Mario Roberto Dal Poz

A reforma do sistema de saúde no Brasil e o Programa de Saúde da Família

O texto examina as etapas de formulacao e implementacao do Programa de Saude da Familia, indicando as estrategias esbocadas e analisando os resultados, com vistas a extrair licoes para o aperfeicoamento da politica de saude no Brasil. Foram identificados tres modelos de implantacao do programa: Modelo Regional, Modelo Singular e Modelo Principiante. O primeiro se caracteriza pelo desenvolvimento regional do programa, sendo fortemente influenciado por uma politica estadual de apoio a mudanca nas praticas assistenciais; o segundo desenvolve uma experiencia singular, sem envolvimento de outras esferas de governo; e o terceiro se desenvolve de forma incipiente e incerta.

A qualificação de trabalhadores de saúde e as mudanças tecnológicas

Este artigo examina a qualificacao de trabalhadores de saude, no contexto das mudancas tecnologicas que ocorrem nos processos de reestruturacao produtiva e nas formas de organizacao do trabalho. Na primeira parte, os autores discutem as mudancas que vem ocorrendo no mundo do trabalho e seu impacto no processo de trabalho em saude, a partir dos diferentes estudos realizados. Na segunda, analisa-se a contradicao contida no paradigma tecnologico, pela perspectiva da qualificacao e das novas competencias. Procura-se evidenciar, nas conclusoes, quais as implicacoes desse processo no campo de recursos humanos em saude.

The privatization of medical education in Brazil: trends and challenges

BackgroundLike other countries, Brazil is struggling with issues related to public policies designed to influence the distribution, establishment, supply and education of doctors.While the number of undergraduate medical schools and places available on medical schools has risen, the increase in the number of doctors in Brazil in recent decades has not benefitted the population homogeneously.The government has expanded the medical schools at the country’s federal universities, while providing incentives for the creation of new undergraduate courses at private establishments. This article examines the trends and challenges of the privatization of medical education in Brazil.MethodsThis is a descriptive, cross-sectional study based on secondary data from official government databases on medical schools and courses and institutions offering such courses in Brazil. It takes into account the year when the medical schools received authorization to initiatte the activities, where they are situated, whether they are run by a public or private entity, how many places they offer, how many students they have enrolled, and their performance according to Ministry ofEducation evaluations.ResultsBrazil had 241 medical schools in 2014, offering a total of 20,340 places. The private higher education institutions are responsible for most of the enrolment of medical students nationally (54 %), especially in the southeast. However, enrolment in public institutions predominate more in the capitals than in other cities. Overal, the public medical schools performed better than the private schools in the last two National Exam of Students’ (ENADE) .ConclusionThe privatization of the teaching of medicine at undergraduate level in Brazil represents a great challenge: how to expand the number of places while assuring quality and democratic access to this form of education.Upon seeking to understand the configuration and trends in medical education in Brazil, it is hoped that this analysis may contribute to a broader research agenda in the future.

Formação de recursos humanos de nível médio em saúde no Rio de Janeiro: a experiência da Escola Técnica em Saúde Enfermeira Izabel dos Santos

No Estado do Rio de Janeiro, assim como no resto do pais, os servicos de saude empregam grande quantidade de servidores nao habilitados, dificultando uma assistencia a saude de qualidade. Para reverter essa situacao, os autores propoem a formacao tecnica, a nivel de lo e 2o graus, dos servidores nas habilitacoes de saude aprovadas pelo Conselho Federal de Educacao e analisam a experiencia da Escola Tecnica Enfermeira Izabel dos Santos, da Secretaria de Estado de Saude do Rio de Janeiro. O processo pedagogico tem por base a problematizacao da realidade. Concebida como escola aberta, ja implantou 8 nucleos descentralizados, com um total de 225 alunos-servidores.

Desafios para assegurar a disponibilidade e acessibilidade à assistência médica no Sistema Único de Saúde

Shortages and imbalances in the distribution of the health workforce, are social and political problems that, along with the socio-economic inequality, reduce the access of the population to the health services. This study aims to understand the challenges of SUS policy-makers and managers to ensure the availability and geographical accessibility to health service providers. The analysis was guided by a framework of the health labour market and health policy interventions. Two main problems have been identified: shortage of doctors and maldistribution of professionals between levels of health care and between geographical areas. This review focused on eight interventions in the last 30 years, whose mainly aim was to correct the maldistribution of physicians in the SUS such as Rondon Project, Interiorization of Health Work Program, Medical Specialists Training Program, PHC Program and More Doctors Program. The discussion focuses on the factors that influence the outcome of these interventions.[This corrects the article doi: 10.1590/1413-81232017224.31382016].

Sistematização do conhecimento sobre as metodologias empregadas para o dimensionamento da força de trabalho em saúde

A forca de trabalho em saude representa um fator de grande importância nos sistemas de saude, sendo imprescindivel a promocao e ao avanco da area, relacionada quantitativa e qualitativamente aos resultados alcancados. Esta revisao sistematica visa a identificacao na literatura de metodologias que, empregadas, resultem em dimensionamento eficaz da forca de trabalho em saude. Os resultados indicam a necessidade de complementacao da avaliacao, sendo indispensavel a identificacao de metodologias que resultem em dimensionamento mais eficaz da forca de trabalho em saude para subsidiar decisoes gerenciais no sistema de saude.

