THE IMPACT OF PHC IN RIO DE JANEIRO: AN EVALUATION USING LINKED MEDICAL RECORD DATABASES

Introduction and Objectives Brazil’s primary healthcare (PHC) program - the Estrategia de Famila da Saude (ESF) – has been rapidly expanding nationally since the 1990s, but urban centres - such as the city of Rio de Janeiro - have been neglected. Urban poor populations in favelas have received little PHC coverage. Since 2009 coverage has rapidly expanded to nearly 50% coverage in 2016. Many studies on PHC utilise aggregate data to demonstrate the national effects of PHC and the ESF on reducing mortality (infant and cardiovascular) and hospitalisations. Very few studies examine the role of PHC in urban poor populations in a middle-income country and using large, individually linked medical datasets. Methods We link four large, individual socio-demographic and medical record datasets to evaluate access to and use of ESF for the years 2011-2014. Using a social security dataset (Cadastro Unico) containing over 1 million individuals, we assess their coverage and access to ESF, and link individual hospital records and death certificates. We compare patterns of healthcare use and mortality between those using ESF and those not, controlling for a wide-range of individual characteristics. Results and Conclusions We present the findings of this novel and sizeable study which has not been undertaken in a middle-income country before. There are key learning points for researchers and implementers wishing to undertake similar evaluations of local PHC services, and also for policy-makers on the impact of PHC on health in an urban and poor setting.