Investment In Health Care Research Articles

Balancing Investments in Health Care and Social Determinants—The Need for Benefit-Cost Analysis

This JAMA Forum discusses how to balance investments in health care and social determinants of health, using benefit-cost analysis and other methods to rationally balance investments across sectors.

Ensuring leadership at the operational level of a health system in protracted crisis context: a cross-sectional qualitative study covering 8 health districts in Eastern Democratic Republic of Congo

BackgroundThis study examines how leadership is provided at the operational level of a health system in a protracted crisis context. Despite advances in medical science and technology, health systems in low- and middle-income countries struggle to deliver quality care to all their citizens. The role of leadership in fostering resilience and positive transformation of a health system is established. However, there is little literature on this issue in Democratic Republic of the Congo (DRC). This study describes leadership as experienced and perceived by health managers in crisis affected health districts in Eastern DRC.MethodsA qualitative cross-sectional study was conducted in eight rural health districts (corresponding to health zones, in DRC’s health system organization), in 2021. Data were collected through in-depth interviews and non-participatory observations. Participants were key health actors in each district. The study deductively explored six themes related to leadership, using an adapted version of the Leadership Framework conceptual approach to leadership from the United Kingdom National Health Service’s Leadership Academy. From these themes, a secondary analysis extracted emerging subthemes.ResultsThe study has revealed deficiencies regarding management and organization of the health zones, internal collaboration within their management teams as well as collaboration between these teams and the health zone’s external partners. Communication and clinical and managerial capacities were identified as key factors to be strengthened in improving leadership within the districts. The findings have also highlighted the detrimental influence of vertical interventions from external partners and hierarchical supervisors in health zones on planning, human resource management and decision-making autonomy of district leaders, weakening their leadership.ConclusionsDespite their decentralized basic operating structure, which has withstood decades of crisis and insufficient government investment in healthcare, the districts still struggle to assert their leadership and autonomy. The authors suggest greater support for personal and professional development of the health workforce, coupled with increased government investment, to further strengthen health system capacities in these settings.

Provision of health care services related to substance use disorder in southern U.S. jails

IntroductionThe U.S. jail population has more than tripled since the 1980s, and today, one out of every three incarcerated individuals is being held in a county or city jail. Substance use disorders (SUD) are overrepresented in incarcerated populations; however, little recent research has examined the availability and quality of SUD-related health care services in jail settings. Incarcerated individuals may engage with a variety of SUD-related health care services, including: screening and withdrawal management at entry, SUD treatment or other brief health care interventions while they are being held, and overdose prevention education and reentry planning at release. MethodsWe conducted a thematic analysis of qualitative data from 34 interviews conducted with 38 personnel from a purposive sample of jails that varied in size and rurality within a five-state study area. The goals of the analyses were to: 1) describe jail health care services for SUD and barriers to service provision, 2) compare current practices to best practice recommendations, and 3) provide context by describing factors at the jail and community level that influence service provision, such as access to resources. ResultsInterviewees described wide variability in both availability and comprehensiveness of SUD-related health care services. Most adhered to federal guidance for supervising withdrawal from alcohol and benzodiazepines, but not opioids. Medication for addiction treatment was most widely available for pregnant women and rarely for other individuals. Roughly one third of the jails in our sample provided behavioral group or individual therapy with a licensed counselor and roughly one quarter offered self-help groups. Very few jails provided comprehensive re-entry planning and support. Jail staff reported specific barriers to providing each type of service, as well as limiting contextual factors. Despite observed increases in case volume, jail health care staff did not necessarily receive any additional funding or staff members. Overall, lack of investment in mental and behavioral health care contributed to recidivism and feelings of hopelessness among staff. ConclusionsThis study identified several areas where jails could improve SUD-related health care services. Many of the barriers to improvement—organizational buy-in, cost/budgeting, staffing, logistics—were not under the control of health care staff. Implementing changes will require support from local governments, jails administrators, private health care companies, and other local health care providers.

Does bribery increase maternal mortality? Evidence from 135 Sub-Saharan African regions.

