Impact of the Programa Mais médicos (more doctors Programme) on primary care doctor supply and amenable mortality: quasi-experimental study of 5565 Brazilian municipalities

Abstract

Background Investing in human resources for health (HRH) is vital for achieving universal health care and the Sustainable Development Goals. The Programa Mais Médicos (PMM) (More Doctors Programme) provided 17,000 doctors, predominantly from Cuba, to work in Brazilian primary care. This study assesses whether PMM doctor allocation to municipalities was consistent with programme criteria and associated impacts on amenable mortality. Methods Difference-in-differences regression analysis, exploiting variation in PMM introduction across 5565 municipalities over the period 2008–2017, was employed to examine programme impacts on doctor density and mortality amenable to healthcare. Heterogeneity in effects was explored with respect to doctor allocation criteria and municipal doctor density prior to PMM introduction. Results After starting in 2013, PMM was associated with an increase in PMM-contracted primary care doctors of 15.1 per 100,000 population. However, largescale substitution of existing primary care doctors resulting in a net increase of only 5.7 per 100,000. Increases in both PMM and total primary care doctors were lower in priority municipalities due to lower allocation of PMM doctors and greater substitution effects. The PMM led to amenable mortality reductions of − 1.06 per 100,000 (95%CI: − 1.78 to − 0.34) annually – with greater benefits in municipalities prioritised for doctor allocation and where doctor density was low before programme implementation. Conclusions PMM potential health benefits were undermined due to widespread allocation of doctors to non-priority areas and local substitution effects. Policies seeking to strengthen HRH should develop and implement needs-based criteria for resource allocation.

Pay for performance in primary care: the contribution of the Programme for Improving Access and Quality of Primary Care (PMAQ) on avoidable hospitalisations in Brazil, 2009–2018

“…Regardless, some limitations 45 and amenable mortality. 46 We have not controlled for PMM because data were not publicly available for the whole period analysed in this study (particularly data from 2018). However, as PMM have increased the supply of physicians across the country, we partially captured its contribution by controlling the PHC coverage.…”

Work Process of Primary Health care Teams in Brazil from Rural/Urban Municipal Typology: A National Evaluation Study

“…It is worth noting that in recent years, the number of primary healthcare teams in the country has expanded exponentially, especially the FHS [22]. This process was in uenced by the creation of the Mais Médicos Program in 2013, responsible for reformulating more than 57.3% of conventional primary care teams to family health teams, especially in municipalities with less than 30,000 inhabitants, which directly impacted the substantial increase in population coverage by PHCs [26,27].…”

Assessing the performance of beneficiary targeting in Brazil’s More Doctors Programme

“…Expanding equitable access to primary care is a priority in many low- and middle-income countries that seek to achieve universal health coverage ( WHO, 2018 ). Strong primary care systems are associated with improvements in population health, better quality of health services and reductions in socioeconomic inequities in access to care ( Macinko et al , 2003 , 2009 ; Kruk et al , 2010 ; Shi, 2012 ; Starfield, 2012 ; Kringos et al , 2013 ; Hone et al , 2017 ). Access to a trained health workforce is crucial to ensure effective health service coverage.…”

“…All Brazilians are eligible to utilize FHS services free-of-charge. The expansion of the FHS led to improvements in access to primary care ( Andrade et al , 2015 ), substantial reductions in maternal and child mortality ( Macinko et al , 2007 ; Rasella et al , 2010 ; Rocha and Soares, 2010 ; Brentani et al , 2016 ), in racial inequalities in mortality amenable to primary care ( Hone et al , 2017 ), and in hospitalizations and deaths due to conditions sensitive to primary care ( Macinko et al , 2010 , 2011 ; Macinkoand Lima-Costa, 2012 ; Da Silva and Powell-Jackson, 2017 ; Cavalcante et al , 2018 ).…”