Privatization and geographic inequalities in the distribution and expansion of higher nursing education in Brazil

Soares, Fabiana Alves; Oliveira, Bruno Luciano Carneiro Alves de

doi:10.1590/0034-7167-2021-0500

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (04) • 2022 • https://doi.org/10.1590/0034-7167-2021-0500 copy

Privatization and geographic inequalities in the distribution and expansion of higher nursing education in Brazil

Privatización y desigualdades geográficas en la distribución y expansión de la educación superior en enfermería en Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to analyze the influence of privatization and geographic inequalities in the distribution and expansion of higher education in nursing in Brazil.

Methods:

a cross-sectional study, with online data of 1,244 courses and 190,610 nursing vacancies, started between 1890 and 2019. Proportions were estimated and differences were verified with statistical tests (α=5%), vacancy rate per 10,000 inhabitants and private ratio/public.

Results:

there was an accelerated, disorderly and heterogeneous growth in the number of courses and vacancies for nursing over 129 years, with strong private influence, favoring their concentration in large urban centers, capitals and richer states.

Conclusions:

the significant expansion of higher education in nursing in Brazil occurred with excessive private supply and unequal distribution between its locations, indicating the need for state regulation in the opening of new courses and vacancies, which can minimize the negative repercussions on the quality of education, health care and workforce imbalances.

Descriptors:
Nursing; Schools of Nursing; Educational Institutions; Education; Higher; Privatization

Distribution	Courses						p value^* * Pearson’s chi-square test; 1- Small size: <50,000 inhabitants and demographic density (DD) <80 inhabitants/km2; Medium size: 50,000 to 100,000 inhabitants or DD ≥80 inhabitants/km2; Large: >100,000 inhabitants.	Vacancies						p value^* * Pearson’s chi-square test; 1- Small size: <50,000 inhabitants and demographic density (DD) <80 inhabitants/km2; Medium size: 50,000 to 100,000 inhabitants or DD ≥80 inhabitants/km2; Large: >100,000 inhabitants.
	Private		Public		Total			Private		Public		Total
	n	%	n	%	n	%		n	%	n	%	n	%
Type of administration	1,069	85.9	175	14.1	1,244	100		179,384	93.6	11,235	6.4	190,619	100
Federal
State			87	49.7	87	7.0				5,310	47.2	5,310	2.7
Municipal			72	41.2	72	5.8	---			4,085	36.4	4,085	2.2	----
Private			16	9.1	16	1.3				1,840	16.4	1,840	1.0
Location of courses	1,069	100			1,069	85.9		179,384	100			179,384	94.1
Capital
Metropolitan Region (excluding capital)	383	35.8	52	29.7	435	35.0		86,345	48.1	3,722	33.1	90,067	47.2
Countryside of the state	216	20.2	22	12.6	238	19.1	0.002	34,079	19.0	1,475	13.1	35,554	18.7	0.001
Population size¹1 Diniz RV, Goergen PL. Educação superior no Brasil: panorama da contemporaneidade. Avaliação. 2019;24(3):573-93. https://doi.org/10.1590/s1414-40772019000300002 https://doi.org/10.1590/s1414-4077201900... of cities in 2010^* * Pearson’s chi-square test; 1- Small size: <50,000 inhabitants and demographic density (DD) <80 inhabitants/km2; Medium size: 50,000 to 100,000 inhabitants or DD ≥80 inhabitants/km2; Large: >100,000 inhabitants.	470	43.0	101	57.7	571	45.9		58,960	32.9	6,038	53.8	64,998	34.1
Large
Medium	784	73.3	117	66.9	901	72.4	0.203	149,916	83.6	7,811	69.5	157,727	82.8	0.001
Small	194	18.2	40	22.8	234	18.8		20,706	11.5	2,412	21.5	23,118	12.1
Pequeno porte	91	8.5	18	10.3	109	8.8		8,763	4.9	1,012	9.0	9,774	5.1

