Big Data: Predicting Future Tuberculosis rates in Brazil’s Uncertain Times

The Bolsa Familia, Brazil’s highly acclaimed conditional cash transfer programme (and one of the largest in the world) has been an inspiration to many a developing country. It has been widely replicated, including by major cities like New York. Once considered a fundamental feature of modern Brazil, today, in the midst of the country’s worst political and economic crisis in decades, the future of this social protection system, the hallmark of the current Worker Party government, is becoming less certain.

The programme’s successes are well-known. It has helped to nearly eradicate extreme poverty and reduce inequality across the country. [1] It has increased school attendance, reduced infant mortality, and improved public health. It is a powerful force for women’s empowerment with 93% of card holders as women and targeted benefits for pregnant and lactating women.

Perhaps less known has been the programme’s attention to data. In 2007 the Cadastro Unico was created to track socioeconomic and household data of low income families. It is a single registry database used to identify potential beneficiaries of Bolsa Familia and 13 other complementary programmes. As the social programmes expanded, extensive efforts were made to ensure all potential beneficiaries were included and to verify their information –with over 1200 crews visiting homes across the country and even trekking deep into the Amazon by canoe.

Today, the Cadastro Unico is tracking the information of over 103 million people. This massive database has been an essential tool for monitoring implementation and optimizing programme management. But it has also enabled in-depth studies including millions of cases to evaluate the multiple impacts of the Bolsa Familia and other programmes, and making it more difficult to deny the results. In the words of the Minister of Social Development:

We have data, statistics, robust scientific evidence, national and international, to bury the myths and show the effects of this program on the lives of Brazil’s poorest.

Minister of Social Development, TerezaCampello, on the occasion of the 10th Anniversary of the BolsaFamilia

This body of evidence just might be enough to secure the case for Bolsa Familia as an important contributor in Brazil’s efforts to meet the Sustainable Development Goals, even beyond the current crisis. Another way to look at it is to consider what would happen in Brazil if the cash transfers to the poor were to stop. How much would this impact on the many dimensions in education, health, and the economy? Today as we mark World Tuberculosis Day, tuberculosis rates can provide an interesting litmus test. Tuberculosis is largely a disease of poverty. It is associated with overcrowding in households, inadequate health care and poor nutrition. In Brazil conditional cash transfers have been making a difference to these conditions and one study has shown that cure rates are higher for the Bolsa Familia beneficiaries.3

For a policy maker, this is powerful evidence but it comes after the fact, once the programme has already been in place for over a decade. For countries going through social, economic or political crisis such as the current moment in Brazil, it is also helpful to look forward to try to predict impacts of decisions made today. A microsimulation study, supported by the UNDP RIO+ Centre, has done just that[3]. By taking all tuberculosis cases captured under the Cadastro Unico and separating those that received cash transfers from those who did not, and using several other data sources, this methodology was able to forecast the Tuberculosis prevalence  up until 2025 in the country. It estimates that if the Bolsa Familia were to stop today, the Tuberculosis prevalence in 2025 would be approximately 6% higher than if the programme were to continue.  On the flip side, an expansion of the cash transfers to all TB cases would contribute to a faster decrease of the prevalence of the disease, with a 33% lower prevalence in 2025. As part of the study an interactive interface allows policy makers to compare different programme options, playing with the variables to estimate and compare the various outcomes.

This type of tool is not possible without a large database like the Cadastro Unico. It also offers an outstanding opportunity for Brazil to contribute to policy development for the SDG agenda. This database provides the foundation for detailed evaluations of socio-economic impacts of policies and shocks at the household level over nearly a decade. For policy researchers and social scientists it is a quantitative dream. And, if it were to be more openly available, it could be harnessed as a powerful tool of the data revolution that will help usher in a more sustainable future.

 

References:

[1]”Bolsa Familia Program: A Decade of Social Inclusion in Brazil“, by the Institute of Applied Economic Research (Ipea)

[3]Mobilizing Big Data and Microsimulation for SDGs: Forecasting the Impact of a Conditional Cash Transfer Programme on Tuberculosis in Brazil, by Torrens AW, Rasella D, Boccia D, Maciel EL, Nery JS, Olson ZD, Barreira DC, Sanchez MN.Effectiveness of a conditional cash transfer programme on TB cure rate: a retrospective cohort study in Brazil. Trans R Soc Trop Med Hyg. 2016 Mar;110(3):199-206.

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