The physiotherapy workforce in the Brazilian Unified Health Care System

Abstract

Background Maintaining sufficient health care workforce is a global priority to achieve universal health coverage. Therefore this study addresses the availability of physiotherapists in Brazil. Objective To describe secular trends of the physiotherapy workforce-to-population ratio in the Unified Health System, considering public and private sector and care level (primary, secondary, tertiary) in Brazil and its regions. Method Descriptive exploratory quantitative study based on secondary sources. All data related to the distribution of physiotherapists between August 2007 and September 2016 regarding facilities types, location and public and private sectors was obtained from the Brazilian National Registry of Health Care Facilities. Data related to the population of Brazil was extracted from Brazilian Institute of Geography and Statistics. The physiotherapy workforce-to-population ratio was calculated by the number of physiotherapists per 1000 population (public and private sector and care level) by ANOVA test. The distribution trends are represented on maps. Annual growth rates were estimated with Prais–Winsten linear regression models, with a significance level of 0.05, autocorrelation was checked by the Durbin–Watson test. Results The physiotherapists ratio in Brazil was 0.22/1000 population in 2007 and 0.41 in 2016, showing growth of 86%, with an increasing trend of 0.5% on an annual average. The public sector had the biggest physiotherapy workforce in the country in 2007 and 2016. The primary health care had the smallest physiotherapy workforce-to-population ratio (2007: p > 0.001 and 2016: p = 0.003), even though it had the largest growth trend in annual average (0.9% p > 0.001), followed by public and private tertiary health care sectors (0.8% p > 0.001). The workforce in secondary health care was bigger in the private sector than in the public sector (0.6% p > 0.001 vs. 0.2% p = 0.004). Overall, all regions had greater growth of physiotherapy workforce-to-population ratio in public primary and tertiary health care sectors, and private secondary health care sector, mainly the Southeast, South and Central-West regions. Conclusion Although the physiotherapy workforce in Brazil is relatively small, there was a trend towards growth with differences among care levels, and public and private sectors. The physiotherapy workforce-to-population ratio is bigger in the private secondary health care sector, followed by public tertiary, secondary and primary health care sectors. Sub-national regions show similar trends to the national estimates, with minor variations by region.

Describing the Rehabilitation Workforce Capacity in the Public Sector of Three Rural Provinces in South Africa: A Cross-Sectional Study

“…Resultantly, vacant rehabilitation posts are frozen, and therapists are forced to seek employment in the private sector or overseas [10]. Similar trends have been noted in other upper middle-income countries such as Brazil [26,30]. These low ratios show disparities in the rehabilitation workforce at all levels of care.…”

“…Population adjusted ratios are routinely reported as a metric to describe the rehabilitation workforce density [24][25][26][27]. This study showed alarmingly low population-adjusted ratios of the total number of therapists in each of the three provinces per uninsured population (see Table 6).…”

The physiotherapy workforce in Nepal: A national survey

“…Fifth, Nepal has only 1 physiotherapist per 25,000 people, which is fewer than India (1:12,111), Thailand (1:15,942) and Brazil (1:2337), but higher compared to other middle‐income countries such as Bangladesh (1:183,475) and Sri Lanka (1:28,247). 14 , 39 The smaller number of physiotherapists in these countries impedes the quality of physiotherapy care for those in need of comprehensive rehabilitation and hinders the recommendation by World Health Organisation to strengthen the multidisciplinary rehabilitation workforce for the future. 8 , 40 The lower number of physiotherapists in Nepal is attributed to the short history of a physiotherapy degree in Nepal and physiotherapists' migration, mostly to high‐income countries for employment and education.…”

Chronic hemodialysis patients with COVID-19 cared for by the public health system have higher mortality than those treated in private facilities: analysis of the Brazilian dialysis registry

“…Another factor that may have impacted hospitalized patients with COVID-19 was the lack of adequately trained healthcare professionals. Many physicians, nurses, and physiotherapists working in ICU were not board-certified by the specialty [ 37 , 38 ]. Moreover, it is also likely that better equipment, effective and expensive drugs were more available in private than public services.…”