Avaliação de intervenção para aprimorar a resposta da Atenção Primária à Saúde ao cuidado de casos de violência doméstica contra a mulher - São Paulo, Brasil / Evaluation of an intervention to improve Primary Health Care's response to cases of domestic violence against women - São Paulo, Brazil

Resumo O objetivo foi analisar e aprimorar a resposta da Atenção Primária à Saúde (APS) ao cuidado dos casos de violência doméstica contra a mulher (VDCM), desenvolvendo, implementando e avaliando uma intervenção. Pesquisa piloto de avaliação do antes e depois da implementação de uma intervenção, utilizando métodos mistos e realizada em três fases - linha de base, intervenção e avaliação - entre agosto/2017 e março/2019 em duas Unidades Básicas de Saúde (UBS) do Município de São Paulo. Apresentamos neste artigo o detalhamento e a avaliação da intervenção, realizada 6-12 meses após implementação. A intervenção foi desenvolvida com base nos achados da primeira fase e em consonância com a política de saúde que estabelece os Núcleos de Prevenção à Violência (NPV), consistindo em: elaboração de fluxo assistencial; capacitação geral para todos os trabalhadores e específica para o NPV; elaboração de material educativo e discussões mensais de caso durante 6 meses. A avaliação mostrou aceitabilidade entre os trabalhadores, aumentou a identificação e repertório para o cuidado dos casos de VDCM, fortalecendo o encaminhamento interno e à rede intersetorial. Identificamos obstáculos para plena implementação e sustentabilidade da intervenção.

Abstract The aim was to analyse and improve the Primary Health Care (PHC) response to domestic violence against women (DVAW) by developing, implementing and evaluating an intervention. A pilot study evaluating the before and after of intervention implementation, using mixed methods and carried out in three phases - formative, intervention and evaluation - between August 2017 and March 2019 in two Basic Health Units (UBS) in the city of São Paulo. In this paper, we present the details and evaluation of the intervention, carried out six to twelve months after its implementation. The intervention was developed based on the findings of the formative phase and in line with the health policy that establishes the Violence Prevention Nucleus (NPV) and consisted of stablishing a care pathway; general training for all workers and specific training for the NPV; drawing up educational material and monthly case discussions over 6 months. The evaluation showed acceptability among the workers, increased identification and repertoire for caring for cases of DVAW, strengthening internal referral and the intersectoral network. We identified obstacles to the full implementation and sustainability of the intervention.

A systematic review of the evaluation of agricultural policies: Using prisma.

Background: The food security of each country depends on agricultural development, which is sensitive to the implementation of agricultural public policies. These must evolve as new ruralities arise, with new phenomena, such as climate change, ecosystem services, changes in consumer preferences, globalization, sustainability and ecological awareness. Hence, of ex-ante and ex-post evaluations of agricultural policies, are important because they provide timely information to government entities. There are different methodologies for policy evaluation, which have evolved over time. Aims: This systematic review aims to identify manuscript that systematically review methodologies, policies and variables evaluated during the last 50 years to determine whether a policy has been efficient. To assess the quality of the included manuscript and to describe the measures and domains identified. Methods: EBSCO, Dialnet, SciELO, Scopus, Science Direct, Dimensions and Web of Science were searched. A total of 154 manuscript were identified, the review was finalized by reviewing the title, and abstract and the review was finalized by reviewing the title, abstract and full text, resolving disagreements. Of these 154 manuscripts, 37 met the criteria and were included in the analysis. PRISMA checklists were used to evaluate the methodology. Outcomes and results: It were found that there are few studies on the design of evaluation methodologies for agricultural policies in the literature. Research shows that the latest policy evaluation proposals present more complex methodologies involving tools such as machine learning and agent-based modelling (ABM). On the other hand, the issue of sustainability as a policy is seen in the agri-environmental policy evaluation. Conclusions and implications: The evolution of agricultural policy methodologies can be observed at the beginning with the use of quantitative methodologies, such as matrices, statistics and econometrics. With the emergence of new variables, such as agri-environmental variables, citizen participation and market opening, methodologies have become more comprehensive, combining qualitative and quantitative variables. Methodologies were identified that evaluate robust agricultural policies and others that focus on the evaluation of one or two policies. These studies are important for research that focuses not only on the evaluation of agricultural policies but also on their design and implementation processes.