About 295,000 women died globally during and following pregnancy and childbirth in 2017. Two-thirds of these deaths occurred in Sub-Saharan Africa. By linking individual and regional data from 135 regions in 17 Sub-Saharan African countries over the period 2002-2018 this study explores how bribery affects maternal mortality in Sub-Saharan Africa. Our results show that the percentage of people who had first-hand experience in bribery is significantly and positively associated with pregnancy related deaths. We find that a 10 p.p. increase in the prevalence of bribery is associated with up to 41 [95% CI: 10-73] additional deaths for every 1,000 pregnancy-related deaths. However, the healthcare system quality appears to be an important moderator. To reduce maternal mortality, policy makers should not only increase investments in healthcare, they need also to implement measures to combat corruption.

Muslim Communities’ Healthcare Needs and Barriers

Despite being nearly a quarter of the population, Muslim communities’ unique healthcare needs are largely unmet. In this literature review, we highlight the largely unsatisfied and growing healthcare needs of Muslims by examining the unique illnesses that Muslims are commonly susceptible to because of their religious or socioeconomic conditions. We examine their vulnerability to diabetes, vitamin D deficiency, and vaccine-preventable illnesses. We also analyze the numerous healthcare barriers present in developing, Muslim-majority countries and in developed countries in the West. Drawing from published studies, we emphasize the importance of government investment in healthcare and cultural awareness in health workers to address barriers and ensure Muslims’ equitable access to care. We explore the complexities of healthcare access and delivery for Muslims, particularly in contexts where religious practices intersect with medical requirements. We also highlight gaps in current research, urging further investigation into unexplored areas such as broad, global studies and the involvement of religious leaders in Muslim communities.

Chinas Population Aging: Economic Problems, Solutions and Prospect

China's aging population, primarily driven by the family planning policy, increasing life expectancy, and declining fertility rates, poses significant economic challenges for the nation. This paper investigates the implications of this demographic shift on the labor force and productivity, retirement, pension and healthcare systems, and savings and investment behaviors, and provides policy recommendations to address these challenges. The research demonstrates that a shrinking labor force may lead to reduced productivity and wages, impacting the overall economy and China's competitiveness in the global market. However, technological advancements and automation may help mitigate these challenges. In terms of retirement, pension, and healthcare systems, the aging population places considerable pressure on their sustainability. Policy changes, such as delaying retirement age, reforming the pension system, and investing in healthcare infrastructure, may help alleviate these pressures. Regarding savings and investment behaviors, the paper highlights the differences between older and younger individuals, with potential implications for the financial market's stability and growth. The significance of this research lies in its comprehensive analysis of the economic challenges posed by China's aging population and its innovative suggestions for policy changes to address these issues. Key policy recommendations include encouraging technology adoption and innovation, implementing pension system reforms, gradually increasing the retirement age, investing in healthcare infrastructure and professional training, and developing financial products and services tailored to the aging population's needs. These proactive policy changes and adaptations can help China successfully navigate the demographic shift, ensuring continued economic growth and stability for its citizens.

Female Leadership during COVID-19: The Effectiveness of Diverse Approaches towards Mitigation Management during a Pandemic.

This paper tackles the question of how female leaders at national levels of government managed COVID-19 response and recovery from the first COVID-19 case in their respective countries through to 30 September 2021. The aim of this study was to determine which COVID-19 mitigations were effective in lowering the viral reproduction rate and number of new cases (per million) in each of the fourteen female presidents' countries-Bangladesh, Barbados, Belgium, Bolivia, Denmark, Estonia, Finland, Germany, Iceland, Lithuania, New Zealand, Norway, Serbia, and Taiwan. We first compared these countries by finding a mean case rate (29,420 per million), mean death rate (294 per million), and mean excess mortality rate (+1640 per million). We then analyzed the following mitigation measures per country: school closing, workplace closing, canceling public events, restrictions on gatherings, closing public transport, stay-at-home requirements, restrictions on internal movement, international travel controls, income support, debt/contract relief, fiscal measures, international support, public information campaigns, testing policy, contact tracing, emergency investment in healthcare, investment in vaccines, facial coverings, vaccination policy, and protection of the elderly. We utilized the random forest approach to examine the predictive significance of these variables, providing more interpretability. Subsequently, we then applied the Wilcoxon rank-sum statistical test to see the differences with and without mitigation in effect for the variables that were found to be significant by the random forest model. We observed that different mitigation strategies varied in their effectiveness. Notably, restrictions on internal movement and the closure of public transportation proved to be highly effective in reducing the spread of COVID-19. Embracing qualities such as community-based, empathetic, and personable leadership can foster greater trust among citizens, ensuring continued adherence to governmental policies like mask mandates and stay-at-home orders, ultimately enhancing long-term crisis management.

