Abstract
Abstract: Introduction: The scarcity and inequalities in the geographical distribution of physicians challenge the consolidation of the right to health and create migratory flows that increase health inequities. Due to their complex and multidimensional characteristics, they demand multisectoral political approaches, considering several factors related to the availability and area of practice of medical doctors, as well as the social vulnerability of local populations. Objective: This study aimed at analysing results of the “Mais Médicos” (More Doctors) Program Educational Axis in Brazil. Methodology: A documental research was conducted, highlighting the location and the public or private nature of new undergraduate medical school vacancies between the years 2013 until 2017, which were then compared to the goals and strategies outlined in the official Program documents. Results: The Educational Axis reached important milestones despite the resistance of some institutional actors. The Program extended its undergraduate vacancies by 7696 places, 22.48% of that in public institutions and 77.52% in private ones. Vacancy distribution prioritized cities in rural areas of Brazil, at the same instance bringing forward significant regulatory changes for undergraduate medical courses. However, political disputes with representatives of medical societies and stakeholders interested in favouring the private educational and healthcare sectors surface in the official discourses and documents. These factors weakened the program normative body, creating a hiatus between its core objectives and respective implementation. Evidence related to the concentration of vacancies in the Southeast regions allow the maintenance of a known unequal workforce distribution, despite a proportionally bigger increase in the Midwest, North and Northeast regions. Conclusion: The predominance of vacancies in private institutions and the weakening of the new undergraduate courses monitoring instruments can compromise changes in the graduate students’ profiles, which are necessary for the fixation of physicians in strategic geographic areas to promote Primary Healthcare.
Highlights
The scarcity and inequalities in the geographical distribution of physicians challenge the consolidation of the right to health and create migratory flows that increase health inequities
Vacancy distribution prioritized cities in rural areas of Brazil, at the same instance bringing forward significant regulatory changes for undergraduate medical courses
The predominance of vacancies in private institutions and the weakening of the new undergraduate courses monitoring instruments can compromise changes in the graduate students’ profiles, which are necessary for the fixation of physicians in strategic geographic areas to promote Primary Healthcare
Summary
The scarcity and inequalities in the geographical distribution of physicians challenge the consolidation of the right to health and create migratory flows that increase health inequities Due to their complex and multidimensional characteristics, they demand multisectoral political approaches, considering several factors related to the availability and area of practice of medical doctors, as well as the social vulnerability of local populations. Among the recommendations of the World Health Organization (WHO) to deal with the problem, educational policies stand out as the strategies with the most impact in the medium and long-term for health systems[4,5,6] These measures involve the opening of courses or the increase in the number of undergraduate medical school vacancies in regions with a shortage of doctors, the selection of students from these areas and changes in the curricula introducing topics and internships that value local needs and Primary Health Care (PHC). The location of new courses in underserved regions and their public or private characteristics may favor this selection, being considered important predictors of fixation[12]
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