O desafio do Programa Mais Médicos para o provimento e a garantia da atenção integral à saúde em áreas rurais na região amazônica, Brasil

Abstract

The objective of this research was to assess how the More Doctors Program has been implemented in rural areas and the contributions made by providing physicians to ensure comprehensive health care. A study was conducted in a predominantly rural city in the state of Pará, involving 42 interviews with health professionals and managers, council members and users. The interviews then underwent content analysis. The results suggest that there have been improvements in primary health care -such as a higher number of consultations and expanded access to the primary care services offered -that can be attributed to the presence of the physicians and the use of more equitable strategies. However, there are still challenges to be confronted in order to ensure comprehensive health care in rural areas, such as maintenance of the program and overcoming recurrent problems, such as: lack of drugs and tests; limitations in follow-up on patients referred to other services; and weaknesses in the health care network.

A integralidade das práticas dos médicos cubanos no Programa Mais Médicos na cidade do Rio de Janeiro, Brasil

“…Strong territorial integration and community interaction are consistent with findings from other studies on practices in the PMM 21,22,23 . Cuban medical training, targeted to the provision of community-oriented services 24 , may have been a facilitating factor.…”

“…Corroborating previous studies, we found a receptiveness to the spontaneous and scheduled demand based on strategies for its absorption 21,23,26 . Follow-up of various population groups is another positive aspect of the practices by physicians in the PMM.…”

“…The physicians from the PMM analyze the population's health indicators and develop planned activities. This kind of work has also been found by other studies 21,23,26 . The preventive focus, an established principle of the Cuban National Health System, especially in primary health care, where the practice is systematized through action planning mechanisms 23 , may be a practice that favors the physicians from the PMM.…”

“…Although not highly systematized, the six steps to the person-centered approach 25 were present in practices by physicians in the PMM. Other studies have also identified the presence of elements of the person's centrality and autonomy in the work by physicians in the PMM 21,23,26 . The assessments by the supervisors on this point appear to identify a certain tension and the defense of a Brazilian Divergence in adequate adherence to clinical guidelines.…”

Project More Doctors for Brazil in remote areas of the state of Roraima: relationship between doctors and the Special Supervision Group

“…In the indigenous health context, the isolation feeling common to health professionals who work in remote or hard-to-reach areas 22 is potentialized by poor articulation with healthcare networks 23 . In remote rural regions, this is also a challenge for effective comprehensive care and articulation among different levels of care, even the supply of doctors in primary care 24 . In Roraima, the fact that services provided in outpatient clinics and hospitals, focal specialties and diagnostic means are mainly concentrated in the capital, Boa Vista, makes a difference 25 .…”