Eficácia, efetividade e eficiência de governos sobre a mortalidade de crianças e a proporção de gastos públicos destinados à saúde em países pobres – a importância de pensar os governos de forma sistêmica para avançar rumo aos objetivos de desenvolvimento sustentável

• Ano de defesa: 2019
• Autor(a) principal: Garcia, Leandro Pereira
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Palavras-chave em Português: Mortalidade Infantil; Eficácia; Efetividade; Eficiência; Governo; Gastos em Saúde
• Link de acesso: https://repositorio.animaeducacao.com.br/handle/ANIMA/15180

Introduction: Child mortality remains a major social problem in poor countries. The Sustainable Development Goals aim to tackle this problem, and the appropriate allocation of public resources by governments can help. Objective: To analyze the association between the proportion of public spending on health (PropGast) and the governments' efficacy, effectiveness and efficiency in reducing the neonatal mortality rate (TxNeo) and of children aged 28 days to five years (TxNeo_5y) in poor countries. Methods: Ecological study with the following path: 1) Data collection and indicator calculation: TxNeo and TxNeo_5y, public spending and 32 external factors for 157 countries. Indicators were divided into four periods to control bidirectional causation; 2) Missing external factor data were imputed using data from all countries. The other analyzes used data from 72 poor countries; 3) The generalized random forest was used to determine the efficacy of governments on mortality rates, controlling for external factors; 4) effectiveness was calculated by multiplying efficacy by public expenditure per capita; 5) We used effectiveness as outcomes and public health expenditures and public expenditures in other sectors as input for the calculation of efficiency in data envelopment analysis; 6) The association of efficacy, effectiveness and efficiency with PropGast was analyzed. Results: 69 poor countries governments were efficacious and effective, and four were efficient in reducing TxNeo. Regarding TxNeo_5y, 21 were efficacious and effective, and five were efficient. PropGast was negatively associated with effectiveness rather than effectiveness or efficiency. Conclusion: Global resource increases in poor countries can be beneficial, especially for TxNeo. Larger PropGast were associated with a lower impact on mortality, probably because they draw resources from other government sectors that also impact mortality, such as education.