Evaluating the Impact of Community-Based Health Interventions: Evidence from Brazil’s Family Health Program

South America

Brazil

Social Protection

Public health interventions

R Rocha; RR Soares

2010

Rocha, Romero, and Rodrigo R Soares. “Evaluating the Impact of Community-Based Health Interventions: Evidence from Brazil’s Family Health Program.” Health Economics 19.S1 (2010): 126–158.
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Secondary Data: Datasus/Brazilian Ministry of Health. Available at: https://www.sanarmed.com/artigos-cientificos/microdatasus-pacote-para-download-e-pre-processamento-de-microdados-do-departamento-de-informatica-do-sus-datasus.

2010

Family Health Program (‘Programa Saude da Familia,’ or PSF)

1995-2003 (range of dataset)

The objective of the program is to target the prevention and provision of basic health using professional healthcare teams directly intervening at the community level. The purpose of the paper is to assess the effectiveness of community-based health interventions as instruments for improvements in health conditions in less-developed areas and to evaluate whether health improvements associated with the program also brought changes in household behavior predicted by economic theory.

N.A.

The PSF is a project from the Brazilian Ministry of Health. Each team of medical specialists is responsible for a predetermined number of families located in a specific geographic area. The teams provide health counseling, prevention, orientation related to recovery, and advice for fighting frequent diseases and for overall health protection in the community. The supply of basic health care at the community level and the assignment of responsibility to the team of health professionals changed the traditional definition and form of healthcare provision in Brazil.

• Child labor (work during the previous week)
• School enrollment
• Others: employment of adults and fertility

Difference-in-differences

Study design: the unit of observation is a municipality at a point in time (treated municipalities are those that receive the PSF). The main approach is based on the difference-in-difference estimator. An important point is that the effect of the program may vary with time of exposure, both because of logistical considerations in the initial phases of implementation and because some of the health impacts may be felt only after some lag. The authors allow for heterogeneous effects of the PSF according to the number of years a municipality has spent in the program. State-specific time dummies are included in the regression to avoid endogeneity and several controls are included to consider omitted variable bias.
Sample: the sample of children is restricted to those aged between 10 and 17 years old. The sample has 118,269 children.
Survey Instrument: the survey used (Brazilian National Household Survey – PNAD) provides information at the household and individual levels on a series of demographic and economic characteristics.

Municipalities in the poorest regions of the country benefit particularly from the program. For these regions, the implementation of the PSF is also robustly associated with increased labor supply of adults, reduced fertility, and increased school enrollment. No impact on child labor was identified.

Child Labour

Households

National

No impact on child labour was identified.

Municipalities in the poorest regions of the country benefit particularly from the program. For these regions, the implementation of the PSF is also robustly associated with increased labour supply of adults, reduced fertility, and increased school enrollment.

The authors find consistent effects of the program on reductions in mortality throughout the age distribution, but mainly at earlier ages.