title: [The economic-financial sustainability of the Family Health Strategy in large municipalities].
abstract: The universalization of basic care and commitment budget of the Ministry of Health with the Family Health Strategy (ESF) through new systematic financing incentives have been highlighted in the Brazilian health policy scenario. One of the great problems observed is the expansion of the strategy for large urban centres. This paper studies the economic-financial sustainability of ESF in Brazilian municipalities of more than 100 thousand inhabitants according to some selected indicators, considering the geographical region to which they belong, their population size and participation in Project for the Expansion and Consolidation Family Health (Proesf). Municipalities belonging to the Southeast region, more developed of the country, have on average better economic-financial performance, but lower average values of coverage of ESF. Municipalities from the North and Northeast, with the lowest average for economic-financial sustainability indicators, were the ones that made more effort to developments in the period. Thus, we observed the dynamics between bigger fiscal capacity and budgetary commitment with the Health Sector for biggest municipalities and in more economically developed regions, and greater vulnerability and dependence of federative transferences for municipalities with less people, in less developed areas.
authors.affiliation: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 21041-210, Brazil. gustavo.zoio@ensp.fiocruz.br
authors.forename: Gustavo Zoio
authors.initials: GZ
authors.lastname: Portela
authors.forename: José Mendes
authors.initials: JM
authors.lastname: Ribeiro
mesh_terms: D001938:Brazil; D005192:Family Health; D006291:Health Policy / Q000191:economics*; D006801:Humans; D008137:Longitudinal Studies; D011320:Primary Health Care / Q000191:economics*; D015397:Program Evaluation