Mortality associated with alternative policy options for primary care and the Mais Médicos (More Doctors) Program in Brazil: forecasting future scenarios

Francesconi, Gabriel Vivas; Tasca, Renato; Basu, Sanjay; Rocha, Thiago Augusto Hernandes; Rasella, Davide

doi:10.26633/rpsp.2020.31

Cited by 8 publications

(11 citation statements)

References 22 publications

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“…Moreover, many Indigenous communities have difficulty to access primary health facilities, basic medicines and hospitals equipped with ventilators and intensive care unit beds that would be needed to treat severe cases of COVID-19. 7 , 9 Unfortunately, this situation has been exacerbated by reduction in the investments of the More Doctors Program (Programa Mais Médicos, acronym in Portuguese), 10 , 11 which resulted in the dismissal of more than 8000 doctors for primary health care in 2019, mainly affecting Indigenous communities in remote areas.…”

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confidence: 99%

COVID-19 mortality among Indigenous people in Brazil: a nationwide register-based study

Santos

Araújo

Oliveira

et al. 2020

Journal of Public Health

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Coronavirus disease 2019 (COVID-19) has disproportionately affected Black people and minority ethnic groups, but there are limited data regarding the impact of disease on Indigenous people. Herein, we investigated the burden of COVID-19 on the Indigenous population in Brazil. We performed a populational-based study including all cases and deaths from COVID-19 among Brazilian Indigenous people from 26 February to 28 August 2020. Data were obtained from official Brazilian information systems. We calculated incidence, mortality and fatality rates for the Indigenous population for each of the five Brazilian regions. Brazil had an incidence and a mortality rate of 3546.4 cases and 65.0 deaths per 100 000 population, respectively. The case fatality rate (CFR) was 1.8%. The Central-West had the higher estimates of disease burden among Brazilian Indians (incidence rate: 3135.0/100 000; mortality rate: 101.2/100 000 and CFR: 3.2%) followed by the North region (incidence rate: 5664.4/100 000; mortality rate: 92.2/100 000 and CFR: 1.6%). Governmental actions should guarantee the isolation, monitoring and testing capabilities of Indigenous people and rapidly to provide social protection and health facilities.

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confidence: 99%

COVID-19 mortality among Indigenous people in Brazil: a nationwide register-based study

Santos

Araújo

Oliveira

et al. 2020

Journal of Public Health

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“…12 While our study is focused on Brazilian cities, recent literature has also demonstrated the effectiveness of interventions to expand the primary care coverage to rural areas, as the Mais Medicos Programme, on the reduction of premature mortality, 28 and have shown how weakening of such intervention during periods of economic austerity could be responsible for a large number of avoidable deaths. 14 29 Brazil is one of the few low-income and middle-income countries with a universal healthcare system, the Unified Health System (SUS), based on one of the world's largest primary healthcare programmes, the FHS. The expansion of the SUS and FHS during the last 30 years was responsible for large reductions on mortality and health inequalities, 30 but is currently under threat by aggressive and long-term fiscal austerity measures that could undermine its consolidation and even reduce its dimension and effectiveness, 13 14 so robust evidence on the impact of its components-including FHS, are urgently needed.…”

Section: Discussionmentioning

confidence: 99%

Contribution of primary care expansion to Sustainable Development Goal 3 for health: a microsimulation of the 15 largest cities in Brazil

