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Reducing Inequities in Neonatal Mortality through Adequate Supply of Health Workers: Evidence from Newborn Health in Brazil

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  • Angelica Sousa
  • Mario R Dal Poz
  • Cynthia Boschi-Pinto

Abstract

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. Methods: With 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. Results: We 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. Discussion: In 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.

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  • Angelica Sousa & Mario R Dal Poz & Cynthia Boschi-Pinto, 2013. "Reducing Inequities in Neonatal Mortality through Adequate Supply of Health Workers: Evidence from Newborn Health in Brazil," PLOS ONE, Public Library of Science, vol. 8(9), pages 1-7, September.
    • Handle: RePEc:plo:pone00:0074772
    DOI: 10.1371/journal.pone.0074772
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    1. World Bank, 2008. "World Development Indicators 2008," World Bank Publications - Books, The World Bank Group, number 11855, December.
    2. World Bank, 2012. "World Development Indicators 2012," World Bank Publications - Books, The World Bank Group, number 6014, December.
    3. Barros, F.C. & Matijasevích, A. & Requejo, J.H. & Giugliani, E. & Maranhão, A.G. & Monteiro, C.A. & Barros, A.J.D. & Bustreo, F. & Merialdi, M. & Victora, C.G., 2010. "Recent trends in maternal, newborn, and child health in brazil: Progress toward millennium development goals 4 and 5," American Journal of Public Health, American Public Health Association, vol. 100(10), pages 1877-1889.
    4. Farahani, Mansour & Subramanian, S.V. & Canning, David, 2009. "The effect of changes in health sector resources on infant mortality in the short-run and the long-run: A longitudinal econometric analysis," Social Science & Medicine, Elsevier, vol. 68(11), pages 1918-1925, June.
    5. Matijasevich, A. & Victora, C.G. & Barros, A.J.D. & Santos, I.S. & Marco, P.L. & Albernaz, E.P. & Barros, F.C., 2008. "Widening ethnic disparities in infant mortality in southern Brazil: Comparison of 3 birth cohorts," American Journal of Public Health, American Public Health Association, vol. 98(4), pages 692-698.
    6. Angelica Sousa & Mario R Dal Poz & Cristiana Leite Carvalho, 2012. "Monitoring Inequalities in the Health Workforce: The Case Study of Brazil 1991–2005," PLOS ONE, Public Library of Science, vol. 7(3), pages 1-7, March.
    7. World Bank, 2008. "World Development Indicators 2008," World Bank Publications - Books, The World Bank Group, number 28241, December.
    8. Mikkel Zahle Oestergaard & Mie Inoue & Sachiyo Yoshida & Wahyu Retno Mahanani & Fiona M Gore & Simon Cousens & Joy E Lawn & Colin Douglas Mathers & on behalf of the United Nations Inter-agency Group f, 2011. "Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities," PLOS Medicine, Public Library of Science, vol. 8(8), pages 1-13, August.
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    Cited by:

    1. Letícia Xander Russo & Anthony Scott & Peter Sivey & Joilson Dias, 2019. "Primary care physicians and infant mortality: Evidence from Brazil," PLOS ONE, Public Library of Science, vol. 14(5), pages 1-16, May.
    2. Jinlin Liu & Bin Zhu & Ning Zhang & Rongxin He & Ying Mao, 2019. "Are Medical Graduates’ Job Choices for Rural Practice Consistent with their Initial Intentions? A Cross-Sectional Survey in Western China," IJERPH, MDPI, vol. 16(18), pages 1-15, September.

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