CJPH-Mortalidade-infantil-e-Qualidade-da-ESF-41997_2019_Article_246
Objective Evaluate how coverage and quality of primary health care (PHC) and a conditional cash transfer (CCT) program
associate with child mortality in Brazil.
Methods Multivariate linear regression models and least absolute shrinkage and selection estimator (LASSO) were utilized with
the municipal level child mortality rate as the key dependent variable. PHC quality with PHC and CCT coverage were the
independent variables. The quality of the Brazilian PHC was assessed using the Brazilian National Program for Access and
Quality Improvement in PHC data. PHC and CCT coverage were calculated based on Brazilian official databases. Human
developmental index (HDI), municipality size, and country region were used as control variables. A total of 3441 municipalities
were evaluated.
Results We found that ESF (Estratégia Saúde da Família) quality variables PLANNING [Family Health Team Planning activ-
ities], CITYSUPPORT [municipality support for Family Health Strategy activities], EXAMS [exams offered and priority groups
seen by the family health team], and PRENATAL [prenatal care and exams provided by the family health team], as well as HDI,
percentage of PHC coverage, percentage of CCT coverage, and population size have significant and negative relationships with
1-year-old child mortality. LASSO regression results confirmed these associations. Quality is an important element of effective
social service provision.
Conclusion This exploration represents one of the first investigations into the role of PHC system quality, and how it is related to
health outcomes, while also considering PHC and conditional cash transfer program coverage. Quality of PHC, measured by
work process variables, plays an important role in child mortality. Efforts on PHC quality and coverage, as well as on CCT
program coverage, are important to child mortality reduction. Therefore, this is an important finding to other PHC public health
services.
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