A escassez de profissionais de saúde em áreas remotas e vulneráveis é um importante obstáculo para a universalização do acesso à saúde em diversos países. Este artigo examina as políticas de provimento de profissionais de saúde na Austrália, nos Estados Unidos da América e no Brasil. Apesar do sucesso parcial de iniciativas anteriores, foi apenas com o Programa Mais Médicos que a provisão de médicos em áreas vulneráveis teve a magnitude e a resposta em tempo adequado para atender a demanda dos municípios brasileiros. Estão em curso, no país, mudanças quantitativas e qualitativas na formação médica, que buscam garantir não apenas a universalidade, mas, também, a integralidade e sustentabilidade do Sistema Único de Saúde. O êxito dessas iniciativas dependerão da continuidade da articulação interfederativa, de políticas regulatórias de estado, bem como, do constante monitoramento e aprimoramento do programa.

The More Doctors Program was created in 2013 to address challenges that constrained the expansion and development of PC, mainly the insufficiency and maldistribution of physicians and the inadequate training profile related to the needs of the population. The program consists of three axes: emergency provision, improvement of infrastructure and changes in training. This paper performs documentary and literature review as well as analysis of official databases with the objective of evaluating the results achieved up to 2015 with regards to physicians supply. We identified important advances in the allocation of physicians with equity; in the expansion of PC coverage; in expanding access to basic health care for the population; its impact on health indicators; and the positive evaluation made by users, physicians and managers regarding the program. As a conclusion, challenges faced by the program to effectively achieve its objectives are pointed out.

RESUMO Existe ampla evidência que a contenção da pandemia de Covid-19 requer vigilância sindrômica e isolamento de casos suspeitos/confirmados. É essencial a disponibilidade de testes diagnósticos no Sistema Único de Saúde, que poderia ser facilitada pela soberania nacional no desenvolvimento e produção, considerando-se a alta demanda/escassez no mercado internacional. Este estudo identificou as etapas da pesquisa translacional de testes diagnósticos para Covid-19 no Brasil, verificando sua distribuição geográfica, entre outros indicadores. Estudo transversal, exploratório, partindo de banco público com 789 projetos de Pesquisa, Desenvolvimento e Inovação (PD&I) em Covid-19, complementado com outras buscas, inclusive no CVLattes dos pesquisadores. No banco, havia 89 projetos de testes diagnósticos. Em 45 casos, foi possível obter informações complementares para classificá-los conforme as etapas da pesquisa translacional. Identificaram-se 15 inovações que atingiram o estágio T3, ou seja, tiveram seus produtos incorporados em protocolos clínicos na atenção à saúde, mesmo considerando-se as profundas restrições orçamentárias em PD&I. O Brasil possui potencial de desenvolvimento e implementação de produtos tecnológicos na área de testes de diagnóstico para Sars-CoV-2. Políticas públicas de PD&I em saúde necessitam ser priorizadas para ampliação de cooperações nacionais e internacionais, a fim de promover efetiva autonomia nacional na vigilância sindrômica e à saúde da população.

Background The “ Mais Médicos (More Doctors) Program” established in 2013 by the Brazilian Government aimed to reduce inequalities by means of an emergency provision of physicians, the improvement of medical care service in the Brazilian Unified Health System, and the expansion of medical education training in Brazil. In this context, equity should be considered when defining priorities and allocating resources. This study describes the distribution of physicians for the Program in five Brazilian metropolitan regions (MRs) and analyses whether the most vulnerable areas within each one of these regions had been prioritized in compliance with the legislation framework of the program. Methods This is a quantitative cross-sectional study. Official secondary data was analyzed to verify the relationship between the Index of Social Vulnerability, set up by the Institute of Applied Economic Research, and the physician allocation provided by the Program. The data were organized into categories and quintiles. For spatialization purposes, the QGIS 3.4 Madeira software was used. Results There are 2592 primary health care units, (in Portuguese, UBS), within the five MRs studied; 981 of these hosted at least one physician from the Program. In the Manaus, Recife, and the DF MRs, the 4th and 5th quintiles (the most vulnerable ones) hosted physicians in more significant proportions than the other quintiles, namely, 71.4%, 71.4%, and 52.2%, respectively, exceeding the national average (51.7%). It is worth mentioning that in the São Paulo MR, the units located in the most vulnerable quintiles (4th and 5th) also hosted physicians in proportions significantly higher than others (45.8%); however, this proportion did not reach 50%. There was no significant difference in the allocation of physicians in the Porto Alegre MR, indicating that there was no prioritization of the UBS according to vulnerability. Conclusions These results appoint to the enormous gaps of vulnerability existing both between the analyzed MRs and internally in each one of them. It emphasizes the need for criteria for the allocation of physicians so as not to increase inequities. It also highlights the importance of the continuity of the “ Mais Médicos (More Doctors) Program” in the metropolitan regions, above all, in areas of extreme vulnerabilities. On the other hand, they contribute to the national debate about the importance of public policies regarding constitutional rights related to access to health care and the relevance of primary care and the “ Mais Médicos (More Doctors) Program” for the reduction of disparities regarding access to health care, especially for the citizens who live in regions of greater vulnerability, whether it is inside or outside large metropolitan regions.

There is much evidence suggesting that mitigating the COVID-19 pandemic requires syndromic surveillance and isolation of suspected/confirmed cases. The availability of diagnostic tests in the Brazilian Unified Health System (SUS) is essential, which could be facilitated by national sovereignty in development and production, considering the high demand/lack of supply in the international market. This study identified the stages of translational research into diagnostic tests for COVID-19 in Brazil, verifying their geographic distribution, among other indicators. A cross-sectional, exploratory study based on a public database with 789 Research, Development, and Innovation (RD&I) projects regarding COVID-19, complemented by other searches, including the researchers’ curricula (CVLattes). There were 89 diagnostic test projects in the database. In 45 cases, it was possible to obtain additional information to classify them according to the translational research stages. Fifteen innovations that reached the T3 stage were identified, with their products incorporated into clinical protocols in healthcare, even considering the deep budget restrictions in RD&I. Brazil has the potential to develop and implement technological products in the field of diagnostic tests for SARS-CoV-2. Public health RD&I policies need to be prioritized to expand national and international cooperation to promote effective national autonomy in syndromic surveillance and population health.