Financiamento de pesquisas sobre dengue no Brasil, 2004-2020 / Funding for research on dengue in Brazil, 2004-2020

RESUMO A dengue representa um importante problema de saúde pública no Brasil devido às constantes epidemias causadas pela doença no País. Este estudo objetivou analisar o financiamento de pesquisas sobre dengue pelo Departamento de Ciência e Tecnologia do Ministério da Saúde e parceiros no período de 2004 a 2020. Analisou-se a tendência do financiamento por regressão linear generalizada do tipo Prais-Winster e sua distribuição entre as regiões e Unidades Federadas brasileiras, modalidades de contratação das pesquisas, instituições beneficiadas e temas estudados. Entre 2004 e 2020, financiaram-se 232 pesquisas (R$ 164,03 milhões), realizadas, em sua maioria, em instituições da região Sudeste (77,55%), abordando especialmente a temática controle vetorial (37,93%). A tendência de financiamento foi estacionária nos anos estudados. As chamadas estaduais foram a principal forma de modalidade de contratação das pesquisas (65,95%). Houve diferença estatisticamente significante na distribuição do valor financiado entre as modalidades de contratação, bem como no número de pesquisas financiadas e valor financiado entre as regiões brasileiras. Esses achados demonstram a importância de monitorar o financiamento de pesquisas sobre dengue no Brasil e de implementar estratégias de avaliação das pesquisas financiadas, para subsidiar e aprimorar a política de enfrentamento da doença e de seu vetor.

ABSTRACT Dengue represents an important public health problem in Brazil, due to the constant epidemics caused by the disease in the country. This study aimed to analyze the funding of research on dengue by the Department of Science and Technology of the Ministry of Health of Brazil and partners between 2004 to 2020. Was analyzed the trend of the funding by generalized linear regression using Prais-Winster and its distribution between Brazilian regions and Federated Units, research contracting modalities, benefited institutions, and studied themes. Between 2004 and 2020, 232 research studies were funded (R$ 164.03 million), carried out mostly in institutions in the Southeast Region (77.55%), addressing especially the vector control theme (37.93%). The funding trend was stationary in the years studied. The state calls were the main form of contracting modality for the research (65.95%). There was a statistically significant difference in the distribution of the loan amount between the contracting modalities, and in the number of researches funded and loan amount among Brazilian regions. These findings demonstrate the importance of monitoring the research funding on dengue in Brazil and of implementing strategies to evaluate the research funded, to support and improve the policy to combat the disease and its vector.

The Impact of Conditional Cash Transfers on Poverty, Inequality, and Employment During COVID-19: A Case Study from Brazil.

The policy responses to the COVID-19 pandemic varied widely between countries. Understanding how effective these responses were is important to improve preparedness for future crises. This paper investigates how one of largest scale conditional cash transfer COVID relief policies in the world-the Brazilian Emergency Aid (EA)-impacted poverty, inequality, and the labor market amidst the public health crisis. We use fixed-effects estimators to analyze the impact of the EA on labor force participation, unemployment, poverty, and income at the household level. We find that inequality, measured by per capita household income, reduced to a historical low and was accompanied by substantial poverty declines-even as compared to pre-pandemic levels. Furthermore, our results suggest that the policy has effectively targeted those in most need-temporarily reducing historical racial inequalities-while not incentivizing reductions in labor force participation. Absent the policy, adverse shocks would have been significant and are likely to occur once the transfer is interrupted. We also observe that the policy was not enough to curb the spread of the virus, suggesting that cash transfers alone are insufficient to protect citizens.

Pathways to policy integration: a subsystem approach.

Researchers in public policy and public administration agree that policy integration is a process. Nevertheless, scholars have given limited attention to political aspects that facilitate or impede integration. This paper aims at filling that gap, by looking at how different theories of the policy process can help in explaining the process of policy integration as shaped by policy subsystems. By building on insights from theories of the policy process, we develop pathways regarding adoption and implementation in policy integration that account for the politicization and the role of actors and subsystems in the policy process. Our main argument is that policy integration is in permanent political tension with the sectoral logic of policymaking, which predominantly happens between actors in subsystems. Policy integration is, thus, not a single moment when those tensions are solved once and for all, but a political process that requires deliberate efforts to overcome the pull toward sector-specific problem definition, policymaking, implementation, and evaluation.

Policy evaluations of microenterprise business support services in Latin America: A systematic review.

Microenterprises represent 88.4 % of Latin American enterprises, and many countries in the region have developed microenterprise promotion policies in recent years; however, rigorous evaluation remains a pending issue. To shed light on the research done on this topic over the last 20 years and propose a roadmap for the policy evaluation of microenterprise business support services and the development of microenterprise indicators, this work conducts a systematic review, following the PRISMA guidelines, of peer-reviewed journal articles examining the impact of business support services on microenterprise performance in low- and middle-income Latin American countries. We identified 679 studies, and 17 studies met the inclusion criteria. We found that the literature is surprisingly scarce; most studies focus on credits and impacts on financial performance and concentrate on Mexico; and only three articles involve randomised controlled trials. Our results have important implications for policymakers and future research.

