A Comparative Case Study: Does the Organization of Primary Health Care in Brazil and Turkey Contribute to Reducing Disparities in Access to Care?

Figures & data

Table 1. Socioeconomic, demographic and health system indicators in Brazil and Turkey, 1990–2019

Indicator	Brazil		Turkey
	1990	2019	1990	2019
Total population (n)	149,003,223	211,049,527	53,921,760	83,429,615
Annual population growth (%)	1.81	0.8	1.7	1.3
Proportion of population aged 65 years and older (%)	4.3	9.3	4.6	8.7
Non-communicable diseases as % of total deaths	69.1	74.7	80.1	90.2
GDP per capita (constant 2010 USD)	7,983.7	11,121.7	6,774	15,125
GDP growth (annual %)	−3.1	1.1	9.3	0.9
Life expectancy at birth (years)	66.3	75.9	64.3	77.7
Maternal mortality ratio (per 100,000 live births)	69.0	60.0	42	17
Infant mortality rate (per 1,000 live births)	52.4	12.4	55.4	8.6
Total fertility rate (births per woman)	2.9	1.7	3.1	2.1
Number of physicians (per 1,000 inhabitants)	1.1	2.2	0.9	1.8
Number of nurses and midwives (per 1,000 inhabitants)	0.9	10.1	1.4	2.7
Current health expenditure as % GDP	8.3	9.5	4.6	4.1
Current health expenditure per capita (PPP current international $)	756	1531	443	1171
Domestic general government health expenditure (% current health expenditure)	41.6	41.7	62	77
Voluntary health insurance (% current health expenditure)	20.5	29.3	0	2.6
Out-of-pocket health expenditure (% current health expenditure)	36.6	27.5	28.6	17.5

Source: Data are extracted from the World Development Indicators Database and WHO Global Health Expenditure Database.^18,19

Notes: Data are for the years 1990 and 2019 unless specified otherwise. For Turkey, data for physician, nurse and midwife density are from the year 2017. For Brazil, physician, nurse and midwife density are for the year 2018. For both countries, data on maternal mortality ratio, health current health expenditure as % of GDP, current health expenditure per capita (PPP current international $), domestic general government health expenditure (% current health expenditure), voluntary health insurance (% current health expenditure) and out-of-pocket health expenditure (% current health expenditure) are from the years 2000 and 2018; and data on non-communicable diseases as % of all causes of death are from the years 2000 and 2019.

Table 2. The current organization of PHC programs in Brazil and Turkey

	Brazil	Turkey
Level of decentralization in PHC delivery responsibilities in the public sector	A total of 5,570 municipalities are responsible for management of UHS in local communities, including financing and delivery of PHC, as well as coordination with state and federal health authorities	MOH is the main steward in the health sector, but PHC teams have limited administrative responsibility to cover their operational expenses through monthly transfers from the MOH
Team-based PHC delivery	Multi-professional PHC teams comprised of physicians, nurses, community health workers, supported by other health professionals	Multi-professional PHC teams comprised of physicians, nurses, midwives, and technicians
Impanelment strategy	Geographic impanelment by which each PHC team serves up to 3,500 people residing in non-overlapping catchment areas	Mix of geographic impanelment and voluntary enrollment

World Bank. World development indicators. [accessed 2021 June 2]. https://databank.worldbank.org/home.aspx.

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WHO. Global health expenditure database. [accessed 2021 June 2]. https://apps.who.int/nha/database.

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