The golden rule for prioritisation of treatment for substance use and mental health care – a qualitative study

For many years there has been broad political agreement on prioritising substance use treatment and mental health care in the specialist health service. Between 2014 and 2021, the 'golden rule' applied, meaning that there should be higher relative growth in mental health care and interdisciplinary specialised substance use treatment compared to somatic healthcare services. This study aimed to investigate the understanding among Norwegian health leaders and bureaucrats of the golden rule's role in the prioritisation of resources to the field of substance use and psychiatry in the specialist health service. The study is based on a one-year ethnographic study of priority-setting in Norwegian health trusts and bureaucracy. Documents, observations of meetings and twelve qualitative in-depth interviews were analysed using a qualitative discourse method. The golden rule contributed to an increased investment in substance use treatment and mental health care in the health trusts, according to health leaders. However, the golden rule was only one of many competing and at times conflicting guidelines they had to take into account. Many factors impeded higher growth in substance use treatment and mental health care compared to somatic health care. Several participants argued that it was impossible to follow the golden rule. The inability to achieve the goal was explained by demographic trends, funding arrangements and lack of follow-up of the rule. Healthcare priorities are set in institutions that have to consider numerous political interests and social mandates. The study's findings illustrate the complexity of practical implementation of political priorities.

Utilization of Proximate Healthcare Facilities and Children’s Wait Times in Senegal: An IV-Tobit Analysis

Universal health coverage (UHC) defines individuals’ timely access to healthcare services without suffering any health-related financial constraints. The Senegalese government has shown commitments towards achievement of UHC as a way of improving access by the population to quality healthcare services. This is very pertinent for promoting some indicators of under-five health in Senegal. Therefore, this study analyzed the factors influencing sick children’s utilization of the nearest healthcare facilities and their wait times in Senegal. The data were from the Service Provision Assessment (SPA) survey, which was conducted in 2018. The instrumental Tobit regression model was used for data analysis. The results showed that 63.50% and 86.01% of the children utilized health posts and publicly owned facilities, respectively. Also, 98.46% of the children utilized urban facilities. The nearest facilities were utilized by 74.55%, and 78.19% spent less than an hour in the facilities. The likelihood of using the nearest healthcare facilities significantly reduced (p < 0.05) with caregivers’ primary education, higher education, residence in some regions (Fatick, Kaokack, Saint Louis, Sediou, and Tambacounda), and use of private/NGO not-for-profit facilities, but increased with not having visited any other providers, residence in the Kaffrie region, vomiting symptoms, use of health centers, and use of health posts. Moreover, treatment wait times significantly increased (p < 0.05) with the use of nearest facilities, residence in some regions (Diourbel, Kaokack, Matam and Saint Louis), use of private for-profit facilities, use of private not-for-profit facilities, and urban residence, but decreased with secondary education, use of health centers, use of health posts, vomiting symptoms, and showing other symptoms. It was concluded that reduction in wait times and utilization of the nearest healthcare facilities are fundamental to achieving UHC in Senegal. Therefore, more efforts should be integrated at promoting regional and sectoral equities through facilitated public and private healthcare investment.

A Convolutional Neural Network Model to Detect Stress Levels in Electroencephalogram Signals

Chronic stress is recognized as a major contributing factor to the impairment of people's health and quality of life due to the negative impacts it causes both in personal and professional life. There is a tendency for the increasing of concerns about mental health and investments in healthcare in the coming years and this fact has motivated the conduction of several studies that aim to develop technological solutions that can be applied for monitoring of people's mental state to early detection and treatment of stress. Machine Learning and Deep Learning techniques have proven to be a promising alternative to provide technology to help solve the challenges in the medical field. This study presents a Convolutional Neural Network (CNN) model for classifying stress levels in data from electroencephalogram signals. The model was trained with a dataset generated from an experiment in which individuals were monitored by electroencephalogram while performing stress-inducing tasks. The model achieved an accuracy rate of 98.95% in predictions and presented an adequate balance between performance and computational costs. The results obtained demonstrate the potential of Deep Learning techniques as tools to aid in the health monitoring and diagnosis. Key Words: machine learning, deep learning, mental stress, electroencephalogram

Delivering a net zero National Health Service: where does otorhinolaryngology - head and neck surgery stand?

