Evaluation of the epidemiologic impact of a national primary health care policy on infant health outcomes in Brazil, from 1999 to 2002

Programa de Saude da Familia-PSF was initially proposed as a novel model of primary health care in Brazil in 1994 as it was implemented in several Brazilian municipalities. This national policy embraces different dimensions of primary care, but has a primary reliance on maternal and child health, especially on the survival of infants, given the unfavorable Brazilian child health scenario. This study has proposed that an improvement on infant health is expected to occur through three major mechanisms: overcoming of socio-cultural and geographical barriers of access to maternal and child health services; integrality of care; and community empowerment. An ecological longitudinal study design was utilized to assess the impact of the policy implementation on municipal indicators of infant health of 1201 municipalities, from 1999 to 2002. A group of municipalities that first implemented PSF in 1999 and were covered continuously from 1999 from 2002 were compared to a group of municipalities that didn't implement this policy within the same time period. This study has found that PSF has had an overall positive impact on infant health. Overall, it might be concluded that PSF implementation has brought an important short-term improvement on municipal indicators of infant health from 1999 to 2002, especially on the infant mortality rate. Such beneficial impact tended to be stronger in socially disadvantaged municipalities, commonly with unfavorable health care scenario. Thus, the expansion of primary health care capacity and overcoming of major gaps within the access to MCH services might explain such beneficial impact of PSF implementation in Brazilian municipalities.