Proceedings of the 15th International Academic Conference, Rome

HEALTH AND WELFARE: RESULTS OF A POLICY BASED ON ECONOMIC INCENTIVES BUT NOT ONLY.

CECILIA SEVERI, JAVIER LASIDA, MARISA BUGLIOLI, IMA LEON, NOEMÍ KRATOVICH

Abstract:

The Health reform in Uruguay included a payment for assistance goals in 2007. In 1996, it began a quality improvement experience called Accreditation in Good feeding Practices (AGFP), which in 2009 was included as a heath goal. This policy strategy includes the best practices maternities and primary health care centers a health service should implement to improve little children diet and growth. Objective: To study associated factors to the success and the positive impact of health goals through the analysis of ABPA as a goal. Metodology. Secondary analysis of survey data applied by UNICEF over a representative sample of the population adjusted by age, type of health provider and region. It were processed excusive breast feeding rates at 6 month over 1996, 1999, 2003, 2007 and 2011 data bases. It was calculated the evolution by accreditation, type of provider and geographic region. A binary probit model was applied to measure the ABPA impact on providers. The variable to explain was exclusive breast feeding and the independent variables were accreditation on GFP, country region, kind of health provider (private/public), birth weight, baby’s age, mother’s age and mother’s work situation. Afterwards a qualitative analysis was made by interviewing actors who play different roles in the governance system: Ministry of health, health services providers, representatives in the National Board of Health (workers, Institutions, patients). Results. Exclusive breast feeding increased in providers which applied ABPA all over the period (37% to 67%). Probit regression showed that ABPA was the variable which increases most the probability of exclusive breast feeding (17%, SD 2% and p<0.05). Breast feeding rate in 2007 differs 10 points with that of 2011 (57 Y 67% respectively). The qualitative analysis showed that the success was due to governance based in three factors: training, institutional strengthening and gradual accountability. Conclusion: The AGFP strategy has been demonstrated to be an effective tool to improve exclusive breast feeding at 6 months old. The inclusion as a health goal had capitalized and enhanced a previous experience. Results showed that a governance strategy which contains: training, institutional strengthening and incentives achieve the expected health impacts over the population

Keywords: health reform, economic incentives, best feeding practices

DOI: 10.20472/IAC.2015.015.164

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