Abstract
The shortage of physicians in remote and underprivileged areas poses an obstacle to universal access and quality of health care. Through the More Doctors Program (PMM), as of 2015, 18 thousand physicians had been incorporated into Brazil's Unified National Health System (SUS) to work in basic care, 79% of whom were Cubans. This article analyzed the comprehensiveness of practices by Cuban physicians in the PMM using a qualitative study in the city of Rio de Janeiro, Brazil, based on interviews with Cuban physicians (24) and a focus group with supervisors of the PMM (4). Comprehensiveness was analyzed in two dimensions: the community-oriented biopsychosocial approach to care and the range of activities in health promotion, prevention, and care. The work by Cuban physicians presents elements that are consistent with the comprehensiveness of practices in primary care, providing a wide range of care and services, in keeping with the health problems' complexity and the plurality of settings. These health workers show outstanding capacity for community interaction, a preventive focus, planning of activities, and positive interpersonal team relations. The study identified attitudes and techniques of solidarity, physician-patient bonding, and community accountability. Challenges were identified in the promotion of participatory practices with communities, the expansion of users' autonomy in clinical decisions, management of psychological problems, systematization of approach tools, and performance of invasive procedures. The study furnishes strong evidence that the PMM, in addition to medical consultations, provides comprehensive health care and contributes to strengthening basic care in Brazil.
Highlights
Health workforce shortage is one of the bottlenecks to universal access to health care 1
Territorial dynamics are valued in the practices by the Cuban physicians in the PMM
Follow-up of all people enrolled in the Brazilian Income Transfer Program in the territory Special action in cases of social vulnerability Community diagnosis with local leaders Community accountability Participation in local health council
Summary
Health workforce shortage is one of the bottlenecks to universal access to health care 1. Factors such as the demographic and epidemiological transition and the implementation of new health care models affect the need for health workers, and less developed and peripheral regions are generally the most underserved in terms of the availability and quality of the health workforce 2. In addition to posing a problem for equity, workforce concentration leads to inefficiency in health systems 3. As for global distribution of physicians, despite an increase in the total number, the pattern is one of concentration in large cities and shortages in rural areas 4. Regulation of the health workforce has been a global challenge. The medical profession’s interests are not impartial; on the contrary, the profession takes organized moves to maintain the undersupply through regulation of human resources and pressure on health systems in favor of liberal medical practice
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