The effect of non-pharmaceutical policy interventions on COVID-19 transmission across three cities in Colombia.

Governments across the globe have implemented different strategies to handle the COVID-19 pandemic. A national mandatory quarantine was the most applied policy tool. While there are studies that tested the effectiveness of a national mandatory quarantine, the question about the effectiveness of additional quarantine policies is not yet answered. In this study we focus on three large cities in Colombia (Bogota, Medellin and Cali) with similar socio-economic conditions but made use of different COVID-19 prevention measures. We examine whether different non-pharmaceutical policy interventions (NPIs) conducted in these three cities are effective against the spread of the COVID-19 pandemic. We inspect the effect of the quarantine policies restricting exit from home by sex, ID number, whereby only Bogota implemented the restriction to leave the home according to sex followed by a restriction according to ID number, and Medellin and Cali implemented a restriction by ID number only. Data for the analysis are obtained from the National Administrative Department of Statistics of Colombia [Departamento Administrativo Nacional de Estadística (DANE)]. The data on pandemic severity is measured by the number of confirmed COVID-19 cases per city. We conduct single-group interrupted time series analysis (ITSA) to examine differences in the extent of the pandemic severity in Bogota, Medellin and Cali. We found that NPIs in all three Colombian cities had a positive effect on slowing the spread of the pandemic.

Comparison Between China and Brazil in the Two Waves of COVID-19 Prevention and Control.

OBJECTIVE: This study analyzes the effectiveness of COVID-19 prevention and control in China and Brazil from the perspectives of policy and meteorological conditions, and provides experience for epidemic prevention and control. METHODS: This study collects data on meteorological conditions, vaccination and mutant strains in the two countries to analyze the reasons for the differences in epidemic status between the two countries and extracts public data on COVID-19 through various official websites, summarizes the prevention and control policies implemented by the two countries, and evaluates their effectiveness. RESULTS: As of August 12, 2021, the total number of COVID-19 cases and the daily number of new COVID-19 cases in China have been growing steadily, showing remarkable results in epidemic control. The total number of confirmed cases and the daily number of new confirmed cases in Brazil have continued to increase rapidly. The total death case in Brazil has reached 560,000, far exceeding that in China, and the effect of epidemic prevention and control is not satisfactory. CONCLUSIONS: Multiple factors, such as meteorological conditions, policies and strategies, and economic conditions, can influence the spread of COVID-19, and therefore, the situation varies greatly from country to country. China and Brazil have chosen different interventions in the fight against COVID-19. The policy measures taken by China are typical containment measures and Brazil has a mitigation strategy. From the perspective of the current situation of the epidemic development in both countries, the cumulative death rate and daily new confirmed cases in Brazil are much higher than those in China, which indicates that the containment strategy is more effective than mitigation strategy in preventing and controlling COVID-19. Fighting the epidemic is a global long-lasting battle, and the two countries should learn from each other with the premise of respecting their national conditions. Countries should deepen cooperation and not let up prematurely.

Planos Municipais de Saúde do Estado do Tocantins: uma análise com foco no enfrentamento da obesidade / Municipal Health Plans in Tocantins, Brazil: an analysis focusing on obesity

Resumo O objetivo deste estudo foi avaliar a abrangência do enfrentamento da obesidade nos Planos Municipais de Saúde (PMS) do Estado do Tocantins, dado que, diante da crescente prevalência da obesidade no Brasil, seu enfrentamento deveria estar no foco de ação da saúde pública e previsto nos instrumentos de gestão. Trata-se de um estudo qualitativo, com análise documental, que analisou os PMS no período de vigência de 2018 a 2021 nos 139 municípios desse estado. Foram selecionados dezessete termos relacionados à obesidade e verificada a frequência e contexto nos PMS. Do total de 139 PMS, foram avaliados 129 (92,8%). Os termos "academia da saúde" e "Sisvan" foram os mais frequentes, e "obesidade" apareceu em apenas 28% dos planos, totalizando 71 citações. Destas, somente 32,4% relacionavam-se diretamente com o enfrentamento da doença, com destaque nas regiões de saúde Bico do Papagaio e Médio Norte Araguaia. Os contextos relevantes de abordagem da obesidade mais frequentes foram a caracterização da situação epidemiológica, quadros de metas de ações e indicadores. Concluiu-se que o enfrentamento da obesidade pactuado nos PMS está ausente em mais de 70% dos municípios do Tocantins, e que ações de direcionamento para inclusão dessa doença dentro dos instrumentos de gestão são urgentes.