The National Health Service (NHS) recognised the risk to public health brought by climate change by launching the Greener NHS National Programme in 2020. These organisational changes aim to attain net zero direct carbon emissions. This article reviews the literature on initiatives aimed at mitigating the environmental impact of ENT practice. Systematic review of the literature using scientific, healthcare and general interest (public domain) databases. The initiatives reviewed can be broken down into strategies for mitigating the carbon footprint of long patient stay, use of operative theatres and healthcare travel. The carbon footprint of in-patient stay can be mitigated by a shift towards day-case surgery. The ENT community is currently focused on the reduction of theatre waste and the use of disposable instruments. Furthermore, supply chains and healthcare delivery models are being redesigned to reduce travel. Future areas of development include designing waterless theatre scrubs, waste-trapping technologies for anaesthetic gases and a continuing investment in virtual healthcare.

Healthcare employment landscape: comparing job markets for professionals in developed and developing countries

PurposeThis literature review aims to assess the current research on healthcare job availability and skilled professionals. The objective of this research is to identify challenges caused by the imbalance between healthcare service demand and qualified professionals and propose potential solutions and future research directions.Design/methodology/approachThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was employed as the guiding framework for conducting this review. A qualitative research design analyzed 38 peer-reviewed, evidence-based research works from 50 journal publications. Inclusion criteria focused on empirical studies, observational research and comprehensive reviews published within the last ten years. Thematic and discourse analysis categorized themes and factors explored in selected publications.FindingsThe findings highlight significant challenges in the healthcare sector regarding job availability and skilled professionals. Developed countries face understaffed healthcare facilities, resulting in increased workloads and compromised care. Developing countries experience high rates of unemployment among healthcare graduates due to limited resources and mentorship.Practical implicationsImproving educational infrastructure, expanding training opportunities and increasing healthcare investments are crucial for nurturing a skilled workforce. Implementing effective retention policies, fostering international collaborations and addressing socioeconomic determinants can create a sustainable job market.Originality/valueThe healthcare sector faces critical challenges in balancing job availability and skilled professionals. Strategic solutions are proposed to create a sustainable and equitable healthcare workforce. By implementing recommendations and conducting further research, access to quality healthcare and global public health outcomes can be improved.

Assessment and Analysis of the Complexities in Sustainability of the Transport Projects Under CPEC: A Grounded Theory Approach

This study proposes a modern research framework for establishing a grounded theory perspective on regional development initiatives along the China-Pakistan Economic Corridor (CPEC). Grounded theory is a well-known research approach that uses comparative analysis to generate hypotheses from analyzed data. Thematic event analysis exposes the transitions between domains throughout CPEC project design and execution, including political, economic, social, technical, legal, and environmental elements. The Orange Line Metro Train (OLMT) project’s axial coding highlights contextual variables such as problematic agreements, circumvention of regulations, lack of preparation, public indignation, heritage demolition, tree cutting, and regional tensions. These elements, coupled with China-Pakistan relations, the CPEC framework, infrastructural conditions, and other considerations, impact top-down planning, bureaucratic difficulties, and mismanagement of government plans. Consequently, these techniques cause project delays, unsustainable subsidies, historical damage, and environmental implications, raising questions about accountability and political regime change. This chapter focuses on data collection by using the Grounded Theory Method. These ramifications go beyond the CPEC project, emphasizing the significance of consulting key parties and selecting projects based on scientific and technological criteria. Institutional strengthening, climate change policies, and a focus on sustainable development are all critical. Policy consequences include open and accountable resource allocation, enhanced planning and risk assessment, cost-cutting techniques, cultural heritage preservation, specialized courts, and investment in education and healthcare. It is also critical to strengthen democratic institutions and reduce the environmental dangers.

