The Relation Between the Health Workforce distribution and Maternal and Child Health Inequalities

Weak health systems with a shortage of qualified staff, and lack of equipment and medicines impede the delivery of quality health care that is required to prevent maternal and newborn deaths and the attainment of the health-related Millennium Development Goals (MDGs). Using the cases of Mexico and Brazil, this thesis investigated whether some of the health sector policies (mostly on health workforce) and interventions implemented in Mexico and Brazil have been successful in reducing maternal and child health inequalities and improving the health of poor people. A framework was conceived to encompass and link the main elements of health systems: financing, production process, health service utilization and the population’s health. It also acknowledged and took into account the influences of social determinants on access, utilization and health outcomes.

This thesis found that over the past decades, there have been great improvements in maternal and child health in Mexico and Brazil. However, despite these improvements, there are persistent inequalities in all the six key health service utilization and population health indicators used in this research: unsafe abortion, coverage of antenatal care, attended deliveries in health facilities, neonatal mortality, infant mortality and child mortality. The evidence in this thesis suggests that addressing the quality of health services and the imbalances in the distribution of qualified health workers between poor and non-poor areas as well as addressing inequalities in other social determinants of health would be key factors to improve maternal and child health in poor areas in both countries. Special attention to a more equitable health system is required to allocate resources in order to improve the health of poor people and attain equitable access to quality services for the entire population.