Abstract This documentary analysis evaluated the scope of addressing obesity in the Municipal Health Plans (PMS) in the state of Tocantins, Brazil, since the growing prevalence of obesity in Brazil should put its confrontation at the center of public health action and management instruments. To analyze the PMS performance from 2018 to 2021 in the 139 municipalities of this state, 17 terms related to obesity were selected and had their frequency and context in the PMS verified. Of the existing 139 PMS, 129 (92.8%) were evaluated. "Health academy" and "SISVAN" were the most frequent terms used, whereas "obesity" appeared in only 28% of the plans, totaling 71 mentions. Of these, only 32.4% were directly related to combating the disease, mainly in the health regions of Bico do Papagaio and Médio Norte Araguaia. Relevant contexts for addressing obesity included the characterization of the epidemiological profile, tables of action goals, and indicators. PMS's role in combating obesity is absent in more than 70% of municipalities in Tocantins, which points to the urgent inclusion of this disease within the management instruments.

Programa Minha Casa Minha Vida (2012-2016): análise da eficiência relativa dos municípios brasileiros na execução de programas federais / Programa Minha Casa Minha Vida (2012-2016): análisis de la eficiencia relativa de los municipios brasileños en la implementación de programas federales / Minha Casa Minha Vida Program (2012-2016): analysis of the relative efficiency of Brazilian municipalities in the implementation of federal programs

Resumo A presente pesquisa busca avaliar a eficiência relativa dos municípios brasileiros na execução do programa Minha Casa Minha Vida. Pretende-se que os resultados deste trabalho permitam a discussão de quais características ou fatores parecem afetar a eficiência municipal na implementação de políticas públicas, de forma a fornecer subsídios teórico-empíricos às pesquisas na área. O programa Minha Casa Minha Vida (MCMV), caso escolhido, compõe o eixo Infraestrutura Social e Urbana do Programa de Aceleração do Crescimento (PAC). O trabalho foi estruturado em duas etapas: a primeira é a classificação de municípios em grupos homogêneos; a segunda refere-se ao levantamento da eficiência relativa dos municípios na implementação do MCMV, por meio da aplicação de Análise Envoltória de Dados (DEA). Como resultado, foi identificado que os municípios brasileiros possuem padrões diversos de estruturação, sendo a maioria classificada como pouco estruturados ou com estrutura mínima, com claro padrão regional, em que Sul e Sudeste apresentam, com maior frequência, municípios bem estruturados em comparação com o Centro-Oeste, o Norte e o Nordeste. Ao analisar a eficiência relativa no MCMV, tendo como universo apenas os municípios que concluíram empreendimentos do PMCMV entre 2012 e 2016, os municípios com melhor estrutura também apresentaram melhores resultados, indicando que a estrutura deve ser determinante para o desempenho no programa. Em contrapartida, a análise regional apresentou o Centro-Oeste, o Norte e o Nordeste com mais municípios eficientes na execução do programa.

Resumen Esta investigación tiene como objetivo evaluar la eficiencia relativa de los municipios brasileños en la implementación del programa Minha Casa Minha Vida (MCMV). Se pretende que los resultados de este trabajo permitan discutir qué características o factores parecen afectar la eficiencia municipal en la implementación de las políticas públicas, a fin de proporcionar apoyo teórico y empírico a la investigación en el área. El programa Minha Casa Minha Vida, si se elige, forma el eje de Infraestructura Social y Urbana del Programa de Aceleración del Crecimiento (PAC). El trabajo fue estructurado en dos etapas: la primera es la clasificación de los municipios en grupos homogéneos; la segunda se refiere al relevamiento de la eficiencia relativa de los municipios en la implementación del MCMV, mediante la aplicación del análisis de envoltura de datos (DEA). Como resultado, identificamos que los municipios brasileños tienen diferentes patrones de estructuración. La mayoría de ellos fueron clasificados como mal estructurados o mínimamente estructurados. Podríamos observar en los datos analizados un patrón regional claro, donde el Sur y el Sudeste tienen municipios mejor estructurados en comparación con el Centro Oeste, el Norte y el Noreste. Al analizar la eficiencia relativa en el MCMV, considerando como universo solo los municipios que completaron proyectos del PMCMV entre 2012 y 2016, los municipios mejor estructurados también presentaron mejores resultados, lo que indica que las condiciones estructurales pueden ser determinantes del desempeño del programa. En contrapartida, el análisis regional presentó el Centro Oeste, Norte y Nordeste con más municipios eficientes en la implementación del programa.

