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REVIEW • Saúde debate 46 (135) • Oct-Dec 2022 • https://doi.org/10.1590/0103-1104202213519I linkcopy

Planning and Sizing of the Health Workforce in Brazil: advances and challenges

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

This study aims to analyze the production of knowledge about Planning and Sizing of the Health Workforce (PDFTS) developed in Brazil, identifying models and methodologies that consider the Guidelines of the Unified Health System (SUS) for the constitution of regionalized care networks. This is an integrative review, including Brazilian studies and full text, in Portuguese, and available in the CAPES, BVS and Google Scholar databases. The searches returned 48,083 documents and, after selection with the PRISMA strategy, 62 studies published between 2011 and 2020 were included. Most of the analyzed productions approach the PDFTS with comparative analyzes between the estimated needs and the current availability, being more frequent the studies of only one professional category, with emphasis on nursing. The findings contribute to the debate on the essentiality of the health workforce for the conformation of networks, by demonstrating that the calculation methods favor the use of indicators and parameters related to the provision of services in specific health facilities, especially hospitals, not operationalizing aspects of regionalization and systemic integration of the Health Care Network.

KEYWORDS
Personnel downsizing; Health workforce; Health planning; Regional health planning

SEARCH STRATEGIES	SELECTED FIELDS
SEARCH STRATEGIES	VIRTUAL HEALTH LIBRARY	CAPES PORTAL OF JOURNALS	GOOGLE ACADEMIC
A - (“downsizing organizacional” OR “dimensionamento de pessoal”) AND (SuS OR saúde)	‘title, abstract, subject’	‘any + ‘contains’.	-
B - “health workforce” OR “human resources in health” OR “administration of human resources in health” OR “human resources management in health” OR “assessment of human resources in health” OR “staf turnover” OR “personnel administration” OR “human resources administration”	‘subject descriptor’	‘no subject’ + ‘contains’	-
C - (“workforce planning” OR “workforce sizing”) AND (health OR SUS)	‘title, abstract, subject’	‘any’ + ‘contains’.	‘with the exact phrase’ + ‘with at least one of the words’

