Sábado Nicolau Girardi

Disponibilidade de medicamentos essenciais em duas regiões de Minas Gerais, Brasil

OBJETIVO: Avaliar a disponibilidade de medicamentos essenciais em localidades com indice de desenvolvimento humano < 0,699. METODOS: Foram pesquisados 69 estabelecimentos, entre almoxarifados municipais, unidades ambulatoriais publicas, unidades privadas, unidades filantropicas e farmacias comerciais. Foram entrevistados os profissionais de saude diretamente responsaveis pelo controle dos estoques e dispensacao dos medicamentos. Tambem foram consultados documentos e registros institucionais. Uma lista de 21 medicamentos essenciais tracadores, selecionados dentre aqueles mais utilizados no Programa Farmacia Basica do Estado de Minas Gerais, foi definida como parâmetro para as medidas de disponibilidade. Para cada medicamento tracador foi verificada a disponibilidade no momento da visita e ao longo dos 12 meses imediatamente anteriores a pesquisa de campo. Tambem foi calculada a disponibilidade de cada um dos medicamentos essenciais tracadores para cada tipo de estabelecimento incluido na pesquisa de campo. RESULTADOS: A disponibilidade de medicamentos essenciais nos almoxarifados municipais foi de 52,0%; nas unidades publicas de saude, 46,9%; e nas unidades ambulatoriais filantropicas e privadas, 41,0% e 38,1%, respectivamente. Nas farmacias privadas, a disponibilidade de medicamentos essenciais alcancou 81,2%. CONCLUSAO: Ha baixa disponibilidade e descontinuidade na oferta de medicamentos essenciais no setor publico, penalizando individuos vulneraveis. As farmacias privadas sao a principal fonte de medicamentos essenciais. Os resultados indicam a necessidade de divulgar e implementar o conceito de essencialidade no pais.

Programa Mais Médicos: uma ação efetiva para reduzir iniquidades em saúde

The Program More Doctors (Programa Mais Medicos) aims to decrease the shortage of physicians and reduce the regional health disparities and involves three main strategies: i) more places and new Medical Courses based on the revised Curriculum Guidelines; ii) investments in the (re)construction of Primary Healthcare Units; iii) provision of Brazilian and foreign medical doctors. Until July 2014, the Program made the provision of 14,462 physicians to 3,785 municipalities with vulnerable areas. Evidence indicates a 53% reduction in the number of municipalities with physicians’ shortage; in the North, 91% of the municipalities with physicians’ shortage have been provisioned, with almost five physicians per municipality, on average. The professionals’ integration in the Family Health Teams has strengthened and expanded the capacity of intervention, particularly in the context of adopting a healthcare model that encompasses different demands of health promotion, prevention, diagnosis and treatment of diseases and disorders, to face the challenge of the double burden of disease. The population is affected by obesity and non-communicable chronic diseases, alongside with infection, parasitic diseases and malnutrition remaining. The people of cities, rural areas and forests want more doctors, health perspectives and more social justice.

Impacto do Programa Mais Médicos na redução da escassez de médicos em Atenção Primária à Saúde