Abstract: This research aims to evaluate the relative efficiency of Brazilian municipalities in the implementation of the Brazilian federal program for affordable housing Minha Casa Minha Vida (MCMV) program. The study discusses characteristics or factors that seem to affect municipal efficiency in policy implementation providing theoretical and empirical support to research in the area. The MCMV program is part of the Social and Urban Infrastructure axis of the Growth Acceleration Program (Programa de Aceleração do Crescimento - PAC). The work was divided into two stages. The first step is the classification of municipalities into homogeneous groups. The second refers to the municipalities' relative efficiency in the MCMV, through the application of data envelopment analysis (DEA). As a result, we identified that Brazilian municipalities have different structuring patterns. The majority of them were classified as poorly structured or minimally structured. In the analyzed data, we observed a clear regional pattern, where South and Southeast have more well-structured municipalities compared to the Central-west, North, and Northeast. By analyzing the relative efficiency in MCMV, considering as universe only municipalities that completed MCMV projects between 2012 and 2016, better-structured municipalities also presented better results, indicating that structural conditions may be determinants of program performance. In contrast, the regional analysis presented that Centralwest, North, and Northeast demonstrated efficient municipalities more often, on average, in implementing the program.

Effect of free trade agreements on pharmaceutical market competition: The case of the 2009 US-Peru free trade agreement and its implementation as national drug policy.

Free Trade Agreements (FTA) are controversial for threatening essential aspects of health, especially access to affordable medicines. The US-Peru FTA required changes in the Peruvian pharmaceutical legislation that resulted in the implementation of the National Drug Policy (NDP) of 2009. The NDP included more robust technical requirements for registration, a Peruvian Good Manufacturing Practices certificate, a longer timeline for drug registration, and an increase in registration fees. This study evaluated the impact of the FTA on the number of registrations and competition in the Peruvian pharmaceutical market. Data for the period January 2005 to April 2014 were provided by the Peruvian drug regulatory authority (Dirección General de Medicamentos, Insumos y Drogas, DIGEMID). A total of 31,114 pharmaceutical products with unique registration numbers were evaluated. Brand drug new registrations decreased from 1789 in 2005 to 455 in 2013, and the number of generic registrations decreased from 621 in 2005 to 114 in 2013. Brand re-registrations also decreased from 714 in 2005 to 58 in 2013. There were 228 brand products awaiting registration in 2009 and 1,908 in 2013. The proportion of products awaiting registration was three times greater for brand than for generic products in 2009-2013. Registration of brand and generic medicines significantly declined after the implementation of the US-Peru FTA in 2009. The decline in the number of registrations was associated with more robust technical requirements, a longer DIGEMID registration timeline, and an increase in registration fees. The stronger registration requirements are expected to increase the quality of the drugs marketed in the country, but also less competition and a reduction in domestic registrations.

Ouvidoria como instrumento de participação, controle e avaliação de políticas públicas de saúde no Brasil / Ombudsman as instrument of participation, control and evaluation of public health policies in Brazil

Resumo As Ouvidorias Públicas representam um avanço na Administração Pública brasileira no campo da gestão democrática. Nessa perspectiva, este artigo objetiva analisar a atuação da Ouvidoria-geral do SUS. Portanto, como a Ouvidoria-geral do Sistema Único de Saúde atua no âmbito das políticas de saúde? Para responder tal pergunta, foi realizada pesquisa documental utilizando relatórios gerenciais da Ouvidoria-Geral do SUS do Ministério da Saúde, produzidos entre 2010 e 2017. Para classificar a informação, utilizou-se como categorias de análise a participação, o controle social e a avaliação. Observou-se que a participação dos cidadãos-usuários do sistema de saúde via ouvidoria vem aumentando e consolidando-se. A Ouvidoria-Geral do Sistema Único de Saúde disponibiliza uma série de canais para a participação da cidadania, incluindo telefone e internet, que são atualmente as formas de participação mais acessadas. Instrumentos como Carta SUS, Lei de Acesso a Informação e manifestações do tipo "denúncia" permitem o exercício do controle social. A satisfação do usuário é uma vertente avaliativa pouco fomentada, demonstrando descontinuidade ou despriorização de ações nesse sentido. Assim, no campo da saúde, as ouvidorias permitem a participação cidadão, o controle social e o aprimoramento das políticas e serviços, sendo importante avançar ainda mais no seu desenvolvimento.

