Decreasing Productivity in the Primary Healthcare: A Study of the Brazilian Case

Abstract

ABSTRACT: In 2015, the United Nations (UN) proposed the 2030 Agenda, a resolution that outlines the global goals for sustainable development. This report focuses on promoting health and well-being, emphasizing the importance of primary healthcare (PHC). However, Brazil faces challenges in managing its healthcare system, exacerbated by fiscal policy changes that have reduced public sector expenditures after 2015. This study was motivated by these recent changes in Brazil’s fiscal policy. We evaluated potential fluctuations in total factor productivity (TFP) in 5,524 Brazilian municipalities’ primary healthcare from 2015 to 2019. TFP, a measure of efficiency and production technology in PHC, was computed using the bootstrapping Malmquist productivity index (MPI) derived from the Data Envelopment Analysis (DEA) algorithm. This study focused on the economic recession and austerity measures initiated in 2015. Moreover, it’s essential to highlight that the SARS-CoV-2 pandemic in Brazil in 2020 brought significant changes to the country’s economic, social, and health dynamics. Therefore, this research intentionally concentrated on the pre-pandemic period. Our results revealed that TFP in the PHC sector in Brazil decreased between 2015 and 2019. It was possible to note that three out of every four Brazilian municipalities experienced either stagnation or a decline in the TFP of primary healthcare, with more pronounced challenges in the Midwest and Northeast regions. Looking at the TFP elements, we could see a continuous drop in technical efficiency everywhere in the country, markedly in the Midwest and Northeast. Conversely, there was a considerable uptick in Brazil’s technological component. These results implied that there might have been advancements in PHC’s technological infrastructure, preventing even less favorable outcomes in the TFP indicator. We concluded that the productivity of primary healthcare in Brazil declined when the 2015 fiscal ceiling was implemented. This decrease in performance was evident in the sluggish growth rate of primary healthcare inputs, a diminution in vaccination coverage indicators, and an increase in hospitalizations for preventable causes. Given that health is a crucial component of social well-being, it is vital to highlight the need for comprehensive efforts to guarantee the effective operation and advancement of primary healthcare services, even during economic downturns.