The Mais Medicos (More Doctors) Program (PMM) was put in place in Brazil aiming to reduce inequalities in access to Primary Healthcare. Based on diverse evidence that pointed to a scenario of profound shortage of doctors in the country, one of its central thrusts was emergency provision of these professionals in vulnerable areas, referred to as the Mais Medicos para o Brasil (More Doctors for Brazil) Project. The article analyses the impact of the PMM in reducing shortage of physicians in Brazilian municipalities. To do this, it uses the Primary Healthcare Physicians Shortage Index, which identifies and measures the shortage in the periods of March 2003 and September 2015, before and after implementation of the program. The results show that there was a substantial increase in the supply of physicians in primary healthcare in the period, which helped reduce the number of municipalities with shortage from 1,200 to 777. This impact also helped reduce inequalities between municipalities, but the inequities in distribution persisted. It was also found that there was a reduction in the regular supply of doctors made by municipalities, suggesting that these were being simply substituted by the supply coming from the program. Thus, an overall situation of insecurity in care persists, reflecting the dependence of municipalities on the physician supply from the federal government.The Mais Médicos (More Doctors) Program (PMM) was put in place in Brazil aiming to reduce inequalities in access to Primary Healthcare. Based on diverse evidence that pointed to a scenario of profound shortage of doctors in the country, one of its central thrusts was emergency provision of these professionals in vulnerable areas, referred to as the Mais Médicos para o Brasil (More Doctors for Brazil) Project. The article analyses the impact of the PMM in reducing shortage of physicians in Brazilian municipalities. To do this, it uses the Primary Healthcare Physicians Shortage Index, which identifies and measures the shortage in the periods of March 2003 and September 2015, before and after implementation of the program. The results show that there was a substantial increase in the supply of physicians in primary healthcare in the period, which helped reduce the number of municipalities with shortage from 1,200 to 777. This impact also helped reduce inequalities between municipalities, but the inequities in distribution persisted. It was also found that there was a reduction in the regular supply of doctors made by municipalities, suggesting that these were being simply substituted by the supply coming from the program. Thus, an overall situation of insecurity in care persists, reflecting the dependence of municipalities on the physician supply from the federal government.

Remuneración y productividad: el caso de la Fundación Hospitalaria del Estado de Minas Gerais, Brasil, 1992­1995

En este articulo se analiza el caso de la Fundacion Hospitalaria del Estado de Minas Gerais, Brasil, a raiz de haberse introducido en sus unidades de servicios de salud a principios de 1993 un nuevo sistema de recompensas, complementarias a la remuneracion salarial, por el buen desempeno y la productividad de los funcionarios. El analisis se baso en un estudio transversal de la evolucion de una serie de indicadores de produccion y productividad en la Fundacion durante el periodo de 1992 a 1995. Se utilizaron como fuentes de informacion los formularios de autorizacion para internacion hospitalaria (AIH), las guias de autorizacion de pagos (GAP) y los boletines de la Administracion de Recursos Humanos. Con la estrategia de remuneracion y de incentivo condicional adoptada se procuraba no solo mejorar la produccion y la productividad, sino tambien aumentar el compromiso de los empleados con la institucion. El analisis de los valores de los indicadores seleccionados parece confirmar que los resultados de este estudio coinciden con los de otros estudios similares en el sentido de que la remuneracion basada en los resultados (o incentivo condicional) conduce a un cambio positivo en el nivel de produccion de servicios y productividad aunque no se sostenga a lo largo del tiempo. Corrobora asimismo la idea de que esas alternativas pueden utilizarse deliberadamente como parte de una estrategia mas general de desarrollo organizacional a largo alcance, y no solamente como un elemento aislado dirigido a lograr mejorias puntuales y temporales en la productividad.

Expanding the primary health care workforce through contracting with nongovernmental entities: the cases of Bahia and Rio de Janeiro

BackgroundBrazil has experienced difficulties in attracting health professionals (especially doctors and nurses) to practice at the primary health care (PHC) level and in rural and remote areas. This study presents two case studies, each a current initiative in contracting for primary health services in Brazil: one for the state of Bahia and the other for the city of Rio de Janeiro. The two models differ considerably in context, needs, modalities, and outcomes. This article does not attempt to evaluate the initiatives but to identify their strengths and weaknesses.MethodsAnalysis was based on indicators produced by the Brazilian health care information systems, a review of literature and other documentation, and key informant interviews.ResultsIn the case of Bahia, the state and municipalities decided to create a State Foundation, a new institutional public entity acting under private law that centralizes the hiring of health professionals in order to offer stable positions with career plans and mobility within the state. Results have been mixed as a lower than expected municipal involvement resulted in relatively high administrative costs and consequent default on municipal financial contributions. In the case of Rio de Janeiro, the municipality opted to contract not-for-profit Social Organizations as it made a push to expand access to primary health care in the city. The approach has been successful in expanding coverage, but evidence on cost and performance is weak.ConclusionsBoth cases highlight that improvements in cost and performance data will be critical for meaningful comparative evaluation of delivery arrangements in primary care. Despite the different institutional and implementation arrangements of each model, which make comparison difficult, the analysis provides important lessons for contracting out health professionals for PHC within Brazil and elsewhere.