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Delivering maternal and childcare at primary healthcare level: The role of PMAQ as a pay for performance strategy in Brazil

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  • Olívia Lucena de Medeiros
  • Jorge Otávio Maia Barreto
  • Matthew Harris
  • Letícia Xander Russo
  • Everton Nunes da Silva

Abstract

Background: Improving access and quality in health care is a pressing issue worldwide and pay for performance (P4P) strategies have emerged as an alternative to enhance structure, process and outcomes in health. In 2011, Brazil adopted its first P4P scheme at national level, the National Programme for Improving Primary Care Access and Quality (PMAQ). The contribution of PMAQ in achieving the Sustainable Development Goals related to maternal and childcare remains under investigated in Brazil. Objective: To estimate the association of PMAQ with the provision of maternal and childcare in Brazil, controlling for socioeconomic, geographic and family health team characteristics. Method: We used cross-sectional quantile regression (QR) models for two periods, corresponding to 33,368 Family Health Teams (FHTs) in the first cycle and 39,211 FHTs in the second cycle of PMAQ. FHTs were analysed using data from the Brazilian Ministry of Health (SIAB and CNES) and the Brazilian Institute for Geography and Statistics (IBGE). Results: The average number of antenatal consultations per month were positively associated with PMAQ participating teams, with larger effect in the lower tail (10th and 25th quantiles) of the conditional distribution of the response variable. There was a positive association between PMAQ and the average number of consultations under 2 years old per month in the 10th and 25th quantiles, but a negative association in the upper tail (75th and 90th quantiles). For the average number of physician consultations for children under 1 year old per month, PMAQ participating teams were positively associated with the response variable in the lower tail, but different from the previous models, there is no clear evidence that the second cycle gives larger coefficients compared with first cycle. Conclusion: PMAQ has contributed to increase the provision of care to pregnant women and children under 2 years at primary healthcare level. Teams with lower average number of antenatal or child consultations benefited the most by participating in PMAQ, which suggests that PMAQ might motivate worse performing health providers to catch up.

Suggested Citation

  • Olívia Lucena de Medeiros & Jorge Otávio Maia Barreto & Matthew Harris & Letícia Xander Russo & Everton Nunes da Silva, 2020. "Delivering maternal and childcare at primary healthcare level: The role of PMAQ as a pay for performance strategy in Brazil," PLOS ONE, Public Library of Science, vol. 15(10), pages 1-18, October.
    • Handle: RePEc:plo:pone00:0240631
    DOI: 10.1371/journal.pone.0240631
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    References listed on IDEAS

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    2. Davide Rasella & Sanjay Basu & Thomas Hone & Romulo Paes-Sousa & Carlos Octávio Ocké-Reis & Christopher Millett, 2018. "Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study," PLOS Medicine, Public Library of Science, vol. 15(5), pages 1-20, May.
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    1. Chen, Taoshan, 2023. "How does Monitoring and Evaluation Affect Racial Health Inequality? Evidence from PMAQ Program in Brazil," Warwick-Monash Economics Student Papers 51, Warwick Monash Economics Student Papers.
    2. Dantas Gurgel, Garibaldi & Kristensen, Søren Rud & da Silva, Everton Nunes & Gomes, Luciano Bezerra & Barreto, Jorge Otávio Maia & Kovacs, Roxanne J & Sampaio, Juliana & Bezerra, Adriana Falangola Ben, 2023. "Pay-for-performance for primary health care in Brazil: A comparison with England's Quality Outcomes Framework and lessons for the future," Health Policy, Elsevier, vol. 128(C), pages 62-68.

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