Médicos pelo Brasil e as políticas de saúde para a Estratégia Saúde da Família de 1994 a 2019: caminhos e descaminhos da Atenção Primária no Brasil

Abstract

No dia 1 de agosto de 2019, o presidente Bolsonaro e seu Ministro da Saúde lançam o Programa Médicos pelo Brasil como aquele que, segundo os mesmos, substituirá o Programa Mais Médicos. O propósito deste artigo é contribuir para uma análise desta mais recente proposta de política de saúde no âmbito da Atenção Primária à Saúde no contexto do Mais Médicos e das demais políticas de desenvolvimento e qualificação da ESF no país no período de 1994 a 2019.

Política Nacional de Atenção Básica: para onde vamos?

“…In this proposal, Primary Care Health Centers (UBS) with at least three teams will provide care for 60 weekly hours, with flexibility and reduction of the workload of professionals. The incentives for Saúde na Hora point to the transformation of UBS, in medium-sized and large cities, into emergency care units 18 .…”

“…The caring for acute illness in PHC must undoubtedly be ensured. However, this initiative tends to transform the ESF into a minor injury unit care, changing its work process and organization of actions 18 . Openness to hiring on-duty personnel may compromise PHC attributes such as longitudinality and coordination of care.…”

“…The omission to other ESF training plans, from undergraduate to postgraduate level, shows that the reorientation towards medical practice in PHC will not be encouraged 18,21 . Maintaining the current FCM Medical Residency programs will be even more difficult given the training proposal provided for in the PMB restricted to a specialization course whose tutoring can be exercised by clinicians, and not family and community physicians 18 . It equates this specialization with FCM medical residency title, shortening the time required (four years) to qualify for the specialty title test by half.…”

“…The PMB provides for the hiring of doctors registered in the country and, after a two-year fellowship along the lines of the PMM, a Consolidated Labor Laws (CLT) contract brokered by a private non-profit entity, euphemistically called PHC Development Agency (ADAPS) 19 . ADAPS promotes a shift of public management from PHC to the private sector 18,21 in alignment with the proposals for universal health coverage. PHC in the SUS is recognized, even by the World Bank, as the most efficient area of the entire Brazilian health sector 22 , because most of the primary care services are state-owned, offered by the direct public administration.…”

Interlocuções entre a Declaração de Astana, o Direito à Saúde e a formação em Medicina de Família e Comunidade no Rio de Janeiro, Brasil

“…In the formation chronology of the specialty, we have that Community Medicine (CM) marks the beginning of this area in Brazil, traversing Community General Medicine until the change to the current name of the specialty. CM emerged in the United States in the 1960s as part of the Kennedy administration's anti-poverty policy, reinforced through the Medicare, Medicaid, and Compulsory Insurance Programs, which were focus measures 17 , which has been the subject of criticism during this period of growing discussions on the establishment of a national health system 18 .…”