Abstract The Public Ombudsmen represent a breakthrough in the Brazilian Public Administration, in the democratic management field. In this perspective, this paper aims to analyze the performance of the Ombudsman-General of the Unified Health System. So, how does the Ombudsman-General of the Unified Health System act within the scope of health policies? To answer this question, it was conducted documentary research using management reports from the Department of Ombudsman-General of the Unified Health System of The Brazilian Health Ministry produced between 2010 and 2017. To classify the information, participation, social control and evaluation were used as categories of analysis. It was noted that the participation of citizens-users of Unified Health System via Ombudsman has been increasing and consolidating. The Ombudsman-General of the Unified Health System provides many channels for citizen participation, including telephone and internet which are currently the most accessed forms of participation. Instruments such as the SUS Letter, the Access to Information Law and "whistleblowing" manifestations allow the exercise of social control. User satisfaction is an evaluative aspect that is little promoted, demonstrating discontinuity or devaluation of this kind of action. Thus, in the health field, the ombudsman allow citizen participation, social control and the improvement of policies and services, and it is important to advance further in their development.

State or market? How to effectively decrease alcohol-related crash fatalities and injuries.

BACKGROUND: It is estimated that more than 270 000 people die yearly in alcohol-related crashes globally. To tackle this burden, government interventions, such as laws which restrict blood alcohol concentration (BAC) levels and increase penalties for drunk drivers, have been implemented. The introduction of private-sector measures, such as ridesharing, is regarded as alternatives to reduce drunk driving and related sequelae. However, it is unclear whether state and private efforts complement each other to reduce this public health challenge. METHODS: We conducted interrupted time-series analyses using weekly alcohol-related traffic fatalities and injuries per 1 000 000 population in three urban conglomerates (Santiago, Valparaíso and Concepción) in Chile for the period 2010-2017. We selected cities in which two state interventions-the 'zero tolerance law' (ZTL), which decreased BAC, and the 'Emilia law' (EL), which increased penalties for drunk drivers-were implemented to decrease alcohol-related crashes, and where Uber ridesharing was launched. RESULTS: In Santiago, the ZTL was associated with a 29.1% decrease (95% CI 1.2 to 70.2), the EL with a 41.0% decrease (95% CI 5.5 to 93.2) and Uber with a non-significant 28.0% decrease (95% CI -6.4 to 78.5) in the level of weekly alcohol-related traffic fatalities and injuries per 1 000 000 population series. In Concepción, the EL was associated with a 28.9% reduction (95% CI 4.3 to 62.7) in the level of the same outcome. In Valparaíso, the ZTL had a -0.01 decrease (95% CI -0.02 to -0.00) in the trend of weekly alcohol-related crashes per 1 000 000 population series. CONCLUSION: In Chile, concomitant decreases of alcohol-related crashes were observed after two state interventions were implemented but not with the introduction of Uber. Relationships between public policy interventions, ridesharing and motor vehicle alcohol-related crashes differ between cities and over time, which might reflect differences in specific local characteristics.

Do government audits reduce dengue? Estimating the impact of federal monitoring lotteries program on dengue incidence.

The paper examines the relationship between the supervision carried out in the municipalities by the main Brazilan supervisory institution (Controladoria Geral da União-CGU, in portuguese) and the incidence of dengue cases in them. Since the audited municipalities were randomized, this allows the identification of a control group that adequately represents the counterfactual of the treated group. The sample was composed of all municipalities that could be selected for that CGU inspection cycle, that is, 1520 municipalities, of which 70 were drawn and therefore belong to the study treatment group. We identified a negative effect of the policy on the incidence of the disease. However, when we consider a model with lags, we note that this initial impact from the drawing did not persist throughout the year of the inspection. Our analysis suggests that when federal resources are monitored, municipalities reduce irregularities, which may contribute to a decrease in the number of dengue cases.

Assessing the impact of More Doctors Program on health care indicators

This paper aims to assess the short run effects of the More Doctors Program, launched by the Brazilian federal government in 2013. Using differences-in-differences approach with municipal data collected between 2010 and 2015, we confirm that MDP has two correlated impacts. First, it has increased health service attendance on treated municipalities. We document that appointments, consults, referrals, and home visits have increased by 5.9%, 9.4%, 12.3%, and 29.7%. Second, we find a negative impact on hospitalization. We argue that intensification on health service access have reduced general hospitalization (4.6%). However, it does not seem to have been able to reduce mortality in the municipalities, in line with Carrilo and Feres (2018) and Fontes et al. (2017). We argue that increase in referrals and appointment with specialists can be interpreted as quality improvement, since a more precise diagnostic, can reduce hospitalization due to faster health recovery without an impact on mortality.