AUTHOR, DATE	TITLE	WORKFORCE SIZING METHOD	UNITY	LOCATION
Approach – Identification of the needed workforce
Gaidzinski et al., 2011.¹⁹	Computerized sizing of nursing rofessionals: development of a software	Gaidzinski Method, 1998.	Inpatient units: Adult Medical Clinic; Adult Surgical Clinic; Adult Medical-Surgical Clinic; Pediatrics; Maternity without or with Rooming-in System; Nursery; Adult General Intensive Care unit; Cardiac Intensive Care unit; Pediatric Intensive Care unit; Neonatal Intensive Care unit and Semi-Intensive unit	-
Quiñones, 2019.¹⁸	Development of a tool for sizing nursing teams of intensive care units	Proposed by the author.	Adult ICu	Rio de Janeiro - RJ
Approach – Comparative Analysis
Alves et al., 2011.⁴¹	Assessment of the patient degree of dependence in a teaching hospital orthopedic ward	Gaidzinski e Fugulin Method, 2005.	Inpatient unit: Orthopedics Ward	Botucatu - SP
Gil et al., 2011.³⁵	Sizing of nursing staf and patient degree of dependence in a university hospital	Survey of the existing workforce.	Inpatient units: adult medical-surgical	Londrina - PR
Perroca; Jericó; Calil, 2011.⁴²	Configuration of the nursing team in Intensive Care units	Survey of the existing workforce: Professional per bed index	Intensive Care unit	São José do Rio Preto - SP
Rogenski et al., 2011.³⁶	Nursing care time in a teaching hospital	Gaidzinski Method, 1998.	Inpatient units: Surgical Clinic; Medical Clinic; Joint Accommodation; Pediatric Clinic; Nursery and Pediatric Intensive Care; Adult Intensive and Semi-Intensive Care	São Paulo - SP
Rossetti e Gaidzinski, 2011.⁴³	Estimation of the nursing team required in a new hospital	Methods of Gaidzinski, 1998 e Fugulin, 2002.*	Inpatient units: Obstetrics; Medical Surgical; Pediatrics; Adult and pediatric ICu; and Neonatal	São Paulo - SP
Vituri et al., 2011.⁴⁴	Hospital nursing sizing: PAHO/ WHO model	PAHO/WHO Method	Outpatient Surgery; Inpatient units: Medical Clinic; Nursery; Normal or Rooming-in; Surgical Clinic; Gynecological; Psychiatric; Pediatric Clinic; Obstetric; Prepartum; MI/AIDS Clinic; Semi Intensive; Burn Clinic; General ICu; Neonatal ICu; Anesthetic Recovery; Emergency Room Observation.	Londrina - PR
Fugulin et al., 2012.⁴⁵	Nursing care time in intensive care unit: assessment of the parameters proposed by COFEN Resolution No. 293/04	Methods of Gaidzinski, 1998 e Fugulin, 2002.*	Adult Intensive Care unit	São Paulo - SP
Matos et al., 2012.⁴⁰	Sizing of nursing staf in a clinical unit	Methods of Gaidzinski, 1998 e Fugulin, 2002.*	Hospital Clinical unit	Northwest Region – RS**
Velozo, 2012.⁴⁶	Sizing of nursing staf using the tISS-28 and NEMS scores in a Pediatric Intensive Care unit in Southern Brazil	Methods of Gaidzinski, 1998 e Fugulin, 2002.*	Pediatric Intensive Care unit	Porto Alegre - RS
Casarolli et al., 2015.⁴⁷	Level of care complexity and nursing sizing in the emergency room of a public hospital	Methods of Gaidzinski, 1998 e Fugulin, 2002.*	Emergency room	Paraná**
Lorenzini; Deckmann; Silva, 2015.⁴⁸	Sizing of nursing staf in obstetric center	Methods of Gaidzinski, 1998 e Fugulin, 2002.*	Obstetric Center	South of Brasil**
Costa, 2015.⁴⁹	Method for sizing nursing staf in a Material and Sterilization Center (CME)	Proposed by the author.	Sterilization Material Centers	São Paulo - SP
Araújo et al., 2016.⁵⁰	Staf sizing of a surgical inpatient unit	Methods of Gaidzinski, 1998 e Fugulin, 2002.*	Surgical Inpatient unit	Belo Horizonte – MG
Borges et al., 2017.⁵¹	Sizing of nursing staf in the adult ICu of a public university hospital	Inoue e Matsuda Method, 2010.	Adult Intensive Care unit	Cascavel - PR
Pedro et al., 2017.⁵²	Sizing of nursing staf in the pediatric ward of a university hospital	Soares Method, 2009.*	Pediatric ward	Cascavel - PR
Teixeira, 2017.⁵³	Sizing and nursing workload in pediatric and neonatal ICu	Inoue e Matsuda Method, 2010.	Neonatal and pediatric Intensive Care units	Paraná**
Vasconcelos et al., 2017.⁵⁴	Sizing of hospital nursing staf: study with Brazilian government parameters from 2004 and 2017	Methods of Gaidzinski, 1988 e Fugulin, Gaidzinski e Kurcgant, 2005.*	Inpatient unit: Neurology and Orthopedics	Cascavel - PR
Velozo et al., 2017.⁵⁵	TISS-28 versus NEMS scores to size the nursing team in a pediatric intensive care unit	Fugulin, Gaidzinski e Kurcgant Method, 2005.*	Pediatric Intensive Care unit	Porto Alegre - RS
Souza et al., 2018.⁵⁶	Sizing of nursing staf in adult intensive care	Inoue e Matsuda Method, 2010.	Adult Intensive Care unit	Maringá - PR
Pedro et al., 2018.⁵⁷	Sizing of nursing staf in the surgical center of a university hospital	Possari Method, 2001.*	Surgical Center	Cascavel - PR