Private/public number of vacancies ratio	Course start year
Private/public number of vacancies ratio	1890 to 1939	1940 to 1949	1950 to 1959	1960 to 1969	1970 to 1979	1980 to 1989	1990 to 1999	2000 to 2009	2010 to 2019	Total
Brazil	0.4	0.9	2.0	4.5	0.7	9.2	9.8	19.6	63.4	16.0
Location of courses
Capital	0.4	0.8	1.4	4.5	0.7	15.6	21.0	60.9	834.4	23.2
Metropolitan Region (excluding capital)	0.0	1.1	0.0^ There is no record of public vacancies in these locations.	0.0	1.7	45.6	46.7	19.0	115.3	23.1
Countryside of the state	0.0	0.0	2.4	0.0	0.3	3.5	2.9	10.6	22.3	9.8
Population size¹1 Diniz RV, Goergen PL. Educação superior no Brasil: panorama da contemporaneidade. Avaliação. 2019;24(3):573-93. https://doi.org/10.1590/s1414-40772019000300002 https://doi.org/10.1590/s1414-4077201900... of cities in 2010^* * Pearson’s chi-square test; 1- Small size: <50,000 inhabitants and demographic density (DD) <80 inhabitants/km2; Medium size: 50,000 to 100,000 inhabitants or DD ≥80 inhabitants/km2; Large: >100,000 inhabitants.
Large	0.4	0.9	1.9	4.5	0.6	8.8	10.1	34.6	173.3	19.2
Medium	0.0	0.0	0.0	0.0	6.0	10.0	12.3	5.0	32.5	8.6
Small	0.0	0.0	0.0	0.0	0.0	0.0^ There is no record of public vacancies in these locations.	0.0	9.0	8.6	8.7

