O Programa Mais Médicos: análises e perspectivas

Abstract

Three years after the implementation of the Mais Médicos (More Doctors) Program, the Coordinating Committee of the Research Network on Primary Health Care (PHC) of the Brazilian Public Health Association (ABRASCO), in partnership with the Pan American Health Organization (PAHO), issued a call for papersand organized this thematic issue. The publication of results of research on the Mais Médicos Program, currently present in 4,058 municipalities and 34 Special Indigenous Health Districts, with a contingent of more than 18,000 physicians, set out to report on progress made and challenges faced by this public policy.In addition to deploying emergency measures for the provision of physicians to ensure access to unattended population groups, the Mais Médicos Program has altered the structure for the training of physicians in Brazil in the medium and long term. It is oriented to the universalization of medical residency, with an emphasis on general practice training in family and community medicine, opening up more places on courses in medicine and making changes in curriculum guidelines, all of which are important initiatives for the consolidation of the Unified Health System (SUS). Thus, the focus on medical professionals for PHC is brought to center stage, being considered the most important initiative of the Brazilian government geared to this end. Never before has medical training for PHC had such prominence in Brazilian health policy.Selected articles with distinct methodologies and a diversified focus and scope provide a broad overview of the deployment of the Mais Médicos Program and cover issues related to its three components: emergency provision, medical training and infrastructure of the basic health units.The implementation of the Mais Médicos Program is recent, and its full impact will only be evaluated in the medium and long term. Nevertheless, the following aspects have been revealed in the research presented here: a significant reduction in the number of municipalities with a shortfall of physicians; the predominant deployment in municipalities with greater social vulnerability; an increase in access to PHC services, both in those municipalities that have historically had difficulty including physicians in their Family Health Strategy teams, and also in those where the permanence of these professionals was a hindrance to good performance with the intermittent presence of physicians; a positive impact on production indicators; the convergence with other programs for the improvement of the quality of primary health care; user satisfaction; scope of practice of the participants highlighting the need for structural changes in the Basic Health Units for multifunctional PHC to attain more advanced levels; and reflections on the training and mentoring processes and how they have a positive impact on the daily life of the teams. Challenges remain and are highlighted as the partial replacement of the physicians of already existing teams, regional inequalities in distribution, the precarious nature of stable ti...

Atenção primária à saúde nos 25 anos da Revista Ciência & Saúde Coletiva

“…In 2013, the More Doctors Program (PMM) produced an inflection in the national primary care policy, bringing to light the immense hardships in providing services in remote and more vulnerable areas 24 , In a short span, such policy generated an expressive set of publications, and the special issue of C&SC on the PMM produced in 2016 was considered the primary vehicle for the dissemination of opinion papers and debate on the PMM, and empirical papers with research results 25 .…”

Qualidade da Atenção Primária à Saúde no Brasil: avanços, desafios e perspectivas

“…The launch of the More Doctors Program (PMM) in 2013 marked important progress in addressing the historical shortage of professionals in number and adequate training to meet the health needs of the population, mainly doctors [55][56][57] . The PMM is the most comprehensive intervention to increase access to health care in FHS 48,58 , through a large-scale emergency provision (about 18,000 doctors at its peak) combined with interventions to improve service infrastructure and medical training and lifelong education 55 .…”

sistemas universais para a América Latina: jovens e antigas inovações nos serviços de saúde

“…Os resultados do provimento emergencial feito, principalmente, através de um acordo com o governo cubano, mostram melhoria do acesso e satisfação dos usuários. Houve diminuição de desigualdades por uma oferta de profissionais em municípios com populações vulneráveis e dificuldades em fixar médicos, além de melhores indicadores de produção e de práticas com maior responsabilização comunitária (14,15) . Mas, algumas preocupações têm sido debatidas e se referem à expansão do ensino médico em Escolas privadas, ausência de uma carreira para profissionais do SUS e o não enfrentamento de entraves estruturais do sistema de saúde como um todo (financiamento, novas formas de gestão, coordenação entre atenção básica e demais serviços) (15,16,17) .…”