Infant mortality increases with post-election transition – 01/14/2024 – Power

Infant mortality increases by an average of 6.7% during the municipal government transition period when there is a change in management, according to research by IEPS (Institute of Studies for Health Policies).

The effects are even greater for mortality from preventable causes, that is, those that could be avoided. The average increase is one death for every thousand live births.

The study “Municipal Elections and Government Transitions: Disruption of Services and Increase in Infant Mortality”, carried out by researchers Helena Arruda, from IEPS, and Rudi Rocha, from EAESP/FGV (São Paulo School of Business Administration, Fundação Getulio Vargas), used the 2008, 2012, 2016 and 2020 elections as a basis.

The sample evaluated 2,900 municipalities in 2008, 2,200 in 2012, 2,395 in 2016 and 3,040 in 2020. In the study, cities were analyzed that had a candidate running for re-election in a fierce election between competitors.

The study was based on different data sources. Health information was collected from Siab (Primary Care Information System), Sisab (Primary Health Care System), Sinasc (National Information System on Live Births) and SIM (National Mortality Information System) , all from the Ministry of Health.

Hiring and firing information was collected from the Annual Social Information List. The analysis was restricted to health workers (doctors, nurses and community health agents).

To analyze public finances and spending, annual data from Finbra (Brazilian Financial System) was used. Sociodemographic information was taken from IEPS Data, a portal that provides official data from various sources.

The study compared two groups of municipalities: those with re-elected governments and those with a government transition. The choice also took into account municipalities where the elections were close.

Researcher Helena Arruda says that the idea for the study arose from the interest in investigating how health interacted with electoral cycles. “We took advantage of the situation that primary health care is linked to municipal activity to ask how the election could impact it.”

She also says that she chose to study the gestational period because it is a very critical moment in the baby’s development.

“We understand that at this moment in life, if we encountered a shock, even if small, in terms of duration, there would be a chance that it would have a longer-term consequence in the lives of these children.”

The study concluded that there are negative effects on the provision of health services after the elections. More specifically, throughout the transition period and the first two years of the new government.

From October of the election year onwards, a reduction in the number of consultations per month was observed in municipalities that underwent a government transition compared to those that did not.

Infant mortality rates also increased when the second trimester of pregnancy coincided with periods of government change.

According to Helena Arruda, a confluence of factors can contribute to this result, but one seems to be decisive: human resources.

“We know that, in primary care, people are a vital part of providing this service. [Por isso] We investigated what happens to the main occupations that work in the area”, he states.

What the research found was an increase in layoffs of public servants in these occupations. Dismissals were higher in municipalities that underwent a government transition, even though the Brazilian Electoral Law states that public servants cannot be fired during election periods.

Arruda explains that the dismissals were of commissioned employees, who, unlike standard public service contracts, do not have stability. “There is a considerable proportion of municipal health workers who have this type of contract,” he says.

According to Michelle Fernandez, professor and researcher at the UnB Institute of Political Science, in most city halls in Brazil there is no consolidated bureaucratic career structure, but employees who are hired or appointed. “[Por isso] there may be this variation in the change of government”, he states.

When investigating what would justify the exemptions, the study found an explanation related to another Brazilian legislation: fiscal responsibility.

The law says that municipalities cannot spend more than 60% of their resources on personnel. Although the rule is not restricted to health professionals, the study concluded that municipalities close to the personnel spending limit had, on average, more layoffs after the elections when there was a change of government.

The reduction in staff is understood as one of the factors that justify the reduction in prenatal consultations, which are important for identifying a series of preventable diseases.

If the pregnant woman also misses appointments at a critical time during pregnancy, the child may develop illnesses that will, for example, lead to a greater chance of being born with low birth weight.

Isabela Brandão, professor at Insper’s Health and Public Policy Center, explains that the second trimester of pregnancy is a period in which some exposures that the fetus has in the womb can have effects on the child’s health in the short and medium term.

“The study focuses on the first effect, which is reduced birth weight, but there are researchers in the medical and even economic literature who associate, for example, the effect of a lower weight with worse health outcomes in adult life. “, says Brandão.

The professor also says that the public health system is overloaded and that, in the country, children and pregnant women die due to lack of access to prenatal care.

Therefore, she defends as a basic public policy offering prenatal consultations in adequate quantity and quality. “Sometimes we see in the public system that prenatal consultations do exist, but not necessarily with all the appropriate resources to carry out screening”, she adds.

For Helena Arruda, one of the solutions proposed by the study is for governments to guarantee that there will be no layoffs of health professionals during the government transition period.

“Infant mortality occurs until the beginning of the second year of the other term. Once prenatal consultations are missed, the effect is somewhat irreparable. That’s why it’s so important to talk and think of ways to ensure this doesn’t continue to happen. “