O Programa Mais Médicos: A Formulação De Uma Nova Política Pública De Saúde No Brasil

Abstract

O Programa Mais Médicos, ao contratar profissionais médicos para atuar nas regiões prioritárias para o SUS, visa ampliar o acesso da população à atenção básica de saúde. Este estudo resgata o processo de formulação deste programa, pela perspectiva do Modelo de Múltiplos Fluxos, desenvolvido por John Kingdon, com ênfase nos embates estabelecidos entre os Poderes Executivo e Legislativo. Analisa, ainda, a Exposição de Motivos Interministerial n.º 024/2013-MS/MEC/MP, a Medida Provisória n.º 621/2013 e o Projeto de Lei de Conversão n.º 026/2013-CN que culminaram na edição da Lei n.º 12.871/2013. Ao final, são apresentados resultados pontuais para explicitar a perenidade da agenda governamental de saúde pública nacional frente à atuação dos atores envolvidos neste processo e seus interesses e estratégias aplicados com o objetivo de influenciar os decisores políticos para a formulação do Programa.

Programa Mais Médicos: análise documental dos eventos críticos e posicionamento dos atores sociais

“…They also mentioned competition for manpower between certain cities, based on attractive compensation (high wages), which generated high turnover among these professionals and discontinuity in health initiatives 6,10,16,[26][27][28][29][30][31][32] . Given the lack of an international parameter to measure the ideal ratio of physicians in a country, it was agreed to use the parameter from the United Kingdom (2.7 physicians per thousand inhabitants), since that country has a universal health system.…”

“…To assist with hiring foreign physicians whose diplomas were not formally recognized Physicians who were not registered with the Federal Council of Medicine obtained a special registration through the Ministry of Health that allowed them to work in activities defined by the MDP 5,16,21,36,49 . Dispensing with the formal process for recognizing the diplomas of these physicians upset some of the medical associations, which alleged state interference in the autonomy of the federal and regional councils of medicine.…”

“…As an alternative, visiting physicians were required to participate in an orientation process to assess their proficiency in Portuguese, communication skills and qualifications, in order to provide a deeper theoretical and practical understanding of the principles and guidelines of the SUS, through monitoring and evaluation by academic tutors 16,29 .…”

“…Another issue discussed was the recruitment of a large contingent of foreign physicians from Cuba to fill the first set of places in the MDP selection notices, due to the technical cooperation agreement 19,25,36,50 However, the rights of visiting physicians were guaranteed according to international agreements 16 and Brazilian physicians were given the right to register for through the Primary Healthcare Unit Requalification Program 56 , increased expenditures related to the computerization of these units, implementation of a new primary care information system and the e-SUS strategy, with electronic medical records for health services 25 , were considered essential to boost the effectiveness of primary care 19 . The law also referred to the creation of Public Health Organizational Contracts in education and health 14,25 .…”

“…The positions and management of government resources by social actors triggered a series of divergent "initiatives" in the local, regional and national implementation of the MDP. It was also possible to identify secondary actors, classifying them as allies, opponents or indifferent actors in relation to the central actors (Ministry of Health and Ministry of Education) 6,10,16,[26][27][28][29][30][31][32]57 . Table 3 Regarding initiatives to legitimize the MDP, it was possible to identify political, technical and tactical negotiations of the central actors 5,15,16,35 .…”