Research Project

Challenges of Social Protection in Health in the Context of Inequities in the Brazilian Amazon

Country
- Brasil

Institutions Involved
- Department of Preventive Medicine, Medical School, University of Sao Paulo; National Public Health School/Oswaldo Cruz Foundation; and the Health Institute, State Secretariat of Health, Sao Paulo.

- The Executive Secretariat of the Federal Ministry of Health.

- Ministry of Social Development and the Fight Against Hunger.

Project Description
Two policy priorities of the new Lula Government defined the topic of this project. On the one hand, the Legal Amazon Region was prioritized as the most important area of inter-sectorial collaboration for development. On the other hand, there was very early exploration of a policy option to partially recentralize the current descentralized management of health resources at the regional level. Ministry of Health officials were concerned that the descentralization of the 1990s may have gone too far, and the resulting local power silos had made the equitable allocation of resources more difficult. The hypothesis that emerged from discussions among the policymakers and researchers was that inequities in the allocation of resources may be exacerbated by poor relations among different governmental decision-making levels and the lack of inter-sectorial coordination. The team therefore focused on a new policy in the Amazon region to regionalize health policy. Anticipating political resistance to the policy, the team proposed to study the political relationships that evolved during this period among multiple government and non-governmental bodies. They also proposed to evaluate the impact of the regionalization policy by examining its effects on the equitable distribution of resources and health, and to the extent possible, health outcomes, both within the region, and in comparison to other regions of Brazil. The project team expects to use their findings on the political process and on the equity impact of the new policies to inform the national health policy making process.

The objective of the research project is to evaluate the results of the Buenos Aires Maternal and Child Health Insurance Program in primary care services, with special emphasis on certain tracer health conditions. It will examine different dynamics of governance at the municipal and provincial levels, and explore whether they are associated with different levels of program impact.

The evaluation seeks to inform the design and management of the Buenos Aires program, It will also produce useful lessons for other provinces considering implementing this type of social insurance program. Lastly, the discussion of findings may be relevant to a larger debate in Latin American on the successes and failures of maternal and child health insurance programs.

Contacts
Ana Luiza d Avila Viana, ENSP/FIOCRUZ, Universisty of Sao Paulo.
email: anaviana@usp.br

Dario Federico Pasche, Federal Ministry of Health.
email: dario.pasche@saude.gov.br