Policies, programs, and actions of education in health: perspectives and challenges

IN 2018, THE UNIFIED HEALTH SYSTEM (SUS) COMPLETED 30 YEARS. Among its milestones, we highlight the creation of the Secretariat of Labor Management and Health Education (SGTES) with the objective of assuming a strategic role in the intersectoral guidelines for the development of a National Policy for Human Resources in Health. Throughout its existence, the SGTES, which has just turned 15 years old, has adopted innumerable inductive strategies with technical, political, and financial investments for the qualification of management, producing significant impacts on the process of conducting public health policies^1,2.

It was from the SGTES that health education acquired a character of State policy, which enabled the establishment of initiatives related to the reorientation of professional training and with the permanent education of health workers, with emphasis on the integration between educational institutions, health services, and the community. There are many advances, however, there are challenges to be overcome and proposals to be implemented and/or adapted in this area that will contribute to the improvement of the capacity of national health systems, as proposed by the Strategy for Universal Access to Health and Universal Health Coverage, launched by the World Health Organization in 2014³.

That strategy, based on lines of action, seeks to ensure that all people can use the promotional, preventive, curative, rehabilitative, and palliative health services they need, and they must be of sufficient quality to be safe, effective, people-centered, timely, equitable, integrated, and efficient^B4. That requires, among other elements, human resources with adequate capacities and consistent with the needs of the population.

Taking that strategy as a commitment, in 2017 the Pan American Health Organization (Paho) approved the Human Resources Strategy for Universal Access to Health and Universal Health Coverage⁵, which aims to urge its Member States, including Brazil, to establish formal mechanisms to overcome the problems in the area of Human Resources in Health (HRH), highlighting as priorities, among others: the transformation of education of health professions; the development of interprofessional teams in service networks through interprofessional training and the diversification of learning contexts; and promoting the integration of the education and health sectors in order to align HRH education with the needs of health systems.

Furthermore, in view of the new socio-epidemiological, scientific, and technological requirements that are presented to health, the implementation of HRH public policies in Brazil, in the perspective of a contemporary democratic political system, puts into question the need to understand the binomial work and education under a new prism⁶.

In that direction, the SGTES/Ministry of Health (MS), through its Department of Health Education Management (Deges), has been making efforts to broaden the collective discussion and to stimulate, develop, and strengthen educational initiatives in line with the proposals advocated by international public health entities.

It is in that context that the research group Policies, Programs and Actions of Education in Health (PPAES) of the Institute of Social Medicine of the State University of Rio de Janeiro (IMS/Uerj) presents this thematic edition dedicated to the publication of articles that present and discuss the stage of implementation of management policies for health education. This group, in partnership with the Deges/SGTES/MS and other educational institutions, has been accompanying and systematizing the actions developed by the Deges, in a process of collecting data and producing evidence to support decision-making in federal management, whose results deserve to be published.

The aim here is to point out the limits, accumulations, and possibilities that are presented in the field of health education due to the changes that have occurred in the area in recent years. It is assumed that the qualification of health education management activities, the discussion and evaluation of the main current actions will support the planning, reorientation, and continuity of the national policies and programs in force and, consequently, the expansion of the access and the improvement of the quality of services provided to the Brazilian population.

The publication of this thematic issue is an opportunity to promote the dissemination of scientific works by the researchers involved in the theme, to create a space for dialogue with a view to strengthening existing partnerships and publicizing the efforts of workers, managers, and researchers in the development and sustainability of health education management actions.

It is known that it is a challenge to train and form SUS workers in a way that is aligned with the health needs of the population, which implies channeling efforts to construct and reconstruct educational processes in the field of health education, understanding them as a substantial part of a strategy of institutional change, and not only as a means to reach a specific objective. In order for these processes to consolidate, it is urgent to promote and strengthen educational designs built with and for the collective of actors of the SUS, as maintained by Permanent Education in Health (EPS).

