Health Affairs

Health Affairs, 28, no. 4 (2009): 1127-1135 doi: 10.1377/hlthaff.28.4.1127 © 2009 by Project HOPE	New Online   Getting Health Reform Done   After the State of the Union   Incremental Reform   E-Health in Developing World   Most-Read Articles in 2009

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Brazil

The Health Effects Of Decentralizing Primary Care In Brazil

Frederico C. Guanais and James Macinko

A renewed focus on primary health care could lead to improved health outcomes in developing countries. Moving more control to local authorities, or decentralization, is one approach to expanding primary care’s reach. Proponents argue that it increases responsiveness to local needs and helps local resources reach those in need. Critics argue that it might increase fragmentation and disparities and provide opportunities for local economic and political gains that do not improve population health. We explore questions surrounding decentralization using the example of infant mortality in Brazil. Our study of two programs identified positive effects on health outcomes in the context of infant mortality.

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