1. Social protection policy in Brazil
and impacts on health status of the
population
Romulo Paes de Sousa
Rio+ Centre

2. Summary
• Determinants of the decline of poverty in
Brazil
• The Brazilian Conditional Cash Transfer
• The contribution of the Bolsa Familia
Programme on the reduction of the infant
mortality
• Discussion
2

3. 33Ferreira, F.H.G. Et al. 2013. Economic Mobility and the Rise of the Latin American Middle Class. Washington, DC: World Bank.

4. Brazil’s poverty has declined in
past 8 years
4
Ministry of Finance of Brazil (2012). Brazilian economic outlook. MF: Brasília. 16th Edition.

5. High labour force demand
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6. Increase of income
6
Nominal BFP evolution (R$)
Transfer (billion R$) Families (million) Source: MDS, 2013

7. Also a reduction on inequality
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8. The Brazilian Bolsa Família Program (PBF)
• Conditional cash transfer (health and education) focusing
on:
– Poor families: monthly income per capita US$ 38.2-US$ 76.5
– Extremely poor families: monthly income per capita bellow US$
38.2
• Goals
– Poverty alleviation
– Break the intergenerational poverty cycle
– Comprehensive attention to families
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9. Monthly Benefits
• Basic Benefit (USD 35 or R$ 70)
Paid to extremely poor families, regardless of the number of
children (1 benefit per family).
• Variable benefit (USD 16 or R$ 32) - maximum of 5
benefits per family
Paid to extremely poor and poor families per:
– child aged 15 or younger
– pregnant woman
– nursing mother
• Variable Youth Benefit (USD 19 or R$ 38) - maximum
of 2 benefits per family
Paid to extremely poor and poor families per:
– adolescent aged 16 and 17
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10. The new benefit: filling the
poverty gap
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Family 1 Family 2 Family 3
Filling the gap
Per capita income
Benefit

11. 11
Brazil without Ultra Poverty
Source: Paes-Sousa ( forthcoming Rio+/IPC/IDS publication, 2013)

12. Size of CCT budgets
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Source: Paes-Sousa, Regalia and Stampini ( forthcoming IADB/ADB publication, 2013)
The Brazilian CCT grew from 0.27 of the GDP in 2004 to 0.5 in 2012

13. Budget grows because of increased
coverage
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In Brazil that runs the largest CCT programs, the share of the
population living in beneficiary households grew from 12% to 27%
over the period 2003-10
2003 2004 2005 2006 2007 2008 2009 2010
Brazil 20.8 23.0 24.8 25.8 24.5 22.6 26.2 26.9
Colombia 3.8 3.5 5.4 7.2 16.3 17.6 25.3 25.3
Honduras 6.5 6.1 11.0 9.4 10.9 14.7 10.5 14.1
Jamaica 15.8 15.7 15.6 19.0 21.5 24.0 26.5 30.6
Mexico 20.8 23.8 23.0 23.2 22.9 22.8 23.3 24.0
Peru 0.7 3.2 6.9 8.1 7.8 8.9
CCT coverage in selected LAC countries, % of total population
Source: Paes-Sousa, Regalia and Stampini (forthcoming IADB/ADB publication, 2013)

14. Budget grows because of increased
transfers
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The value of the transfer in Brazil grew 43% over the period
2004 - 2011
2004 2005 2006 2007 2008 2009 2010 2011
Brazil 34.3 33.8 33.9 36.1 38.6 40.5 39.3 49.2
Colombia 49.9 49.1 48.6 50.8 49.3 47.1 46.8 46.7
Honduras 13.5 12.8 n/a 13.0 12.7 12.5 62.9 60.8
Jamaica 34.5 30.9 51.9 53.5 45.5 44.3 53.5 51.3
Mexico 58.2 61.1 63.3 70.5 88.4 85.4 97.7 98.8
Peru 60.5 61.2 61.9 60.7 58.8 58.8 58.7
CCT transfer per beneficiary household in selected LAC countries,
PPP constant 2005 international $
Source: Paes-Sousa, Regalia and Stampini (forthcoming IADB/ADB publication, 2013)

15. Brazil: effects timeframe and the policy of the offer
Source: Paes-Sousa, Pacheco and Miazaki (2011).Bull World Health Organization vol.89 no.7.
t = time

17. Methods
• The study had a mixed ecological design, covering the period from 2004–
09 for 2853 (of 5565) municipalities with death and livebirth statistics of
adequate quality.
• BFP coverage was classified as low (0·0–17·1%), intermediate (17·2–
32·0%), high (>32·0%), or consolidated (>32·0% and target population
coverage 100% for at least 4 years).
• Multivariable regression analyses was performed for panel data with
fixed-effects negative binomial models, adjusted for relevant social and
economic covariates, and for the effect of the largest primary health-
care scheme in the country (Family Health Programme).
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18. • Overall mortality and hospitalization rates for
children younger than 5 years (per 1000
livebirths)
• Selected causes of mortality and
hospitalization rates were calculates for:
– diarrhoeal diseases (A00, A01, A03, A04, A06-A09)
– malnutrition (E40-E46)
– lower respiratory infections (J10-J18, J20-J22)
– external causes (V01-Y98)
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Methods: dependent varables

19. RESULTS AND DISCUSSION

25. • BFP had a significant role in reduction of under-5 mortality, overall
and from poverty-related causes such as malnutrition and
diarrhoea, in Brazilian municipalities
• The effect was maintained even after the adjustment for
socioeconomic covariables and FHP, increasing consistently with
the level of coverage, specially when reaching full coverage of the
target population of poor families was maintained for 4 years or
more.
• FHP is associated with reduction of overall admissions to hospitals
and to those due to diarrhoea and lower respiratory infections.
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Discussion

26. Discussion
• The results of the study provide evidence that a
multisectoral approach, combining a large-scale
conditional cash transfer programme and effective
primary health care can can substantially reduce
childhood mortality from poverty-related causes in a
large middle-income country such as Brazil.
• A small investment, as the CCT is, can
significantly increase the probability of
survivorship of the children.
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27. In the future
• A more comprehensive and sophisticated
intervention such as Brazil without Ultra
Poverty can bring even greater impact on
health (and wellbeing) of the Brazilian poor
population
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28. THANK YOU!
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