From the perspective of EPS, all intervention emanates from the problematizing analysis of the real contexts of the practice, in the understanding that in the work one also learns and produces knowledge that opens the way for the experimentation of new actions of coping with the problems. Assuming that this is the political-pedagogical conception that underpins the actions of education in the health of the Country, this thematic issue of ‘Health in Debate’ devotes special attention to the National Policy of Permanent Education in Health (PNEPS).

Through such policy, we hope that educational opportunities will multiply and become permanent processes of intersectoral and interprofessional participation, and that they will be able to account for the complexity of our territories, in which it is recognized that health work is capable of creating and recreating other ways of doing, caring, attending, and assisting, and promoting training and qualification.

The PNEPS, which represents a milestone in the field of health education, is the result of many struggles and efforts promoted by its advocates, who understand it as an essential strategy for modifying health practices and, therefore, for improving the quality of health care⁷. It is from its assumptions that the other HRH training initiatives discussed in the articles that compose this publication are supported, such as the Interprofessional Health Education (EIP), the Education through Work for Health Program (PET-Saúde), and the professional technical education at the high school and university levels.

The set of articles gathered here deals with ongoing health education initiatives, rescuing the contexts in which they were conceived and implemented, and discussing their current stage, weaknesses and strengths, and their contributions to strengthening the PNEPS. Still, the authors urge us to reflect on the potential of using new technologies as tools to support the EPS and on new ways of evaluating and improving the formative processes in health.

That being said, we believe that with this publication we are collaborating to the consolidation of this field, including the support for the maintenance and improvement of instituted policies that have significantly contributed to the process of strengthening the SUS and the fragilities and challenges that must yet be overcome.

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  Orcid (Open Researcher and Contributor ID).

Referências

• ¹
  Pierantoni CR, Varella TC, Santos MR, et al. Gestão do trabalho e da educação em saúde: recursos humanos em duas décadas do SUS. Physis [internet]. 2008 [acesso em 2019 mar 13]; 18(4):685-704. Disponível em: http://dx.doi.org/10.1590/S0103-73312008000400005
  » http://dx.doi.org/10.1590/S0103-73312008000400005
• ²
  Magnago C, Pierantoni CR, França T, et al. Policy of Labor Management and Health Education: a ProgeSUS experience. Ciênc. Saúde Colet. [internet]. 2017 [acesso em 2019 mar 13]; 22(5):1521-1530. Disponível em: http://dx.doi.org/10.1590/1413-81232017225.32962016
  » http://dx.doi.org/10.1590/1413-81232017225.32962016
• ³
  Organização Mundial da Saúde, Organização Pan-Americana da Saúde. Resolução CD53.R14: Estratégia para o Acesso Universal à Saúde e a Cobertura Universal de Saúde. OMS/OPAS: Washington, DC; 2014.
• ⁴
  World Health Organization, International Bank for Reconstruction and Development. Tracking universal health coverage: 2017 Global Monitoring Report. Switzerland: WHO/IBRD; 2017.
• ⁵
  Organização Mundial da Saúde, Organização Pan-Americana da Saúde. Resolução CSP29/10: Estratégia de Recursos Humanos para o Acesso Universal à Saúde e a Cobertura Universal de Saúde. OMS/OPAS: Washington, DC; 2017.
• ⁶
  França T, Magnago C, Santos MR, et al. PET-Saúde/GraduaSUS: retrospectiva, diferenciais e panorama de distribuição dos projetos. Saúde debate [internet]. 2018 [acesso em 2019 mar 13]; 42(esp2):286-301. Disponível em: http://dx.doi.org/10.1590/0103-11042018s220
  » http://dx.doi.org/10.1590/0103-11042018s220
• ⁷
  Brasil. Ministério da Saúde, Secretaria de Gestão do Trabalho e da Educação na Saúde, Departamento de Gestão da Educação na Saúde. Política Nacional de Educação Permanente em Saúde: o que se tem produzido para o seu fortalecimento? Brasília, DF: Ministério da Saúde; 2018.

Publication Dates

• Publication in this collection
  16 Sept 2019
• Date of issue
  Aug 2019