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The impact of the Brazilian family health on selected primary care sensitive conditions: A systematic review

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  • Mayara Lisboa Bastos
  • Dick Menzies
  • Thomas Hone
  • Kianoush Dehghani
  • Anete Trajman

Abstract

Background: Brazil has the largest public health-system in the world, with 120 million people covered by its free primary care services. The Family Health Strategy (FHS) is the main primary care model, but there is no consensus on its impact on health outcomes. We systematically reviewed published evidence regarding the impact of the Brazilian FHS on selective primary care sensitive conditions (PCSC). Methods: We searched Medline, Web of Science and Lilacs in May 2016 using key words in Portuguese and English, without language restriction. We included studies if intervention was the FHS; comparison was either different levels of FHS coverage or other primary health care service models; outcomes were the selected PCSC; and results were adjusted for relevant sanitary and socioeconomic variables, including the national conditional cash transfer program (Bolsa Familia). Due to differences in methods and outcomes reported, pooling of results was not possible. Results: Of 1831 records found, 31 met our inclusion criteria. Of these, 25 were ecological studies. Twenty-one employed longitudinal quasi-experimental methods, 27 compared different levels the FHS coverage, whilst four compared the FHS versus other models of primary care. Fourteen studies found an association between higher FHS coverage and lower post-neonatal and child mortality. When the effect of Bolsa Familia was accounted for, the effect of the FHS on child mortality was greater. In 13 studies about hospitalizations due to PCSC, no clear pattern of association was found. In four studies, there was no effect on child and elderly vaccination or low-birth weight. No included studies addressed breast-feeding, dengue, HIV/AIDS and other neglected infectious diseases. Conclusions: Among these ecological studies with limited quality evidence, increasing coverage by the FHS was consistently associated with improvements in child mortality. Scarce evidence on other health outcomes, hospitalization and synergies with cash transfer was found.

Suggested Citation

  • Mayara Lisboa Bastos & Dick Menzies & Thomas Hone & Kianoush Dehghani & Anete Trajman, 2017. "The impact of the Brazilian family health on selected primary care sensitive conditions: A systematic review," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-14, August.
    • Handle: RePEc:plo:pone00:0182336
    DOI: 10.1371/journal.pone.0182336
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    References listed on IDEAS

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    1. Romero Rocha & Rodrigo R. Soares, 2010. "Evaluating the impact of community‐based health interventions: evidence from Brazil's Family Health Program," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 126-158, September.
    2. Guanais, F.C., 2013. "The combined effects of the expansion of primary health care and conditional cash transfers on infant mortality in Brazil, 1998-2010," American Journal of Public Health, American Public Health Association, vol. 103(11), pages 2000-2006.
    3. Fabiana Fontes Rocha & Marislei Nishijima & Sandro Garcia Duarte Peixoto, 2013. "Primary health care policies: investigation on morbidity," Applied Economics Letters, Taylor & Francis Journals, vol. 20(11), pages 1046-1051, July.
    4. Aquino, R. & De Oliveira, N.F. & Barreto, M.L., 2009. "Impact of the Family Health Program on infant mortality in brazilian municipalities," American Journal of Public Health, American Public Health Association, vol. 99(1), pages 87-93.
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    2. Leonardo Graever & Aurora Felice Castro Issa & Viviane Belidio Pinheiro da Fonseca & Marcelo Machado Melo & Gabriel Pesce de Castro da Silva & Isabel Cristina Pacheco da Nóbrega & Leonardo Cançado Mon, 2023. "Telemedicine Support for Primary Care Providers versus Usual Care in Patients with Heart Failure: Protocol of a Pragmatic Cluster Randomised Trial within the Brazilian Heart Insufficiency with Telemed," IJERPH, MDPI, vol. 20(11), pages 1-16, May.
    3. Natalia Nunes Ferreira‐Batista & Adriano Dutra Teixeira & Maria Dolores Montoya Diaz & Fernando Antonio Slaibe Postali & Rodrigo Moreno‐Serra & James Love‐Koh, 2023. "Is primary health care worth it in the long run? Evidence from Brazil," Health Economics, John Wiley & Sons, Ltd., vol. 32(7), pages 1504-1524, July.
    4. Thomas Hone & Valeria Saraceni & Claudia Medina Coeli & Anete Trajman & Davide Rasella & Christopher Millett & Betina Durovni, 2020. "Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults," PLOS Medicine, Public Library of Science, vol. 17(10), pages 1-20, October.
    5. Marcello Barbosa Otoni Gonçalves Guedes & Sanderson José Costa de Assis & Geronimo José Bouzas Sanchis & Diego Neves Araujo & Angelo Giuseppe Roncalli Da Costa Oliveira & Johnnatas Mikael Lopes, 2021. "COVID-19 in Brazilian cities: Impact of social determinants, coverage and quality of primary health care," PLOS ONE, Public Library of Science, vol. 16(9), pages 1-12, September.
    6. João Victor Muniz Rocha & Carla Nunes & Rui Santana, 2019. "Avoidable hospitalizations in Brazil and Portugal: Identifying and comparing critical areas through spatial analysis," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-16, July.

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