Reducing inequities in neonatal mortality through adequate supply of health workers: evidence from newborn health in Brazil.

Angelica Sousa,Cynthia Boschi-Pinto,Mario R Dal Poz,Lawrence Kazembe

doi:10.1371/journal.pone.0074772

Angelica Sousa, Cynthia Boschi-Pinto + Show 2 more

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https://doi.org/10.1371/journal.pone.0074772

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Abstract

IntroductionProgress towards the MDG targets on maternal and child mortality is hindered worldwide by large differentials between poor and rich populations. Using the case of Brazil, we investigate the extent to which policies and interventions seeking to increase the accessibility of health services among the poor have been effective in decreasing neonatal mortality.MethodsWith a panel data set for the 4,267 Minimum Comparable Areas (MCA) in Brazil in 1991 and 2000, we use a fixed effect regression model to evaluate the effect of the provision of physicians, nurse professionals, nurse associates and community health workers on neonatal mortality for poor and non-poor areas. We additionally forecasted the neonatal mortality rate in 2005.ResultsWe find that the provision of health workers is particularly important for neonatal mortality in poor areas. Physicians and especially nurse professionals have been essential in decreasing neonatal mortality: an increase of one nurse professional per 1000 population is associated with a 3.8% reduction in neonatal mortality while an increase of one physician per 1000 population is associated with a 2.3% reduction in neonatal mortality. We also find that nurse associates are less important for neonatal mortality (estimated reduction effect of 1.2% ) and that community health workers are not important particularly among the poor. Differences in the provision of health workers explain a large proportion of neonatal mortality.DiscussionIn this paper, we show new evidence to inform decision making on maternal and newborn health. Reductions in neonatal mortality in Brazil have been hampered by the unequal distribution of health workers between poor and non-poor areas. Thus, special attention to a more equitable health system is required to allocate the resources in order to improve the health of poor and ensure equitable access to health services to the entire population.

Highlights

Progress towards the Millennium Development Goals (MDGs) targets on maternal and child mortality is hindered worldwide by large differentials between poor and rich populations
In the first regression for all Minimum Comparable Areas (MCA) -Model 1, we found that, after controlling for municipalities’ socioeconomic characteristics, the densities of physicians, nurse professionals and nurse associates have an inverse effect on neonatal mortality and these effects are highly significant
Our analysis suggests that larger gains in neonatal mortality have been hindered by the large differentials in the availability of health workers between the poor and non-poor areas in Brazil

Summary

Introduction

Progress towards the MDG targets on maternal and child mortality is hindered worldwide by large differentials between poor and rich populations. Using the case of Brazil, we investigate the extent to which policies and interventions seeking to increase the accessibility of health services among the poor have been effective in decreasing neonatal mortality. Few of the 75 countries that account for more than 95% of all the maternal and child deaths globally are on track to attain the Millennium Development Goals (MDGs) on child and maternal mortality (MDGs 4 and 5) [1,2]. One of the contributing factors to this slower than anticipated progress has been the lack of access to priority maternal and child health interventions among the poor [3]. It is crucial that countries share experiences on policies and interventions that have been effective in decreasing neonatal mortality

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