The end of Brazil’s More Doctors programme?

Santos, Leonor Maria Pacheco; Millett, Christopher; Rasella, Davide; Hone, Thomas

doi:10.1136/bmj.k5247

Cited by 9 publications

(6 citation statements)

References 10 publications

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“…In the 2013–2015 period, there was a substantial expansion in smaller municipalities, and the increase in the physician-inhabitant ratio in these locations were similar to that found in larger municipalities, especially when considering only physicians practicing in the SUS. These results reflect the importance of the PMMB's recruitment component and the government incentives to expand primary care in SUS to reduce inequalities in access to healthcare, although physicians graduated in Brazil and Brazilians trained in other countries have priority in the recruitment program, Cuban physicians, recruited as part of a Brazilian government cooperation with Cuba government, were an important contingent of professionals who practiced in rural and remote areas [ 9 , 26 ]. This cooperation generated intense debate during its establishment.…”

Section: Discussionmentioning

confidence: 99%

“…In December 2019, the federal government created the Doctors for Brazil Program [ 27 ]. This program established a new structure to expand the hiring of physicians in underserved areas and revoked the changes in the training of specialists defined by the PMMB [ 26 ]. However, none of the new measures proposed to increase the number of physicians in underserved areas of this program have been implemented.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating medical education regulation changes in Brazil: workforce impact

et al. 2021

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Background Shortages and inequitable distribution of physicians is an obstacle to move towards Universal Health Coverage, especially in low-income and middle-income countries. In Brazil, expansion of medical school enrollment, curricula changes and recruitment programs were established to increase the number of physicians in underserved areas. This study seeks to analyze the impact of these measures in reduce inequities in access to medical education and physicians’ distribution. Methods This is an observational study that analyzes changes in the number of undergraduate medical places and number of physicians per inhabitants in different areas in Brazil between the years 2010 and 2018. Data regarding the number of undergraduate medical places, number and the practice location of physicians were obtained in public databases. Municipalities with less than 20,000 inhabitants were considered underserved areas. Data regarding access to antenatal visits were analyzed as a proxy for impact in access to healthcare. Results From 2010 to 2018, 19,519 new medical undergraduate places were created which represents an increase of 120.2%. The increase in the number of physicians engaged in the workforce throughout the period was 113,702 physicians, 74,771 of these physicians in the Unified Health System. The greatest increase in the physicians per 1000 inhabitants ratio in the municipalities with the smallest population, the lowest Gross Domestic Product per capita and in those located in the states with the lowest concentration of physicians occurred in the 2013–2015 period. Increase in physician supply improved access to antenatal care. Conclusions There was an expansion in the number of undergraduate medical places and medical workforce in all groups of municipalities assessed in Brazil. Medical undergraduate places expansion in the federal public schools was more efficient to reduce regional inequities in access to medical education than private sector expansion. The recruitment component of More Doctors for Brazil Program demonstrated effectiveness to increase the number of physicians in underserved areas. Our results indicate the importance of public policies to face inequities in access to medical education and physician shortages and the necessity of continuous assessment during the period of implementation, especially in the context of political and economic changes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluating medical education regulation changes in Brazil: workforce impact

et al. 2021

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“…These declines in ESF coverage are based on published forecasts [8], whilst a range of possible declines is tested in sensitivity analyses (Additional file 1). A contracting ESF coverage as above and termination of the MMP, which could end in 2019 due to the lack of political support from the new government [21]. This scenario additionally models specific ESF coverage declines in municipalities where Mais Médicos doctors operate.A UHC scenario, where ESF coverage increases to 100% in all municipalities by 2030, reflecting SDG 3, target 3.8 [2].…”

Section: Introductionmentioning

confidence: 99%

“…A contracting ESF coverage as above and termination of the MMP, which could end in 2019 due to the lack of political support from the new government [21]. This scenario additionally models specific ESF coverage declines in municipalities where Mais Médicos doctors operate.…”

Section: Introductionmentioning

confidence: 99%

Mortality associated with alternative primary healthcare policies: a nationwide microsimulation modelling study in Brazil