Força de trabalho em saúde mental no Brasil: os desafios da reforma psiquiátrica

O artigo analisa a formacao de recursos humanos em saude mental em uma conjuntura de mudanca do modelo assistencial no Brasil, um dos paises que mais rapidamente vem adotando um modelo de atencao comunitaria em substituicao ao modelo asilar. Os autores argumentam que a preparacao dos recursos humanos e um dos pontos mais frageis no processo de mudanca do modelo de atencao a saude mental no Brasil, apesar de esta dificuldade nao ser exclusivamente da area de saude mental, mas de toda a Reforma Sanitaria Brasileira. Segundo os autores, o desafio e planejar de maneira articulada a formacao profissional e a politica assistencial, articulando saude e educacao. A sustentabilidade da nova politica assistencial no longo prazo requer a elaboracao de politicas adequadas para os recursos humanos, bem como o enfrentamento da desigualdade distributiva da forca de trabalho.

Saúde global e responsabilidade sanitária brasileira: o caso da erradicação da poliomielite

A poliomielite foi declarada uma emergencia global em 2012, apos surtos ocorridos em paises anteriormente livres da doenca. Estudos apontam que, se a erradicacao global falhar, havera o ressurgimento mundial da doenca. Apesar da polio ja ter sido erradicada no Brasil, o pais tem um valioso papel a cumprir no cenario internacional, particularmente nos aspectos tecnicos e no apoio politico a Iniciativa Global de Erradicacao da Polio. As estrategias adotadas tem sido utilizadas como referencias e replicadas em muitos outros paises. Alem disso, a lideranca brasileira na erradicacao ajudou a abrir caminhos para ampliar a imunizacao nas Americas e no mundo.

Building evidence on HRH programme implementation: assessment in 15 Latin American and Caribbean countries

The health systems in the Americas region are characterized by fragmentation and segmentation that constitute an important barrier for expanding coverage, achieving integrated primary health care, and reducing the inefficiency and discontinuity of care. An assessment of the HRH programmes that have been implemented at country level was developed as part of the measurement of the 20 Human Resources for Health (HRH regional goals 2007-2015 adopted in 2007 the Pan-American Sanitary Conference (CSPA)). The exercise was a combination of academic research and the development/application of an advocacy tool, involving policy makers and stakeholders to influence decision-making on the development, implementation or change the HRH programmes, while building evidence through a structured approach based on qualitative and quantitative information, and exchange and dissemination of best practices. The presentation will cover the methodological challenges, as well as a summary of the main findings of the study that included 15 countries: El Salvador, Costa Rica, Guatemala, Honduras, Nicaragua, Panama, Dominican Republic and Belize in Central America, Ecuador, Colombia, Chile and Peru in the Andean region and Argentina, Paraguay and Uruguay in the Mercosur.The health systems in the Americas region are characterized by fragmentation and segmentation that constitute an important barrier for expanding coverage, achieving integrated primary health care, and reducing the inefficiency and discontinuity of care. An assessment of the HRH programmes that have been implemented at country level was developed as part of the measurement of the 20 Human Resources for Health (HRH regional goals 2007-2015 adopted in 2007 the Pan-American Sanitary Conference (CSPA)). The exercise was a combination of academic research and the development/application of an advocacy tool, involving policy makers and stakeholders to influence decision-making on the development, implementation or change the HRH programmes, while building evidence through a structured approach based on qualitative and quantitative information, and exchange and dissemination of best practices. The presentation will cover the methodological challenges, as well as a summary of the main findings of the study that included 15 countries: El Salvador, Costa Rica, Guatemala, Honduras, Nicaragua, Panama, Dominican Republic and Belize in Central America, Ecuador, Colombia, Chile and Peru in the Andean region and Argentina, Paraguay and Uruguay in the Mercosur.

The utilization of research evidence in Health Workforce Policies: the perspectives of Portuguese and Brazilian National Policy-Makers.

Background The production of knowledge on Human Resources for Health (HRH) issues has increased exponentially since 2000 but integration of the research in the policy-making process is often lagging. We looked at how research on HRH contributes or not to inform policy decisions and interventions affecting the health workforce in Portugal and Brazil. Methods We designed a comparative case study of semi-structured interviews with present and past national decision-makers, policy advisors and researchers. Issues explored included the existence of a national HRH policy and the use, or non-use, of research evidence by policy makers and reasons to do so. Interviews were audio recorded, transcribed, anonymized and analysed thematically. Results Policy-makers in Brazil recognize a greater use of evidence in the process of defining HRH policy when compared to Portugals. But the existence of formal instruments to support policy development is not sufficient to ensure that policies are informed by evidence. Conclusions In both countries the importance of the use of evidence in the formulation of policies was recognized by policy-makers. However, the influence of other factors, such as political pressures from various lobby groups and from the media and the policy short timeframe which requires rapid responses, is predominant.