Pay for performance in Brazilian primary health care: quality of work processes, actions and services

• Date: 09 August 2023
• Pages: 578-591
• DOI: https://doi.org/10.1108/IJPSM-01-2023-0022
• Published date: 09 August 2023
• Subject Matter: Public policy & environmental management,Politics,Public adminstration & management
• Author: Davllyn Santos Oliveira dos Anjos,Magda Duarte dos Anjos Scherer,Juliana Leal Ribeiro Cantalino,Everton Nunes da Silva

Pay for performance in Brazilian

primary health care: quality

of work processes, actions

and services

Davllyn Santos Oliveira dos Anjos

Programa de P

os-Graduaç~

ao em Sa

ude Coletiva, Universidade de Bras



ılia,

Bras



ılia, Brazil and

D

epartement de gestion, d’



evaluation et de politique de sant

e, Universit

e de Montr

eal,

Montr

eal, Canada

Magda Duarte dos Anjos Scherer

Programa de P

os-Graduaç~

ao em Sa

ude Coletiva, Universidade de Bras



ılia,

Bras



ılia, Brazil and

Conservatoire National des Arts et M

etiers,

Centre de Recherche sur le Travail et le D

eveloppement, Paris, France

Juliana Leal Ribeiro Cantalino

Programa de P

os-Graduaç~

ao em Sa

ude Coletiva, Universidade de Bras



ılia,

Bras



ılia, Brazil, and

Everton Nunes da Silva

Faculdade de Ceil^

andia, Universidade de Bras



ılia, Bras



ılia, Brazil

Abstract

Purpose –In 2011, Brazil introduced a national pay-for-performance (P4P) scheme called the National

Program for Improving Primary Health Care Access and Quality (PMAQ), rolled out over three cycles and

reaching more than 5,000 municipalities and 40,000 family health teams (FHTs). There is little evidence on how

the PMAQ was implemented locally and whether this variation in implementation affects performance,

particularly, in terms of work process indicators. This study compared different cases of municipal-level

PMAQ implementation(bonuses paid or not to FHTs) over the last two program cycles to analyze the quality of

the work processes, actions and services of FHTs.

Design/methodology/approach–This was a cross-sectional analyticalstudy using secondary data from an

external evaluation of the Brazilian PMAQ. In total, 27,500 FHTs participated in the evaluation. They were

divided into four clusters based on whether or not municipalities paid bonuses to workers during cycles 2 and 3

of the program (2013–2019). Variables regarding work processes, actions and services were classified as

“Quality Assurance –QA”or “Continued Quality Improvement –CQI”, and an individual score was assigned

based on the average score of each variable.

Findings –The four clusters displayed an increase in overall QA and CQI scores between the two program

cycles; though this increase was small between the set of primary health care teams that received bonuses and

those that did not.

Originality/value –This paper contributes to bridging the gap in the scientific literature for evaluative

studies on the relationship between direct payment for performance to health professionals and better quality

actions and services in low and middle-income countries.

Keywords Pay for performance, Primary health care, Work process, Quality of health care,

Low and middle-income countries

Paper type Research paper

IJPSM

36,6/7

578

Funding: This study was financed in part by the Coordenaç~

ao de Aperfeiçoamento de Pessoal de N

ıvel

Superior - Brasil (Capes) - Finance Code 001.

The current issue and full text archive of this journal is available on Emerald Insight at:

https://www.emerald.com/insight/0951-3558.htm

Received 27 January 2023

Revised 26 May 2023

23 June 2023

Accepted 6 July 2023

International Journal of Public

Sector Management

Vol. 36 No. 6/7, 2023

pp. 578-591

© Emerald Publishing Limited

0951-3558

DOI 10.1108/IJPSM-01-2023-0022