AUTHOR, DATE	TITLE	WORKFORCE SIZING METHOD	LEVEL OF ATTENTION AND/OR SERVICES	LOCALION
Approach - Workforce Diagnosis
PHARMACIST
Soares, 2020.²³	Pharmaceutical Workforce at the Health Department of the Municipality of Florianópolis	Survey of the existing workforce: professional ratio per inhabitant.	Primary and Secondary Care: Health Centers, Psychosocial Care Centers, Polyclinics and Emergency Care units	Florianópolis – SC
PHYSICIAN
Seixas et al., 2012.²⁰	Project: MigraMed II - Education and Health: Structural and Institutional Conditions for the Attraction and Settlement of Physicians in the National territory	Survey of the existing workforce.	All	Brazil
Approach – Comparative Analysis
ADMINISTRATIVE ASSISTANT
Cruz; Oliveira, 2013.²⁶	Study for the resizing of Administrative Auxiliaries in the Basic Health units of the Municipal Health Department of Belo Horizonte	Survey of the existing workforce and estimation of the administrative staf work hours necessary as per the size of the units.	Primary Care: Basic Health units	Belo Horizonte – MG
SPEECH THERAPIST
Nascimento; Nakamura, 2018.³¹	Speech therapy at the unified Health System of the State of São Paulo	Survey of the existing workforce: professional ratio per inhabitant.	All	São Paulo
Nascimento, 2020.⁶⁰	Stories of the speech therapy introduction in the unified Health System: water encounters	Adaptation of the Workload Indicators of Staffing Need - WISN - proposed by the author.	All	*
PHYSICIAN
Girardi et al., 2013.⁵⁸	Medical Labor Market: scarcity and inequalities in the distribution of the workforce in Brazil	Adaptation of the “Demographic Components Method” – professional ratio per inhabitant.	All	Brazil
Machado, 2015.⁶¹	Sizing the workload in a high complexity unit of traumatology and orthopedics	Workload Indicators of Staffing Needs – WISN.	Hospital Care: Orthopedics	Rio de Janeiro - RJ
Martins, 2016.⁶²	the need of specialists in Obstetrics and Gynecology for the unified Health System -SUS in the state of Pernambuco	Survey of the existing workforce.	All	Pernambuco
Matsumoto, 2018.⁶³	Parameters for the sizing of physicians in the Family Health Strategy	Workload Indicators of Staffing Needs – WISN.	Primary Care: Family Health units	Brazil
Pierantoni et al., 2011.⁶⁴	Working Indicators for Family Health Strategy Professionals	Workload Indicators of Staffing Needs (WISN).	Primary Care: Family Health units	Juiz de Fora – MG
Pierantoni et al., 2013.⁶⁵	Strengthening the human resources planning capacity for National Health Systems	Projection of needs -professional ratio per inhabitant.	Primary Care: Family Health units	Brazil
Pierantoni; Magnago, 2015.⁵⁹	Ofer and Needs of Health Human Resources	Projection of needs -professional ratio per inhabitant.	Primary Care	Brazil
Silva, 2011.⁶⁶	Behavior of the medical and pediatric clinic shifts of the emergency services of the health network in the city of Recife from August 2009 to July 2010	Survey of the existing workforce.	Emergency Services	Recife - PE

