Perceptions and Uses of Public and Private Health Care in a Brazilian Favela

Castiglione, Debora de Pina; Lovasi, Gina S.; Carvalho, Marília Sá

doi:10.1177/1049732317739611

Cited by 17 publications

(15 citation statements)

References 24 publications

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“…This is consistent with findings of another study where these states reportedly have poor quality health services and inadequate specialty services (Bajpai, 2014). A study done in Rio de Janeiro showed that participants sought health care in the private sector because they perceived it as an assurance of receiving the required treatment and because of the feeling of disempowerment they felt in their interactions with doctors in the public health system (Castiglione et al, 2018). Tertiary health facilities were set up in the last decade to meet the shortfall of quality health services ("Bill on AIIMS-Like Institutes Introduced in Lok Sabha," 2012) but have not bridged service gaps, as seen in our analysis.…”

Section: Discussionsupporting

confidence: 86%

“…This study highlighted issues of access such as the routine problem of long queues, also seen in another study in a slum settlement in Delhi (Barua & Pandav, 2011). Another study done in Rio de Janeiro showed that the even while appointments were scheduled weeks in advance, the doctor was absent on the day of the appointment (Castiglione et al, 2018).…”

Section: Discussionsupporting

confidence: 54%

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Understanding the Experiences of Health Care–Seeking Migrants in Delhi: Trajectories and Challenges

Mathew

Nambiar

2020

Qual Health Res

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Many studies have reported on issues of accessibility and quality of health care among the different vulnerable subgroups in urban locations. To date, no study has been done on the challenges faced by health care–seeking migrants (those traveling to cities for health reasons). This qualitative study used in-depth interviews and nonparticipant observation to examine the health problems, health care–seeking trajectories, and challenges faced by health care–seeking migrants in Delhi, India. Participants described long courses of health care seeking, typically from the district to the state capital to the national capital. There were variegated paths to health care seeking characterized by delays in service utilization, progression of disease, and cost escalation. The challenge relating to the delay in receiving health care was exacerbated by the residency status of health care–seeking migrants. In conclusion, health-related migration is associated with shared but also unique barriers to health care seeking. India’s urban health care reform agenda needs to cater to the needs of this population.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 54%

Understanding the Experiences of Health Care–Seeking Migrants in Delhi: Trajectories and Challenges

Mathew

Nambiar

2020

Qual Health Res

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“…This underlines the importance of achieving and maintaining political support for investment in PHC, including embracing a model of universal provision around which popular support can be built—especially during periods when public expenditures are severely constrained. Other studies of PHC in Rio de Janeiro have identified long distances to clinics, wait times, staff and equipment shortages, and perceived poor treatment by healthcare professionals as barriers to accessing healthcare, and addressing these is essential to ensure investments in PHC that characterized the program in Rio de Janeiro are sustained [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults

et al. 2020

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Background Expanding delivery of primary healthcare to urban poor populations is a priority in many low- and middle-income countries. This remains a key challenge in Brazil despite expansion of the country’s internationally recognized Family Health Strategy (FHS) over the past two decades. This study evaluates the impact of an ambitious program to rapidly expand FHS coverage in the city of Rio de Janeiro, Brazil, since 2008. Methods and findings A cohort of 1,241,351 low-income adults (observed January 2010–December 2016; total person-years 6,498,607) with linked FHS utilization and mortality records was analyzed using flexible parametric survival models. Time-to-death from all-causes and selected causes were estimated for FHS users and nonusers. Models employed inverse probability treatment weighting and regression adjustment (IPTW-RA). The cohort was 61% female (751,895) and had a mean age of 36 years (standard deviation 16.4). Only 18,721 individuals (1.5%) had higher education, whereas 102,899 (8%) had no formal education. Two thirds of individuals (827,250; 67%) were in receipt of conditional cash transfers ( Bolsa Família ). A total of 34,091 deaths were analyzed, of which 8,765 (26%) were due to cardiovascular disease; 5,777 (17%) were due to neoplasms; 5,683 (17%) were due to external causes; 3,152 (9%) were due to respiratory diseases; and 3,115 (9%) were due to infectious and parasitic diseases. One third of the cohort (467,155; 37.6%) used FHS services. In IPTW-RA survival analysis, an average FHS user had a 44% lower hazard of all-cause mortality (HR: 0.56, 95% CI 0.54–0.59, p < 0.001) and a 5-year risk reduction of 8.3 per 1,000 (95% CI 7.8–8.9, p < 0.001) compared with a non-FHS user. There were greater reductions in the risk of death for FHS users who were black (HR 0.50, 95% CI 0.46–0.54, p < 0.001) or pardo (HR 0.57, 95% CI 0.54–0.60, p < 0.001) compared with white (HR 0.59, 95% CI 0.56–0.63, p < 0.001); had lower educational attainment (HR 0.50, 95% CI 0.46–0.55, p < 0.001) for those with no education compared to no significant association for those with higher education ( p = 0.758); or were in receipt of conditional cash transfers ( Bolsa Família ) (HR 0.51, 95% CI 0.49–0.54, p < 0.001) compared with nonrecipients (HR 0.63, 95% CI 0.60–0.67, p < 0.001). Key limitations in this study are potential unobserved confounding through selection into the program and linkage errors, although analytical approaches have minimized the potential for bias. Conclusions FHS utilization in urban poor populations in Brazil was associated with a lower risk of death, with greater reductions amon...

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“…The lack of resources impedes the access to public healthcare [33,34], and the perceived quality of service is higher in the private sector. This influences Brazilian's health seeking behavior, even in poor urban settings [35].…”

Section: Dengue Surveillance In Brazilmentioning

confidence: 99%

Dengue Surveillance System in Brazil: A Qualitative Study in the Federal District

Angelo

Ramalho

Gurgel

et al. 2020

IJERPH

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Dengue’s increasing trends raise concerns over global health and pose a challenge to the Brazilian health system, highlighting the necessity of a strong surveillance system to reduce morbidity, mortality, and the economic burden of this disease. Although the Brazilian surveillance system reports more dengue cases than any other country, recent studies suggest that non-reported cases are the majority. The aim of the study is to explore the strengths and weaknesses of the Brazilian surveillance system, particularly looking at the functioning of data collection and reporting. This was done through qualitative semi-structured interviews with 17 experts in dengue surveillance, supported by quantitative data from the official notification system. To select the interviewees, purposive and theoretical sampling were used. Data were analyzed through thematic analysis. The research highlighted that a lack of human and technological resources in healthcare units and surveillance departments slows down the notification process and data analysis. Due to a lack of integration in the private sector, the surveillance system fails to detect the socioeconomic profile of the patients. Investments in public healthcare, human and technological resources for surveillance and better integration in the private healthcare system, and vector surveillance may improve dengue surveillance.

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Perceptions and Uses of Public and Private Health Care in a Brazilian Favela

Cited by 17 publications

References 24 publications

Understanding the Experiences of Health Care–Seeking Migrants in Delhi: Trajectories and Challenges

Understanding the Experiences of Health Care–Seeking Migrants in Delhi: Trajectories and Challenges

Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults

Dengue Surveillance System in Brazil: A Qualitative Study in the Federal District

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