Two decades of primary health care expansion in Latin America: evaluation and forecasting study for health-related SDGs
Medical Research Council
Federal University of Bahia (UFBA)
A strong Primary Health Care(PHC) is essential for achieving Universal Health Coverage(UHC) and should be an integral part of and coordinate multi-sectoral actions addressing economic and social determinants of health, acting synergistically with social interventions such as cash transfer programmes(CCT) and social pensions(SP). The evidence of PHC effectiveness in LMICs is sparse, with most studies conducted in North America and Europe, moreover PHC's long-term effects and synergistic interactions with social assistance interventions have rarely been evaluated. We will perform a multi-country study in Brazil, Colombia, Ecuador and Mexico (BCEM) with the aim to: 1)Evaluate of the effects of PHC coverage on all the range of notifiable diseases, hospitalizations and mortality (overall, for specific causes and age-groups) over the last two decades using ecologic longitudinal data at municipal level in each BCEM from 2000 to 2018. We will also measure the effects of duration of PHC coverage (expressed as the average coverage of the previous years) and the presence of long-term effects (with lag and age-cohorts analyses). 2)We will evaluate the synergistic effects of PHC with the other healthcare system components (secondary and tertiary levels of care),CCT and SP on the full range of health outcomes at the municipal level. We will also measure as local factors, such as human development index(HDI) or local administration capacity, affected the effectiveness of PHC, paying attention to the heterogeneity of effects within and between countries.3)Using individual-level data from national health cohorts, surveys and censuses and multilevel modelling we will evaluate the granularity of PHC effectiveness on health outcomes in all BCEM.4)Using an integrated microsimulation approach we will forecast the effects of PHC coverage changes, calibrating the best implementation scenarios for achievement of health-related SDGs and reduction of health inequalities in BCEM up to 2030.
8.1 Organisation and delivery of services / Research Grant