AUTHOR, DATE	TITLE	WORKFORCE SIZING METHOD	LEVEL OF ATTENTION AND/OR SERVICES	LOCATION
Approach - Workforce Diagnosis
TECHNICAL AND HIGHER LEVELS WORKERS
Mora; Rizzotto, 2016.²¹	Health workforce and hospital network in the 9th health region of Paraná	Survey of the existing workforce.	Hospital Care	9ª Health Region - PR
BASIC, TECHNICAL AND HIGHER LEVELS WORKERS
Rizzotto et al., 2014.²²	Workforce and management of health work: revelations from the External Evaluation of the National Program for Improving Access and Quality of Primary Care in Paraná	Survey of the existing workforce.	Primary Care: Basic Health units	Paraná
Souza et al., 2013.²⁴	Sizing the Workforce due to the Reconstruction of Health Surveillance of the undersecretary of State for Health of the Federal District	Survey of the existing workforce.	Environmental, Sanitary and, Epidemiological Surveillance, Occupational Health and Central Public Health Laboratory.	Federal District
Approach - Identification of the Required Workforce
WORKERS OF ANY LEVEL OF TRAINING - NOT SPECIFIED
Fagundes, 2015.¹⁵	Estimate of the need for medical professionals in a unit: practical calculation	Estimate of needs according to installed capacity, activity time, workload of categories and parameters chosen.	Hospital Care	*
Approach – Comparative Analysis
HIGHER-LEVEL WORKERS
Carvalho et al., 2016.³²	Expansion and diversification of the higher-level workforce in basic health units in Brazil, 2008-2013	Survey of the existing workforce.	Primary Care: Basic Health units	Brazil
Carvalho et al., 2018.³⁴	Need and dynamics of the workforce in Primary Health Care in Brazil	Survey of the existing workforce.	Primary Care: Basic Health units	Brazil
Silva, 2020.⁷⁰	Staf sizing for palliative care in a complex oncology institution	Workload Indicators of Staffing Needs – WISN	Hospital Care: Outpatient Clinic, Home Care, Pharmacy, Hospitalization, Physiotherapy and Emergency Care	Rio de Janeiro – RJ
FUNDAMENTAL OR MEDIUM AND HIGHER LEVELS WORKERS
Lopez et al., 2020.¹⁴	Mapping of health professionals in Brazil: some notes in regarding the health crisis of COVID-19	Survey of the existing workforce.	All	Brazil
TECHNICAL AND HIGHER LEVELS WORKERS
Pereira et al., 2018.²⁷	Sizing of the administrative workforce: application of the method in two units of SuS federal management	Estimate of needs based on the collection and analysis of information on the results of areas and identification of the professional profile required for the units.	SuS management units	Federal District + unidentified Federation unit
WORKERS OF ALL LEVELS OF TRAINING
Àvila et al., 2020.³³	Dimensioning of the workforce: historical and comparative analysis of the General Hospital of Palmas (tO)	Survey of the existing workforce.	Hospital Care: all áreas	Palmas – tO
Àvila et al., 2020.⁶⁹	Workforce and hospital indexes: comparative analysis of two state units in tocantins	Survey of the existing workforce.	Hospital Care: all areas	Palmas e Araguaína – TO
Carvalho; Nascimento, 2020.⁷¹	Sizing of the health workforce of the municipality of Fortaleza – CE: technical report	Estimate of needs based on the number of inhabitants and classification of vulnerability of territories (APS); the size and physical structure of the unit (uPAs); the monthly average of medical appointments performed and physical structure (Polyclinics) and the professional index per bed (Hospitals).	Primary Care: Basic Health units; Secondary Care: Emergency Care units and Polyclinics; and Hospital Care.	Fortaleza – CE
Guimarães et al., 2020.⁷²	Strengthening of the work management in primary care: sizing of the workforce in Maringá-PR	Estimate of needs based on population definitions, criteria and parameters by categories, as per the vulnerability classification of the territories.	Primary Care: Basic Health units	Maringá – PR
Marques; Goulart Castro, 2016.⁷³	Human Resources Sizing in Primary Care – the experience of the Municipal Secretary of Campinas (SP)	Estimate of needs based on guiding questions: For whom? What to offer? How to do it? How many?	Primary Care: Basic Health units	Campinas – SP
Nascimento et al., 2020.⁶	Planning and Sizing of the health workforce: courseware for health departments	Estimate of needs based on the number of inhabitants and classification of the territories vulnerability (APS); and the installed capacity, production and work processes (Secondary and tertiary Care).	Primary Care: Basic Health units; Secondary and tertiary Care	*
Nascimento; Carmona, 2020.²⁹	Experience of sizing elaboration in primary care of the Municipal Health Secretary of Campinas	Estimate of needs based on the ascription of uBS clientele and the vulnerabilities classification in the territory, as per chosen indexes and parameters.	Primary Care: Basic Health units and Family Health Support Centers	Campinas – SP
Oliveira, 2018.⁷⁴	Proposal of a model for sizing of the personnel as to the Clinical Engineering service for the university hospitals of the Federal university of Ceará	Estimate of needs based on the definition of work processes, manageable items, average time for each activity, positions and profiles of professionals demanded.	Hospital Care	Fortaleza – CE
Possa; Gosch; Ferla, 2020.²⁵	Workforce planning and sizing: a device-tool for the management of work and health education	Estimate of needs as to agreements and systematization of the scope of the service, workers’ practices and parameters.	All	*
Rocha et al., 2020.³⁰	Sizing of the workforce of the State Secretary of Public Health of Rio Grande do Norte	Survey of the existing workforce.	Hospital units; Administrative regional units; therapeutic agent units; Blood centers; Laboratories; Milk Bank; Child and Adult Rehabilitation Center; Personnel training Center in Health Services; Death Verification Service; Central of the Metropolitan Samu the ‘Central Level’.	Rio Grande do Norte
INCLUDES UNSPECIFIED TRAINING LEVEL WORKERS
Ávila et al., 2020.⁷⁵	The process of planning and sizing the workforce in SuS hospitals: the experience of a training-intervention in the tocantins State Secretary of Health	Estimate of needs as per project scope definition, health network analysis, description of existing workforce; comparative analysis of the workforce and; the sizing of the workforce.	Hospital Care: Assistance Areas, technical Support and Diagnostic Support	Palmas – tO
Cruz et al., 2013.⁷⁶	Sizing of the Workforce in the Assistance units of the Network pertaining to the Health Secretary of the State of Bahia – Sesab	Estimate of needs based on the acknowledgement of the physical structure, the installed capacity and the work process, and the assessment of technical parameters.	Hospitals and ‘Reference Centers’.	Bahia
Marques; torres, 2013.⁷⁷	Personnel sizing for the State Secretariat of Public Health of Rio Grande do Norte	Survey of the existing workforce and estimate of needs as to negotiation with managers after applying parameters, as per the profile, demand and care model of the unit.	Hospitals and ‘Reference units’.	Rio Grande do Norte
Ventin; Pereira; Moraes, 2019.²⁸	Workforce sizing: the innovative experience of the Ministry of Health	Estimate of needs based on the application of quantitative information on results, efort and personnel in a mathematical model and analysis of qualitative information to identify the professional profile and level of computerization, the complexity and the added value of work processes.	Administrative areas of the Ministry of Health: National Health Fund, General Coordination of Personnel Management, Health Care Secretariat and State Center of the Ministry of Health in the State of Ceará.	Brasília – DF and Fortaleza – CE

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