Reducing inequities in neonatal mortality through adequate supply of health workers: evidence from newborn health in Brazil.
BACKGROUND
Progress towards the MDG targets on maternal and child mortality is hindered worldwide by large differentials between poor and rich populations. Using the case of Brazil, we investigate the extent to which policies and interventions seeking to increase the accessibility of health services among the poor have been effective in decreasing neonatal mortality.


METHODS
With a panel data set for the 4,267 Minimum Comparable Areas (MCA) in Brazil in 1991 and 2000, we use a fixed effect regression model to evaluate the effect of the provision of physicians, nurse professionals, nurse associates and community health workers on neonatal mortality for poor and non-poor areas. We additionally forecasted the neonatal mortality rate in 2005.


RESULTS
We find that the provision of health workers is particularly important for neonatal mortality in poor areas. Physicians and especially nurse professionals have been essential in decreasing neonatal mortality: an increase of one nurse professional per 1000 population is associated with a 3.8% reduction in neonatal mortality while an increase of one physician per 1000 population is associated with a 2.3% reduction in neonatal mortality. We also find that nurse associates are less important for neonatal mortality (estimated reduction effect of 1.2% ) and that community health workers are not important particularly among the poor. Differences in the provision of health workers explain a large proportion of neonatal mortality.


CONCLUSIONS
In this paper, we show new evidence to inform decision making on maternal and newborn health. Reductions in neonatal mortality in Brazil have been hampered by the unequal distribution of health workers between poor and non-poor areas. Thus, special attention to a more equitable health system is required to allocate the resources in order to improve the health of poor and ensure equitable access to health services to the entire population.
Department for Health Systems Policies and Workforce, World Health Organization, Geneva, Switzerland.
Angelica
A
Sousa
Mario R
MR
Dal Poz
Cynthia
C
Boschi-Pinto
D001938:Brazil; D002983:Clinical Competence / Q000592:standards*; D003153:Community Health Services / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D006282:Health Personnel / Q000592:standards / Q000706:statistics & numerical data*; D006280:Health Workforce / Q000706:statistics & numerical data*; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D015233:Models, Statistical; D012959:Socioeconomic Factors