Effectiveness of Community-based Primary Health Care: A Participatory Discussion of Program Implications PAUL FREEMAN and HENRY PERRY Part 2

1. Equity
• 43 reports included an equity assessment

2. Equity effects of CBPHC by socio-economic
status/wealth quintile
Type of indicator
Effect on equity
Inequitable Equitable
Pro-
equitable Total
Process 0 2 7 9
Population coverage of
evidence-based intervention 4 1 24 29
Serious morbidity 0 0 4 4
Nutritional status 0 0 2 2
Mortality 0 0 8 8
Total 4 3 45 52

3. Equity outcome indicators
Process indicators
Receipt of home visits by community-level
workers
CHW contact with a sick child
Recognition of danger signs during pregnancy
or among sick children
Cleanliness of house and of food preparation
process
Population coverage of evidence-based
indicators
Antenatal care
Delivery by a trained birth attendant
Delivery in a facility
Postnatal care
Essential newborn care practices
Immediate drying after birth
Immediate breastfeeding after birth
Exclusive breastfeeding during the first 6
months of life
Diagnosis and treatment of childhood
fever/malaria
Diagnosis and treatment of childhood
pneumonia
Vitamin A coverage
Immunization coverage
Morbidity
Diarrhea prevalence
Nutritional status
Weight-for-age score
Height-for-weight score
Mortality
Neonatal mortality rate
Infant mortality rate
Under-5 mortality rate
Ratio of mortality in lower versus higher
income/SES groups (for NNMR and U5MR)

4. An example of equitably decreasing
infant mortality through strong
CBPHC and strong PHC in Brazil

5. Introduction
• Brazil is known for having substantial inequities, and
also for making national-level efforts to address social
determinants of health and improve health equity
• Brazil’s Family Health Program (FHP) was established in
1994 and served 1% of municipalities included in this
study
• By 2004, the FHP was serving 82% of Brazil’s 5,561
municipalities (44% of total population)
• FHP services center around routine monthly visits of all
homes by Community Health Agents who are closely
linked to PHC centers
Source: Aquino, AJPH, 2009

6. Methods utilized
• Utilized panels of data from a set of 771/5,561
municipalities annually from 1996-2004
• Infant mortality rate was the outcome of
interest

7. Impact related to infant mortality
• The declines in infant mortality were greater in
the municipalities with the greatest increases in
FHP coverage, adjusting for covariates
• The declines in infant mortality were greater in
municipalities with the lowest human
development indices at the beginning of the
study period