Provider supply, utilization, and infant health: evidence from a physician distribution policy

We analyze a policy that substantially expanded the supply of primary care physicians in Brazil. The program is associated with a significant increase in doctor visits across all age groups, and greater utilization of doctors as source of prenatal care. However, this increased used of doctors was accompanied by significant reductions in prenatal care from nurses. As a result of this shift in the provider of care, there were no gains in widely-used metrics of infant health, including birth weight, gestation and infant mortality. These findings suggest that physicians and nurses may be good substitutes in terms of neonatal health.

Este estudo analisa uma política que ampliou substancialmente a oferta de médicos de atenção primária no Brasil. O programa está associado a um aumento significativo de consultas médicas em todas as faixas etárias e `a maior utilização de médicos como fonte de assistência pré-natal. No entanto, esse aumento no uso de médicos foi acompanhado por reduções significativas no número de consultas pré-natais fornecidas por enfermeiras. Como resultado dessa mudança no provedor da atenção, não houve ganhos em métricas amplamente utilizadas de saúde infantil, incluindo peso ao nascer, gestação e mortalidade infantil. Esses resultados sugerem que médicos e enfermeiras podem ser bons substitutos em termos de saúde neonatal.

Creating a preference for prevention: the role of universal health care in the demand for preventive care among Mexico's vulnerable populations.

The introduction of Seguro Popular (SP)- providing health insurance to over 50 million Mexicans since the early 2000s-represents a large shift in health care delivery to the Mexican population. And yet, its impact on Mexico's marginalized communities has been little studied, and its impact on health is unclear. Using a survey of poor urban Mexicans and Mexican Ministry of Health administrative data, this article investigates SP's effect on those at the most risk for health disparities by looking at the impact of the programme on demand for preventive care services, especially among women, children and the indigenous. Three outcomes important to Mexico's burden of disease are explored: general physical exams, diabetes screening, and cervical cancer screening. Ordinary least square regressions show that the introduction of SP is associated with an increase in demand for all three services, but these results are likely biased due to selection into the programme. I then use the staggered geographic roll out of SP between 2004 and 2007 to identify the causal impact of the programme on demand. I use length of exposure to SP as an instrumental variable to predict SP affiliation in 2009. Two stage least squares estimates of the causal impact of SP on demand for preventive care services finds that SP affiliation increases adult demand for physicals, but does not affect demand for diabetes screening. Additionally, I find that female and child SP affiliates are less likely to demand physicals, while affiliates who identify as indigenous are less likely to demand physicals but more likely to demand cervical cancer screenings.

Assessing the impact of the mais médicos program on basic health care indicators

The Mais Médico Program was launched by the federal government in 2013 with the main objective of reducing the shortage of physicians in regions of socioeconomic vulnerability in Brazil. Since then, the program has been attracting interest in evaluating its effectiveness on the localities adhered. This paper aims to measure the effects generated by the “Mais Médicos” Program on health indicators of Brazilian municipalities from an econometric approach of policy evaluation. Using a difference-in-differences methodology, the effects on indicators of basic health care, morbidity and mortality were analyzed from the Program data between 2013 and 2015. There are evidences that the “Mais Médicos” Program has positive effects on the primary healthcare indicators, particularly on appointments, consultations, referrals, examinations, and home visits, and negative effects over some indicators of morbidity. However, the Program does not seem to have been able to reduce mortality in the municipalities.

Avaliação da Política Nacional de Atenção Domiciliar no estado de Pernambuco: tempo médio de permanência por paciente/dia na rede de urgência e emergência / Evaluation of the National Policy of Home Care in the state of Pernambuco: average length of stay per patient / day in the urgency and emergency

