Análise do ciclo de política do Programa Mais Médicos no Brasil: cooperação Cuba Brasil e seus efeitos para o trabalho médico

Abstract

The education and provision of health professionals are the main strategies to increase capacity and respond to health systems' needs among countries worldwide. Recently, the Brazilian government passed a law to create a national program, called the More Doctors Program, to improve the capacity to respond to the demand for doctors in underserved areas. The law was designed with three main axes: provision, education and infrastructure. The first, provision, would increase the provision of medical doctors through monetary and non-monetary incentives to attract national and foreign doctors to work in remote areas. The education axis was related to opening new Courses and Institutions to graduate new doctors in remote areas. The third axis was to improve primary care facilities. However, the most controversial aspect of this Program was the partnership between Cuba and Brazil, through an international cooperation mediated by the Pan-American Health Organization. It involved 18,240 new primary care physicians. Focusing on provision, mainly in the Brazil-Cuba international cooperation, a qualitative study was designed and conducted, analyzing the More Doctors policy cycle, using Howlet & Ramesh, 2003 as well as Ball, 1992 as a reference. This study examined the five stages of the policy cycle: agenda preparation, policy formulation, decision making, implementation and evaluation and Practitioners. In addition, there could be an influence of the Cuban socialist model. The Cuban doctors bring a new perspective to Brazilian health professionals on how to build linkages with the users and how to deal with poverty and inequity. On the micro level, both groups benefited from ongoing learning strategies, supervisions in locus, distance learning courses, round tables on the main health problems, group practice sharing, and the interchange on health local planning. The main problems involve the temporary nature of the provision strategy, which is not well resolved with the Brazilian medical corporations and professional bodies. Furthermore, the supervisions are not always well organized by the Universities. The study also shows the fragilities of federative integration regarding policy implementation and management.

Analysis of the formulation process of the Mais Médicos Program

“…Furthermore, we had to analyze the role of entrepreneurs who led the PMM formulation process to assess its decisive moments and fundamental characteristics. Studies, such as Gomes (2016) and Paula (2017), found these individuals as protagonists in the PMM implementation but ignored the analysis of their role in its formulation. Strategically positioned in the Ministry of Health, MEC, and the National Congress, since the beginning of Dilma's Government, they acted strategically to create and seize "windows of opportunity," aiming to change an institutional arrangement which had been stable until then (Pinto;Côrtes, 2021a).…”

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

“…Finally, this pedagogical relationship enables a cultural, technical and scientific exchange that brings innovation and a "mosaic of possibilities" to public health policies and medical education in the country 14 . Some professionals, for example, have experience in management, teaching and research, and could contribute with scientific production in the area, with indigenous health protocols or supervising interns from Rural Residency 15 , not being restricted to healthcare in the villages.…”

“…Supervisors' motivation varies according to the doctor's perception of the work's nature. It can be humanitarian, mainly based in solidarity and internationalist vocation to some Cubans 14,26 ; temporary, mainly among Brazilians who want to work in medical residency or between foreigners and Brazilians graduated overseas who want to revalidate their diploma; or realistic, as real agents in a public health system under construction.…”