Efficiency of public spending on primary health care: analysis of the municipalities of Sao Paulo

Objective: To analyze the efficiency of Sao Paulo municipalities with spending on the Primary Health Care subfunction in 2018 and its association with location, population size, wealth generated in the municipality (GDP - Gross Domestic Product) and budget expenditures with this public policy. Methodology: Exploratory descriptive and explanatory study with Sao Paulo municipalities in six similar clusters of population and GDP. It uses the settled expense as input, the Number of ESF Teams, Percentage of ESF Coverage, Number of Basic Health Units and Percentage of Live Births of mothers who performed more than 7 consultations in the prenatal period as an output. The efficiency level of each municipality is shown on georeferenced maps. Pearson's correlation is used to estimate the levels of associations between quantitative variables. Results: 102 municipalities have a maximum level of efficiency, distributed among the five groups. Municipalities with a low number of inhabitants and GDP tend to be more inefficient. Efficiency has a low correlation with population size, GDP or public spending. The municipalities with the lowest levels of efficiency are neighbors of Sao Paulo (Metropolitan Region) or small cities scattered throughout the territory. Theoretical Contributions: identifies that the management (formulation, implementation and evaluation) of the primary health care policy must consider different programs that focus on its location in the territory, population and wealth of the municipalities. There are references to the benchmarks for good practices in managing Primary Health Care policies.