Environmental and Health Impacts of Crude Oil Exploration in the Niger Delta

Purpose: This research aims to assess the environmental and health consequences of crude oil exploration in the Niger Delta, focusing on the emission of greenhouse gases and air pollutants and their impacts on public health. Methodology: Literature search was done independently by the authors. After searching for articles on the identified databases, other sources of available and useful data on the subject such as the print press, student’s thesis and dissertation among others were sourced by hand search to augmented resources from the electronic databases.The Literature search was based on the careful evaluation of key words in the title and abstract of identified studies. Findings: The synthesis of available literature revealed significant insights into the environmental and health repercussions of crude oil exploration in the Niger Delta. The impact of gas flaring emerged as a major concern, leading to the release of pollutants like carbon dioxide, methane, and volatile organic compounds. These emissions contribute to elevated atmospheric temperatures, greenhouse gas concentrations, and the formation of acid rain, exacerbating global warming and disease transmission. The exposed population experiences a range of health problems including chronic respiratory diseases, cardiovascular abnormalities, altered blood parameters, and an increased risk of non-communicable diseases such as hypertension and diabetes. Prolonged exposure to pollutants from oil exploration is linked to disrupted sleep patterns, elevated stress levels, and neurophysiological disturbances, further contributing to adverse health outcomes. Unique contribution to theory, practice, and policy: This study advances existing knowledge by providing a comprehensive analysis of the multifaceted interplay between crude oil exploration, environmental degradation, and human health in the Niger Delta region. The research offers a substantial contribution to theoretical understanding by illuminating the intricate relationship between anthropogenic activities, environmental factors, and health outcomes. Moreover, the study provides practical implications by proposing a series of recommendations aimed at mitigating the negative impacts of oil exploration. These recommendations advocate for stricter regulations on emissions, increased monitoring and enforcement, adoption of cleaner technologies, community engagement, and investment in healthcare and environmental remediation. The findings inform policy formulation by supplying evidence-based insights to develop robust regulations and interventions that promote sustainable development, protect public health, and safeguard the environment for future generations.

Behavioral and Emotional Problems among School Children in Tripoli, Libya: What Impact does it have on Community Public Health?

Objective: to detect the prevalence of mental health problems, including behavioral and emotional difficulties among school children (6-15 years) in Tripoli, Libya as observed by their parents and teachers. Methods: The study took place in Tripoli, Libya. Data was collected over three months period between January and March 2022 from parents and teachers. The Arabic version of Strengths and Difficulties Questionnaire (SDQ. Goodman 2002) were used. The sample size was 300 children aged between 6 and 15 years who were attending compulsory education. Four schools were randomly selected and then children were randomly sampled from each class. Parents were asked to hand over the questionnaire to their child’s teacher and collect them later. Data was analyzed to describe normative scores, bandings and cut-offs for normal, borderline and abnormal scores. Only public schools were included in the study. Results: When it came to the perception of teachers and parents, it was found that the response rate for parents and teachers were almost the same only 245 questionnaires were returned (134 male and 111 female) giving a response rate of 81.6%. out of these, 208, both the parents and teacher questionnaires were returned (84.8%),26 filled in only the parents' questionnaires (10.6%), and 11 returned only the teacher’s questionnaire (4.4%). TEACHERS rated their pupils consistently as showing difficulties in all areas with (23.0 %) of the children considered to be displaying abnormal behavior (Total Difficulties Score). The highest proportion of abnormal behavior was for peer relation (17.0%) and conduct problems (18.0%). PARENTS rated their children as having fewer problems than rated by teachers, but rates were still high with (15%) of the children receiving total difficulty scores in the abnormal band. The most problematic areas as assessed by parents were peer relations (29%) followed by emotion problems (22%). Conclusion: Parent SDQs revealed high rates of children with conduct, emotional and peer problems falling above the 90th centile established in the UK sample. Teachers SDQs revealed higher rates of children with conduct problems. Comparison with UK and Egypt data showed abnormal total difficulties score of 11.9% which is a bit higher than UK (10.1%) but lower than that of Egypt (20.6%). Much greater investment in child mental health care is needed. More efforts are needed to identify those children and decide what we can usefully do to help the many-not only the few. Keywords: Tripoli, Libya, behavioral problems, school children, SDQ, mental health

Analysis of the Impact of State-Owned Banks on the Sustainability of Public Finances

This paper aims to provide a retrospective assessment of Ukraine’s state policy concerning state-owned banks and evaluate their impact on the sustainability of Ukraine’s public finances. The research methodology employs an empirical study of the cash flow of public funds to state-owned banks and the reverse cash flow to determine the impact of the activity and stability of public finances. The cash flow to state-owned banks includes the expenditure of public funds for the creation of authorised capital during the establishment of state-owned banks, the acquisition of shares in operating commercial banks, additional capitalisation of state-owned banks, etc. The reverse cash flow comprises dividends paid based on the performance of state-owned banks, as well as revenue generated for public funds through the sale of shares (privatisation) of state-owned banks. This study highlights the costs associated with recapitalising state-owned banks. These costs disrupt the stability of public finances, create additional debt dependency for Ukraine, impose an additional burden on public finances, and lead to structural changes that reduce funding for social spending. As a result, Ukrainian taxpayers are financing the inefficient activities of state-owned banks while experiencing reduced investments in education, healthcare, social protection, environmental protection, and other essential areas.

