<i>Mais Médicos</i> (More Doctors) Program: its contribution in view of WHO recommendations for provision of doctors

Carvalho, Viviane Karoline da Silva; Marques, Carla Pintas; Silva, Everton Nunes da

doi:10.1590/1413-81232015219.17362016

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Article • Ciênc. saúde colet. 21 (09) • Sept 2016 • https://doi.org/10.1590/1413-81232015219.17362016 copy

Mais Médicos (More Doctors) Program: its contribution in view of WHO recommendations for provision of doctors

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

In order to examine whether Brazil's Mais Médicos (More Doctors) Programme (PMM) reflected World Health Organisation (WHO) recommendations for improved attraction, retention and recruitment of health workers in remote and rural areas, this descriptive, qualitative study drew on document analysis in order to compare the WHO recommendations published in 2010 with Brazil's Law No. 12,871/13, which instituted the PMM. Of the 16 WHO recommendations systematised here, the PMM met 37.5%. Recommendations not incorporated into the PMM include career development programmes and public recognition strategies. Although reflecting WHO recommendations and already in place elsewhere in the SUS prior to announcement of the PMM, the National Retention Grant Programme and multi-professional teams (as in the Family Health Strategy) were not implemented by the PMM. The programme contains innovative components such as a new curriculum for medical schools and compulsory medical service. On the other hand, the PMM could have invested more in personal and professional support.

Key words
Shortages of doctors; Unequal distribution; Attraction; retention and recruitment of health workforce; Provision of health workers; Rural doctors

Category of intervention	Examples	Explanation
A. Education	A1 – Students from rural origins	Use admissions policies for students from rural areas with a view to increasing the likelihood of graduates' working in rural areas
	A2 – Health schools for professionals outside the large towns	Set up medical schools in rural areas for the purpose of training more doctors who work in those areas
	A3 – Clinical rotations in rural areas during studies	Expose undergraduate students to experiences in rural areas, so as to exert a positive influence on the attraction and recruitment of health workers for such areas
	A4 – Curricula that reflect rural health problems	Curricular review to include subjects bearing on primary care and rural concerns
	A5 – Continued professional development for rural health workers	Continued education and professional development programmes
B. Regulatory	B1 – Enhanced scope of practice	Regulate to advanced forms of practice in rural and remote areasso as to increase potential for satisfaction at work
	B2 – Different types of health worker	Introduce different types of health workerswith training and practice in rural areas
	B3 - Compulsory service	Compulsory service in rural areas with appropriate support and incentives
	B4 – Subsidised education in exchange for service	Provide scholarships or other forms of education funding for students who propose to serve in in rural areas
C. Financial incentives	C1 – Appropriate financial incentives	Use a combination of fiscally sustainable financial incentives (free transport, paid holidays, housing allowance etc.).
D. Professional and personal support	D1 – Better conditions of life	Improve workers' conditions of life by investing in infrastructure and services, such as sanitation, electricity, telecommunications, schools etc.
	D2 – Secure, supportive work environment	Ensure all the equipment and materials necessary to the work environment
	D3 – Outreach	Take steps to inform and motivate health workersto foster professional cooperation
	D4 – Career development programmes	Support career development programmes for workers in and from rural areas
	D5 – Professional networks	Support the development of professional networks and associations so as to improve health workers' morale and reduce feelings of professional isolation
	D6 – Measures to foster public recognition	Formulate and encourage measures for public recognition to foster professional motivation

Category of intervention	Examples	Mais Médicos Program (Law 12.871/13 and MP. 621/13)
		Does the Program intervene in this respect?
		Yes	No
A. Education	A1 – Students from rural origins		X
	A2 – Health schools for professionals outside the large towns	I – Reorganises the supply of Medicine courses and vacancies for medical residencies, prioritising health regions with lower ratios of doctors per person and with health service structure in a position to offer students a sufficient and quality field of practice
	A3 – Clinical rotations in rural areasduring medical studies		X
	A4 – Curricula that reflect rural health problems		X
	A5 – Continued professional development for rural health workers	Art. 4 § 2. Internship activities in Primary Health Care and Prompt and Emergency Care in the SUS and Medical Residency activities shall be performed with academic and technical supervision, as pursuant to Art. 27 of this Law. Art. 14. Professional development of participating doctors shall occur by specialisation courses at public institutions of higher education and shall involve teaching, research and extension activities, which shall have a care component assured by integration between teaching and service (Mais Médicos for Brazil Project).
B. Regulation	B1 – Enhanced scope of practice		X
	B2 – Different types of health worker		X
	B3 - Compulsory service	§ 1. The first year of the Residency Programme in General Family and Community Medicine shall be compulsory for entrants to the following Medical Residency Programmes: I – Internal Medicine (Clinical Medicine); II – Paediatrics; III – Gynaecology and Obstetrics; IV – General Surgery; V – Psychiatry; VI – Preventive and Social Medicine.
	B4 – Subsidised education in exchange for service	Art. 19. Doctors on the Mais Médicos for Brazil Project may receive grants in the following forms: I – training grant; II – supervision grant; and III – tutorship grant.
C. Financial incentives	C1 – Appropriate financial incentives	Art. 19. § 1. In addition to the provisions of the main clause, the Union shall grant expenses to defray the participating doctors' installation costs, which may not exceed the amount corresponding to of 3 (three) training grants. (Mais Médicos for Brazil Project) Art. 19. § 2. The Union is authorised to pay the travel expenses of participating doctors and their legal dependents, pursuant to the joint order by the Ministers of State for Planning, Budget and Management and Health. (Mais Médicos for Brazil Project) Meals, travel, drinking water and housing – Order SGTES/MS No. 30 of 12 February 2014. (Mais Médicos for Brazil Project)
D. Professional and personal support	D1 – Better conditions of life		X
	D2 – Secure, supportive work environment	Art. 30. § 2. The SUS shall have 5 (five) years to furnish primary health care facilities with quality equipment and infrastructure, to be specified in the multi-year plans.
	D3 – Outreach		X
	D4 – Career development programmes		X
	D5 – Professional networks		X
	D6 – Measures for public recognition		X

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[1] Collaborations

VKS Carvalho worked on the study design, data analysis and interpretation, the literature review and formatting the article. CP Marques and EN Silva assisted in the literature review, data analysis, formatting of the article and final text revision. All authors approved the final version of the article.