et al. 2022

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ObjectivesAs middle-income countries strive to achieve the Sustainable Development Goals (SDGs), it remains unclear to what degree expanding primary care coverage can help achieve those goals and reduce within-country inequalities in mortality. Our objective was to estimate the potential impact of primary care expansion on cause-specific mortality in the 15 largest Brazilian cities.DesignMicrosimulation model.Setting15 largest cities by population size in Brazil.ParticipantsSimulated populations.InterventionsWe performed survival analysis to estimate HRs of death by cause and by demographic group, from a national administrative database linked to the Estratégia de Saúde da Família (Family Health Strategy, FHS) electronic health and death records among 1.2 million residents of Rio de Janeiro (2010–2016). We incorporated the HRs into a microsimulation to estimate the impact of changing primary care coverage in the 15 largest cities by population size in Brazil.Primary and secondary outcome measuresCrude and age-standardised mortality by cause, infant mortality and under-5 mortality.ResultsIncreased FHS coverage would be expected to reduce inequalities in mortality among cities (from 2.8 to 2.4 deaths per 1000 between the highest-mortality and lowest-mortality city, given a 40 percentage point increase in coverage), between welfare recipients and non-recipients (from 1.3 to 1.0 deaths per 1,000), and among race/ethnic groups (between Black and White Brazilians from 1.0 to 0.8 deaths per 1,000). Even a 40 percentage point increase in coverage, however, would be insufficient to reach SDG targets alone, as it would be expected to reduce premature mortality from non-communicable diseases by 20% (vs the target of 33%), and communicable diseases by 15% (vs 100%).ConclusionsFHS primary care coverage may be critically beneficial to reducing within-country health inequalities, but reaching SDG targets will likely require coordination between primary care and other sectors.

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“…These inequalities in accessing healthcare arise from factors such as structural racism, lack of funding to the Indigenous Health Subsystem, geographical distances, lack of transportation, and shortage of health professionals [ 53 , 54 ]. In 2019, the dismissal of more than 8000 Cuban doctors that primarily served vulnerable and remote communities across all regions of Brazil had a major impact on the delivery of primary health care to Indigenous communities [ 55 ]. It is likely that the COVID-19 pandemic exacerbated the existing barriers to accessing healthcare faced by the Indigenous Peoples from Brazil.…”

Section: Discussionmentioning

confidence: 99%

Disparities in Excess Mortality Between Indigenous and Non-Indigenous Brazilians in 2020: Measuring the Effects of the COVID-19 Pandemic

Soares

Jamieson

Biazevic

et al. 2021

J. Racial and Ethnic Health Disparities

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This study aimed to estimate the number of excess deaths among Indigenous Peoples associated with the COVID-19 pandemic in 2020 and to assess the disparities in excess mortality between Indigenous and non-Indigenous Brazilians. A time series analysis of weekly mortality data including all deaths from January 2015 to December 2020 was conducted. The number of expected deaths for 2020 was estimated using an over-dispersed Poisson model that accounts for demographic changes, temporal trends, and seasonal effects in mortality. Weekly excess deaths were calculated as the difference between the number of observed deaths and the expected deaths. Regional differences in Indigenous mortality were investigated. A significant increase in Indigenous mortality was observed from April 1 to December 31, 2020. An estimated 1149 (95% CI 1018–1281) excess deaths was found among Indigenous Brazilians in 2020, representing a 34.8% increase from the expected deaths for this population. The overall increase in non-Indigenous mortality was 18.1%. The Indigenous population living in the Brazilian Amazon area was the earliest-affected Indigenous group, with one of the highest proportional increases in mortality. Disparities in excess mortality revealed a disproportionate burden of COVID-19 among Indigenous Brazilians compared to their non-Indigenous counterparts. Findings highlight the importance of implementing an effective emergency plan that addresses the increased vulnerability of Indigenous Peoples to COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-021-01162-w.

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Mortality associated with alternative policy options for primary care and the Mais Médicos (More Doctors) Program in Brazil: forecasting future scenarios

Cited by 8 publications

References 22 publications

COVID-19 mortality among Indigenous people in Brazil: a nationwide register-based study

COVID-19 mortality among Indigenous people in Brazil: a nationwide register-based study

Contribution of primary care expansion to Sustainable Development Goal 3 for health: a microsimulation of the 15 largest cities in Brazil

Disparities in Excess Mortality Between Indigenous and Non-Indigenous Brazilians in 2020: Measuring the Effects of the COVID-19 Pandemic

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