Abstract
BackgroundA shortage of physicians, especially in vulnerable and peri-urban areas, is a global phenomenon that has serious implications for health systems, demanding policies to assure the provision and retention of health workers. The aim of this study was to analyze the strategies employed by the More Doctors Program (Programa Mais Médicos) to provide primary care physicians in vulnerable and peri-urban parts of Greater Brasilia.MethodsThe study used a qualitative approach based on the precepts of social constructivism. Forty-nine semi-structured interviews were conducted: 24 with physicians employed as part of the More Doctors program, five with program medical supervisors, seven with secondary care physicians, twelve with primary care coordinators, and one federal administrator. The interviews occurred between March and September 2019. The transcripts of the interviews were submitted to thematic content analysis.ResultsThe partnership between the Ministry of Health and local authorities was essential for the provision of doctors—especially foreign doctors, most from Cuba, to assist vulnerable population groups previously without access to the health system. There was a notable presence of doctors with experience working with socioeconomically disadvantaged populations, which was important for gaining a better understanding of the effects of the endemic urban violence in the region. The incentives and other institutional support, such as enhanced salaries, training, and housing, transportation, and food allowances, were factors that helped provide a satisfactory working environment. However, the poor state of the infrastructure at some of the primary care units and limitations of the health service as a whole were factors that hampered the provision of comprehensive care, constituting a cause of dissatisfaction.ConclusionsMore Doctors introduced a range of novel strategies that helped ensure a supply of primary care doctors in vulnerable and peri-urban parts of Greater Brasilia. The inclusion of foreign doctors, most from Cuba, was crucial for the success of the health services provided for the local communities, who subsist in violent and socioeconomically deprived urban areas. However, it became clear that barriers from within the health service itself hampered the physicians’ capacity to provide a satisfactory service. As such, what is needed for primary care to be effective is not just the recruitment, training, and deployment of doctors, but also investment in the organization of the whole health system.
Highlights
A shortage of physicians, especially in vulnerable and peri-urban areas, is a global phenomenon that has serious implications for health systems, demanding policies to assure the provision and retention of health workers
The More Doctors program (Programa Mais Médicos) was created in 2013, in response to a diagnostic analysis of the situation, which found that there were 1.8 physicians per 1000 inhabitants in Brazil—a number below that found in other countries with universal health coverage, such as Canada (2.4), the UK (2.7), Spain (3.5), and Portugal (3.8), and the mean of the 33 countries in the Organization for Economic Co-operation and Development [8, 9]
The aim of this study was to analyze the strategies used by the More Doctors program, and whether they helped or hindered the provision of primary care doctors in vulnerable and peri-urban areas in municipalities from Greater Brasilia, according to actors who were involved in the program and, as such, are important bearers of knowledge, attitudes, and perceptions and are certainly influenced by the organizational capacity of the institution [15, 16]
Summary
A shortage of physicians, especially in vulnerable and peri-urban areas, is a global phenomenon that has serious implications for health systems, demanding policies to assure the provision and retention of health workers. Most were Cuban (79.0%), followed by Brazilians licensed with the Regional Medicine Council (Conselho Regional de Medicina, CRM) (12.8%), Brazilians with degrees from abroad (3.1%), and doctors of other nationalities (5.1%) [11] They were mostly deployed to more remote and vulnerable areas of the country, where the shortage of primary health physicians was most pronounced [10, 11]. The program provided doctors for peri-urban areas, which had for many years coped with major deficiencies and/or an unreliable supply of physicians in their primary healthcare teams These are transition areas between cities and the countryside, which often have unplanned urban developments with extremely vulnerable populations. They constitute a new type of multifunctional territory that has little in the way of institutional integration [12]
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