Abstract
Abstract: 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.
Highlights
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
Similar problems can be observed in Brazil[6], despite efforts to improve the distribution of doctors across the country, especially in Primary Health Care (PHC), which is a strategy to improve the population’s equitable access to health services[7]
The perceptions of the actors involved in the Programa Mais Médicos (PMM) are quite positive, of a program that brought doctors to the municipalities located in remote and vulnerable areas, where doctors did not go and did not stay, allowing the population to have access to basic health services[21,22,23,24], which is guaranteed in the current Constitution as a right of all citizens, but still finds difficulties to be guaranteed, especially in the PHC, which provides the services to the vast majority of the population[7,21]
Summary
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. Similar problems can be observed in Brazil[6], despite efforts to improve the distribution of doctors across the country, especially in Primary Health Care (PHC), which is a strategy to improve the population’s equitable access to health services[7] Countries such as Iran, Thailand, Canada, Australia and Japan have approached the issue in a systematic way, and demonstrated that interventions, when fragmented, led to negative results[2,3,8], suggesting the construction of broader policies, based on a continuous and non-sporadic planning process, accompanied by monitoring and evaluation. The Mais Médicos Program (PMM, Programa Mais Médicos) was created in 2013, with several strategies to attract, recruit and retain doctors in remote and vulnerable areas It had an intersectoral articulation, with the involvement of the Ministry of Health (MS), the Ministry of Education (MEC), as well as the states and municipalities. It had three lines of action: a) emergency provision of doctors by hiring Brazilian doctors, Brazilian doctors trained abroad and foreign doctors to work in remote and vulnerable regions[6,9], improving the infrastructure of basic health units (BHU), change in the curricular matrix of medical courses with greater emphasis on PHC and the increase in the number of vacancies[6,9]
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