Geographic distribution	Courses¹1 Diniz RV, Goergen PL. Educação superior no Brasil: panorama da contemporaneidade. Avaliação. 2019;24(3):573-93. https://doi.org/10.1590/s1414-40772019000300002 https://doi.org/10.1590/s1414-4077201900...						p value^* * Pearson’s chi-square test; 1- Difference in the distribution of courses (p-value=0.001) and vacancies (p-value=0.001) between regions;	Vacancies¹1 Diniz RV, Goergen PL. Educação superior no Brasil: panorama da contemporaneidade. Avaliação. 2019;24(3):573-93. https://doi.org/10.1590/s1414-40772019000300002 https://doi.org/10.1590/s1414-4077201900...						p value^* * Pearson’s chi-square test; 1- Difference in the distribution of courses (p-value=0.001) and vacancies (p-value=0.001) between regions;	Vacancies/10,000 inhabitants^ To calculate the vacancy rate/10,000 inhabitants, the estimate for the 2019 population reported by the IBGE and the vacancies in activity in the same year were considered.
Region/ Federated Unit	Private		Public		Overall total			Private		Public		Total			Private vacancies	Public vacancies	Total vacancies
Region/ Federated Unit	n	%	n	%	n	%		n	%	n	%	n	%		Private vacancies	Public vacancies	Total vacancies
Brazil	1,069	85.9	175	14.1	1,244	100		179,384	93.6	11,235	6.4	190,619	100		8.4	0.5	8.9
Norte	72	6.7	21	12.0	93	7.5	0.121	12,805	7.1	1,672	14.9	14,477	7.6	0.001	7.0	0.9	7.9
Acre	2	0.2	2	1.1	4	0.3		330	0.2	60	0.5	390	0.2		3.7	0.7	4.4
Amazonas	9	0.8	4	2.3	13	1.0		4,205	2.3	246	2.2	4,451	3.3		10.1	0.6	10.7
Pará	25	2.3	6	3.4	31	2.5		4,200	2.3	366	3.3	4,566	2.4		4.9	0.4	5.3
Rondônia	18	1.7	1	0.6	19	1.5		1,990	1.1	30	0.3	2,020	1.1		11.2	0.2	11.4
Roraima	2	0.2	2	1.1	4	0.3		400	0.2	180	1.6	580	0.3		6.6	3.0	9.6
Tocantins	13	1.2	3	1.7	16	1.3		1,230	0.7	640	5.7	1,870	1.0		7.8	4.1	11.9
Amapá	3	0.3	3	1.7	6	0.5		450	0.3	150	1.3	600	0.3		5.3	1.8	7.1
Nordeste	270	25.3	65	36.6	334	26.8		46,472	25.9	3,619	32.2	50,091	26.3		8.1	0.6	8.7
Alagoas	16	1.5	3	1.7	19	1.5	0.004	2,742	1.5	140	1.2	2,882	1.5	0.001	8.2	0.4	8.6
Bahia	77	7.2	9	5.1	86	6.9		12,410	6.9	526	4.7	12,936	6.8		8.2	0.4	8.6
Ceará	41	3.8	6	3.5	47	3.8		6,610	3.7	410	3.6	7,020	3.7		7.2	0.5	7.7
Maranhão	24	2.2	16	9.1	40	3.2		3,576	1.9	775	6.9	4,351	2.3		5.0	1.1	6.1
Paraíba	18	1.7	6	3.4	24	1.9		3,660	2.1	410	3.7	4,070	2.1		9.1	1.0	10.1
Pernambuco	48	4.5	7	4.0	55	4.4		9,524	5.4	465	4.1	9,989	5.3		9.7	0.5	10.2
Piauí	20	1.9	7	4.0	27	2.2		2,725	1.5	390	3.5	3,115	1.6		8.3	1.2	9.5
Rio Grande do Norte	13	1.2	7	4.0	20	1.6		2,445	1.4	358	3.2	2,803	1.5		7.0	1.0	8.0
Sergipe	13	1.2	3	1.7	16	1.3		2,780	1.5	145	1.3	2,925	1.5		12.1	0.6	12.7
Sudeste	464	43.4	43	24.6	507	40.8		83,969	46.8	3,328	29.6	87,297	45.8		9.3	0.4	9.7
Espírito Santo	23	2.2	2	1.1	25	2.0	0.879	2,420	1.4	110	1.0	2,530	1.3	0.001	6.0	0.3	6.3
Minas Gerais	134	12.5	12	6.9	146	11.7		16,280	9.1	862	7.7	17,142	9.0		7.6	0.4	8.0
Rio de Janeiro	96	9.0	7	4.0	103	8.3		18,407	10.2	598	5.3	19,005	9.9		10.2	0.3	10.5
São Paulo	211	19.7	22	12.6	233	18.7		46,862	26.1	1,758	15.6	48,620	25.6		10.0	0.4	10.4
Sul	152	14.2	24	13.7	176	14.1		16,571	9.3	1,275	11.3	17,846	9.3		5.5	0.4	5.9
Rio Grande do Sul	52	4.9	7	4.0	59	4.7	0.658	5,645	3.2	447	4.0	6,092	3.2	0.446	4.9	0.4	5.3
Santa Catarina	39	3.7	5	9.9	44	3.5		3,880	2.2	279	2.4	4,159	2.1		5.4	0.4	5.8
Paraná	61	5.7	12	6.9	73	5.9		7,046	3.9	549	4.9	7,595	4.0		6.1	0.5	6.6
Centro-Oeste	111	10.4	23	13.1	134	10.8		19,567	10.9	1,341	11.9	20,908	11.0		11.8	0.8	12.6
Goiás	42	3.9	8	4.6	50	4.0	0.662	6,704	3.7	480	4.3	7,184	3.7	0.001	9.5	0.6	10.1
Mato Grosso do Sul	15	1.4	4	2.3	19	1.5		2,500	1.4	190	1.7	2,690	1.4		9.0	0.7	9.7
Mato Grosso	24	2.6	7	4.0	31	2.5		3,425	1.9	410	3.6	3,835	2.0		9.8	1.2	11.0
Distrito Federal	30	2.8	4	2.3	34	2.7		6,938	3.9	261	2.3	7,199	3.8		22.3	0.9	23.2

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[1] Corresponding author: Fabiana Alves Soares E-mail: fabianaalvessoares23@hotmail.com