As mais remotas referências em medicina já descreviam cuidados domiciliares. A utilização do domicílio como espaço de cuidado à saúde expandiu-se mundialmente nas últimas décadas. Essa tendência verificada em vários países do mundo foi motivada pela necessidade de racionalizar a utilização dos leitos hospitalares, devido a problemas relativos à ineficiência, ineficácia e ao aumento crescente da demanda em cuidados de saúde, acompanhando das mudanças demográficas e epidemiológicas. Nesta perspectiva, este estudo propõe avaliar a Política Nacional de Atenção Domiciliar no tocante ao tempo médio de permanência por paciente/dia na rede de urgência e emergência em Pernambuco entre os anos de 2013 a 2016. O período estabelecido na pesquisa justifica-se pelo fato dos anos incidirem com a publicação da Portaria do Ministério da Saúde nº 963 em 2013 que "Redefine a Atenção Domiciliar no âmbito do Sistema Único de Saúde (SUS)", e a publicação da Portaria Ministério da Saúde n° 825 em 2016 que também "Redefine a Atenção Domiciliar no âmbito do Sistema Único de Saúde (SUS) e atualiza as equipes habilitadas". Para este estudo considerou-se para a amostra: 1. Municípios com números de habitantes acima de 20 mil, correlacionando com os que possuem serviços de atenção domiciliar habilitados; 2. Municípios com, pelo menos, uma equipe implantada de atenção domiciliar tipo 2 e tipo 3; 3. Municípios com 50% do teto de implantação de equipes de serviço de atenção domiciliar; 4. Tempo de implantação igual ou superior a 12 meses; como covariável dependente o tempo médio de permanência por paciente/dia. Entendendo, que esse tempo médio de permanência está relacionado ao tempo que o paciente permanece aguardando leito de internação, ligado diretamente a eficiência da rede de atenção de urgência em racionalizar os leitos existentes na rede. Como método de estudo escolheu-se o Controle Sintético, que propõe a construção de uma contrafactual, com o objetivo de determinar os efeitos causados pelo programa na capacidade de aliviar a porta de urgência, relacionada ao tempo médio de permanência. A análise por este método se deu por ser um método aplicado em estudos com amostras reduzidas e com apenas uma ou poucas unidades tratadas. Tratasse, exatamente, do caso do nosso estudo, no qual temos apenas 15 municípios tratados e 47 serviços de atenção domiciliar implantados no estado. Os resultados obtidos com o estudo demonstrou que Política Nacional de Atenção domiciliar, ainda é um processo em construção no estado, contudo aponta a potencialidade da política como uma 'porta saída' qualificada frente ao cenário caótico da rede de urgência do estado, no tocante a racionalização de leitos.

The most remote references in medicine already described home care. The utilization as a space for health care has expanded worldwide in recent years. decades. This trend in many countries around the world was motivated by the need rationalize the use of hospital beds due to problems related to inefficiency, inefficiency and increasing demand for health care, demographic and epidemiological changes. In this perspective, this study proposes to evaluate the National Home Care Policy regarding the average length of stay for patient / day in the urgency and emergency network in Pernambuco between 2013 and 2016. The period established in the research is justified by the fact that the years focus on the publication Ministry of Health Ordinance No. 963 in 2013 that "Redefines Home Care in Health System (SUS) ", and the publication of the Ministry of Health 825 in 2016 which also "Redefines Home Care within the Unified Health System Health (SUS) and updates the qualified teams ". For this study we considered for the sample: 1. Municipalities with numbers of inhabitants above 20 thousand, correlating with the who have qualified home care services; 2. Municipalities with at least one implemented type 2 and type 3 home care team; 3. Municipalities with 50% of the ceiling of implementation of home care service teams; 4. Deployment time equal to or over 12 months; as covariate dependent the average length of stay per patient / day.

The remotest references in medicine already described home-based care. The use of the home as a space for health care has expanded worldwide in the last decades. This tendency in several countries around the world was motivated by the need to rationalize the use of hospital beds, due to problems related to inefficiency, ineffective, and increasing demand in health care, along with demographic and epidemiological changes. In this perspective, this study proposes to evaluate the National Home Care Policy regarding the average length of stay per patient / day in the emergency and urgency network in Pernambuco between 2013 and 2016. The period established in the research is justified by the fact of the years with the publication of the Ministry of Health Ordinance No. 963 in 2013, which "Redefines Home Care under the Unified Health System ", and the publication of Ministry of Health Ordinance No. 825 in 2016 which also " Redefines Home Care within the Unified Health System and updates the teams authorized ". For this study, we considered for the sample: 1. Counties with a population of more than 20 thousand, correlating with those who have able care services; 2. Counties with at least one implanted type of home care type two and type three; 3. Counties with 50% of the ceiling for the implementation of home care service teams; 4. Time of implantation of 12 months or more; as covariate dependent the mean residence time per patient / day. Understanding, that this average time of permanence is related to the time that the patient remains waiting for bed of hospitalization, directly linked to the efficiency of the emergency care network in rationalizing the existing beds in the network. As a method of study we chose Synthetic Control, which proposes the construction of a counterfactual, in order to determine the effects caused by the program on the ability to relieve the emergency door, related to the average time of permanence. The analysis by this method was given as a method applied in studies with reduced samples and with only one or a few treated units. It was exactly the case of our study, in which we have only 15 treated municipalities and 47 home care services implanted in the state. The results obtained from the study demonstrated that the National Policy on Home Care is still a process under construction in the state, but points out the potential of the policy as a qualified 'exit door' in the chaotic scenario of the emergency network of the state, regarding rationalization of beds.