Evidence exists on the health impacts of the current COVID-19 pandemic on health workers, but less is known about its impact on their work dynamics and livelihoods. This matters, as health workers—and physicians in particular—are a scarce and expensive resource in low- and middle-income countries (LMICs). Our cross-sectional survey set out to explore changes in working hours and earnings during the second year of the pandemic in a representative sample of 1183 physicians in Brazil’s São Paulo (SP) and Maranhão (MA) states. Descriptive analysis and inferential statistics were employed to explore differences in working hours and earnings among public and private sector physicians across the two locations. The workloads and earnings of doctors working exclusively in the public sector increased the most in the second year of the epidemic, particularly in MA. Conversely, the largest proportion of private-only doctors in our sample saw a decrease in their working hours (48.4%, 95% CI 41.8–55.0), whereas the largest proportion of public-only doctors in MA saw an increase in their working hours (44.4%, 95% CI 38.0–50.8). Although earnings remained broadly stable in the public sector, a third of public sector-only physicians in MA saw an increase in their earnings (95% CI 24.4–36.2). More than half of private-only doctors across both states saw a decrease in their earnings (52.2%, 95% CI 45.6–58.8). The largest proportion of dual practitioners (the majority in Brazil and in our sample) maintained their pre-pandemic levels of income (38.8%, 95% CI 35.3–42.3). As public-sector doctors have been key in the fight against the pandemic, it is critical to invest in these cadres in order to develop epidemic preparedness in LMICs, and to find new ways to harness for-profit actors to deliver social benefits.
Background Economic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world’s most affected countries, and its health system was already experiencing the aftermath of the 2015 recession. Methods Between 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (São Paulo) and impoverished (Maranhão) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings. Results We found the concept of ‘health sector crisis’ to be politically charged among healthcare providers in São Paulo and Maranhão. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible–if insecure–working arrangements. Following a drop in employment and health plans, private health insurance companies have streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but were also credited for having moved to cater for higher-income customers in Maranhão. Conclusions The ‘plates’ of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID economic recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded.
Background. Economic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world’s most affected countries, and its health system was already living the aftermath of the 2015 recession. Methods. Between 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (São Paulo) and impoverished (Maranhão) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings.Results. We found the concept of ‘health sector crisis’ to be politically charged among healthcare providers in São Paulo and Maranhão. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible – if insecure – working arrangements. Following a drop in employment and health plans, private health insurance companies streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but also credited for having moved to cater for higher-income customers in Maranhão.Conclusions. The ‘plates’ of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded.
Resumo O objetivo deste artigo é avaliar práticas de atenção ao parto e nascimento em maternidades do Norte e Nordeste brasileiros. Avaliação qualitativa realizada em 91 maternidades no Norte e 181 no Nordeste do Brasil. A técnica de pesquisa foi a observação sistematizada, realizada por 44 avaliadores previamente treinados e registrada em diário de campo. Foi realizada análise de conteúdo na modalidade temática. Os núcleos temáticos encontrados foram: Desafios da Gestão Colegiada; Desafios para o enfrentamento da Violência Obstétrica; e Potencial do processo avaliativo na indução de mudanças. Foram identificados avanços na implantação de boas práticas na gestão do cuidado e atenção à saúde, embora algumas maternidades ainda reproduzam um modelo hierárquico, sem espaços colegiados de gestão e com práticas de violência obstétrica. Situações de risco em gestantes justificaram menor adesão dos profissionais de saúde às boas práticas, ainda que ações em direção à humanização também tenham sido visibilizadas. Identificou-se a potência do processo avaliativo na indução de mudanças. Foram evidenciadas mudanças em direção às boas práticas preconizadas pela Rede Cegonha, tanto na gestão quanto na atenção, mas são muitos os desafios frente ao predomínio de um modelo de gestão hierárquico associado a um modelo de atenção com práticas intervencionistas.
RESUMO Objetivo: analisar mudanças na assistência à saúde materna durante a pandemia da Covid-19, segundo relatos dos profissionais de saúde. Método: pesquisa qualitativa, realizada com gestores, médicos, enfermeiros, residentes e técnicos de enfermagem atuantes nos setores de ambulatório de pré-natal, emergência obstétrica, hospitalização obstétrica e centro de parto de um hospital público federal de alta complexidade no Nordeste do Brasil. Os dados foram coletados de no período de dezembro de 2020 a agosto de 2021. A amostra, escolhida intencionalmente, buscou a diversidade de características e situações, foi encerrada pelo critério da saturação de sentidos. Questionário estruturado e roteiro semiestruturado de entrevista foram utilizados para coleta dos dados. As entrevistas foram gravadas e transcritas. Empregou-se a análise de conteúdo, na modalidade temática. Resultados: entrevistaram-se 28 profissionais. Foram identificadas mudanças na dinâmica da assistência obstétrica categorizadas em: pré-natal; e parto/puerpério. No pré-natal, houve diminuição das consultas eletivas; aumento do tempo entre consultas; a paramentação atrasava o atendimento; implantação de novos protocolos de higienização; limitação do número de acompanhantes; criação de novos ambientes como a sala Covid-19 para gestantes sintomáticas; teleatendimento e sobrecarga de trabalho pelo aumento da demanda vinda da Atenção Primária à Saúde. No parto/puerpério, os relatos apontaram redução do número de leitos; testagem e isolamento das pacientes sintomáticas; limitação da deambulação, restrição de acompanhantes e obrigatoriedade do uso de máscara pela parturiente. Conclusão: a reestruturação dos serviços e a criação de novos espaços para atendimento de pacientes com Covid-19 ocasionaram redução na oferta de vagas para consultas de pré-natal e pós-parto. As mudanças foram acompanhadas por novas regras de atendimento, com retrocessos quanto à garantia de direitos previamente conquistados.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.