Rasella

Hone

Souza

et al. 2019

BMC Med

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Background Brazil’s Estratégia Saúde da Família (ESF) is one of the largest and most robustly evaluated primary healthcare programmes of the world, but it could be affected by fiscal austerity measures and by the possible end of the Mais Médicos programme (MMP)—a major intervention to increase primary care doctors in underserved areas. We forecast the impact of alternative scenarios of ESF coverage changes on under-70 mortality from ambulatory care-sensitive conditions (ACSCs) until 2030, the date for achievement of the Sustainable Development Goals (SDGs). Method A synthetic cohort of 5507 Brazilian municipalities was created for the period 2017–2030. A municipal-level microsimulation model was developed and validated using longitudinal data and estimates from a previous retrospective study evaluating the effects of municipal ESF coverage on mortality rates. Reductions in ESF coverage, and its effects on ACSC mortality, were forecast based on two probable austerity scenarios, compared with the maintenance of the current coverage or the expansion to 100%. Fixed effects longitudinal regression models were employed to account for secular trends, demographic and socioeconomic changes, healthcare-related variables, and programme duration effects. Results Under austerity scenarios of decreasing ESF coverage with and without the MMP termination, mean ACSC mortality rates would be 8.60% (95% CI 7.03–10.21%; 48,546 excess premature/under-70 deaths along 2017–2030) and 5.80% (95% CI 4.23–7.35%; 27,685 excess premature deaths) higher respectively in 2030 compared to maintaining the current ESF coverage. Comparing decreasing ESF coverage and MMP termination with achieving 100% ESF coverage (Universal Health Coverage scenario) in 2030, mortality rates would be 11.12% higher (95% CI 9.47–12.76%; 83,937 premature deaths). Reductions in ESF coverage would have stronger effects on mortality from infectious diseases and nutritional deficiencies and would disproportionately impact poorer municipalities, with the concentration index for ACSC mortality 11.77% higher (95% CI 0.31–22.32%) and also ending historical declines in racial health inequalities between white and black/pardo Brazilians. Conclusions Reductions in primary healthcare coverage due to austerity measures are likely to be responsible for many avoidable deaths and may preclude achievement of SDGs for health and inequality in Brazil and in other low- and middle-income countries. Electronic supplementary material The online version of this article (10.1186/s12916-019-1316-7) contains supplementary material, which is available to authorized users.

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“…In this sense, several studies have shown that the PMM mainly allowed the concretization of the principle of equity, through the distribution of doctors in PHC according to the criteria of social vulnerability and of specific populations [21][22][23][24][25] . It provided the presence of doctors in areas of difficult access, of extreme poverty, far from large centers, in the outskirts of metropolitan regions, and indigenous populations, as well as riverside, quilombolas, and rural populations [21][22][23][24][25] , who were previously excluded from the system. Nevertheless, it must be considered that, initially, part of the medical corporation was in opposition to the program, mainly due to the arrival of a large number of Cuban doctors 26 , which contributed to the creation of negative perceptions of these doctors and the program [27][28][29] .…”

Section: Discussionmentioning

confidence: 99%

Percepções acerca do Programa Mais Médicos e do Processo de Supervisão Acadêmica

Shimizu

Santos

Sanchez

et al. 2020

Rev. bras. educ. med.

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Introduction: This study aims to analyze the perceptions of the involved actors about the “Mais Médicos” Program (PMM) and the academic supervision process, its strengths and weaknesses aiming to improve Primary Heath Care practices. Method: Qualitative study carried out through 05 in-depth interviews with PMM supervising doctors, and 24 interviews with unit managers, 12 Primary Heath Care coordinators, and 07 Secondary Health Care doctors. Results: Three thematic axes emerged from de analysis: benefits of the program for the municipalities and for the population; the challenges of the supervisory process and the difficulties of the fragmented health system. Conclusions: The actors’ perception of the “Mais Médicos” Program are positive, especially because it brought doctors to municipalities with vulnerable areas, where doctors did not go to and where they did not stay. Supervision is an important support for continuing in-service training; however, it requires a better articulation with the different levels of the health system management. The precariousness of the service network limits the performance of both doctors and supervisors, demonstrating that it is necessary to invest in a solid and effective care network. Moreover, it was once again evident that the population will face a shortage of doctors due to changes in health policies. It is necessary to build more comprehensive policies, that will not only result in sporadic provision of medical care. There is a need for continuous actions, better integrated to the healthcare networks, aiming at an efficient and effective healthcare system.

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The end of Brazil’s More Doctors programme?

Abstract: Those in greatest need will be hit hardest

Cited by 9 publications

References 10 publications

Evaluating medical education regulation changes in Brazil: workforce impact

Evaluating medical education regulation changes in Brazil: workforce impact

Mortality associated with alternative primary healthcare policies: a nationwide microsimulation modelling study in Brazil

Percepções acerca do Programa Mais Médicos e do Processo de Supervisão Acadêmica

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