Allocation of Healthcare Resources in National Health Systems Under Climate Change

Climate change has, among others, impacts on human health and by consequence on healthcare systems. Some impacts are direct such as extreme events, air pollution and aeroallergens, and some are indirect such as reduced food production and supply, vector-borne and water-borne infectious diseases, and social and economic disruptions. The main aim of this paper is to study the pressures of climate change on national healthcare systems. An empirical dynamic resource allocation problem is proposed to estimate how healthcare systems may be affected by climate change. The problem is formulated as a nonlinear programming model which finds the optimal allocation of healthcare resources that compensate for life expectancy reductions due to climate change. We examine various scenarios of climate impacts to estimate the additional budget and healthcare resources needed. The results show that the necessary healthcare budget grows nonlinearly with respect to impacts with disproportional demands on lower income countries. Finally, the necessary healthcare investments should be made sooner as climate impacts become heavier. Our methodology could aid policy-makers in prioritizing measures to enhance the climate resilience of national healthcare systems.

Investing in Human Capital for Green and Sustainable Development

Green and sustainable development is crucial for addressing environmental challenges and promoting a more sustainable future. Central to this endeavor is the investment in human capital, which involves developing and empowering individuals with the knowledge, skills, and mindset necessary to contribute and lead sustainable development efforts. Explores the importance of investing in human capital and the various ways in which it can be fostered to drive green and sustainable development. An analysis was made in the areas of investments in health care, education and environmental protection in order to develop a sustainable green development of the economy.

CT perfusion - an up-to-date element of the contemporary multimodal diagnostic approach to acute ischemic stroke.

Acute ischemic stroke is of great clinical and societal importance due to its high incidence and mortality rates, as well as the fact that those who are affected suffer from permanent acquired disability. Modern trends explicitly state that the disease's diagnostic plan should use a multidisciplinary approach. The therapeutic steps that ultimately determine the clinical outcome are defined by an accurate diagnosis of acute ischemic stroke. Highly specialized facilities for the diagnosis and treatment of acute ischemic stroke (Stroke Units) are in operation in countries that make significant investments in healthcare. Imaging the brain parenchyma at risk, or the so-called ischemic penumbra, in acute ischemic stroke is one of the main tasks of the multimodal computed tomography approach. The most rapid method for imaging the ischemic penumbra is computed tomography perfusion (CTP). This modality provides information about the anatomy and the physiologic state of the brain parenchyma.

Evaluation of the availability of secondary dental care within the Brazilian public health system: a cross-sectional study

To achieve the goal of comprehensive care provided between primary and secondary care, the interface must be without barriers. This cross-sectional study evaluated the availability of secondary dental care services in public health services in Brazil. This study focused on reference Dental Specialty Centers (DSCs) with 18,114 Oral Health Teams (OHTs) that adhered to the second cycle of the “National Program for Improving Access and Quality of Primary Care” (PMAQ-AB). Questions about the availability of DSCs for patient referrals by OHTs and the type of dental specialties provided by municipalities in DSCs were analyzed descriptively and compared per Brazilian macro-region. Seventy-five percent of OHTs reported the existence of DSCs for patient referral. The most available specialties at DSCs included minor oral surgery (90.1%), endodontics (82.0%), patients with special needs (81.5%), and periodontics (80.5%). The OHTs presented a mean of 5.77 (±2.08) referable specialties. OHTs from the South and Southeast regions reported the availability of more specialized consultations. The most available specialties in all regions included minor oral surgery, endodontics, patients with special needs, and periodontics. The best results were found in the Southeast, followed by the Northeast and South regions. Brazilian public oral health shows a structure of secondary oral health care, however, a difference was observed among the OHTs, especially as regards the frequency and availability of specialties. More investments in public oral health care in Brazil are required to improve the availability of secondary dental care in regions with lower economic development.