Evaluating Large Scale Interventions on Child Health in

Brazil:The Role of Context and Challenges

FORUM ON INVESTING IN YOUNG CHILDREN GLOBALLY (IYCG)SCALING PROGRAM INVESTMENTS FOR YOUNG CHILDREN GLOBALLY:

EVIDENCE FROM LAC AND OTHER DEVELOPING REGIONS – IOM/NRC

São Paulo, December 2014

Mauricio L Barreto

• Previous situation (1995)- 25% of households connected to sewer

• The intervention – to increase the coverage to 80%

• From 1997 to 2004 were build up over 2000 km of sewers and aprox. 300 households were connected.

• Overall investment = US$ 440 million

Measured Impacts - Summary

• Diarrhoea Long. Prevalence – 21% reduction (42% in the poorest áreas)

Intestinal Helminth Infection

• A lumbricoides Prev. - 51% reduction• T trichiura - 72% reduction• G. duodenalis – 62% reduction

Family Health Program Municipal Coverage 1998-2010

1998 1999 2000 2002 2003 2004

2005 2006 2007 2008 2009 2010

Am J Public Health. 2009;99(1):87-93

Fixed-Effects Models for the Bivariate Association Between Family Health Program Coverage and Infant Mortality Rate:

Brazil, 1996–2004

Large Scale Interventions are implemented by political decisions;

Well informed and science based interventions have great chance of success;

Well designed and conducted evaluative studies are an important resource aiming to measure and disentangle the effect of different interventions

As child health outcomes has multiple causes and could be the effect of multiple interventions and fators, it is a necessary task to develop clear frameworks and complex study designs and analysis;

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Some Remarks

While cost-effectiveness is important, the public perception of the benefits of the program is crucial;

To understand the context where the intervention occurs is an important part of the evaluative task, and to implement similar interventions in other contexts;

To have national information systems and database that collect and keep good quality routine administrative data on processes and outcomes are crucial to the large scale evaluative efforts;

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Some Remarks

That’s all for now!

OBRIGADO !THANK YOU !

mauricio@ufba.br