectURBAN AREAS
dc.subjectVACCINATION
dc.subjectWOMAN
dc.subjectWORKERS
dc.subjectWORKFORCE
dc.subjectWORLD HEALTH ORGANIZATION
dc.titleContracting for Primary Health Care in Brazil : The Cases of Bahia and Rio de Janeiro

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