The health effects of decentralizing primary care in Brazil

Frederico C. Guanais, James Macinko

Research output: Contribution to journalArticlepeer-review


A renewed focus on primary health care could lead to improved health outcomes in developing countries. Moving more control to local authorities, or decentralization, is one approach to expanding primary care's reach. Proponents argue that it increases responsiveness to local needs and helps local resources reach those in need. Critics argue that it might increase fragmentation and disparities and provide opportunities for local economic and political gains that do not improve population health. We explore questions surrounding decentralization using the example of infant mortality in Brazil. Our study of two programs identified positive effects on health outcomes in the context of infant mortality.

Original languageEnglish (US)
Pages (from-to)1127-1135
Number of pages9
JournalHealth Affairs
Issue number4
StatePublished - Jul 2009

ASJC Scopus subject areas

  • General Medicine


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