Spatial distribution and temporal trend of National Health System and Supplemental Health Sector human resources, Brazil, 2005-2016

Campoy, Laura Terenciani; Ramos, Antônio Carlos Vieira; Souza, Ludmilla Leidianne Limirio; Alves, Luana Seles; Arcoverde, Marcos Augusto Moraes; Berra, Thaís Zamboni; Arroyo, Luiz Henrique; Santos, Danielle Talita dos; Arcêncio, Ricardo Alexandre

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Brasil

Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 29 (2) • 2020 • https://doi.org/10.5123/S1679-49742020000200020 copy

Spatial distribution and temporal trend of National Health System and Supplemental Health Sector human resources, Brazil, 2005-2016^* * This study received financial support from the following institutions: Coordination for the Improvement of Higher Education Personnel (CAPES)/Ministry of Science, Technology, Innovation and Communications (MCTIC) - Funding Code 001 -; National Scientific and Technological Development Council (CNPq/MCTIC), via a level 2 Productivity Grant - Process No. 305236/2015-6 and Process No. 88881.132524/2016-01; São Paulo State Research Support Foundation (FAPESP) - Process No. 2018/03700-7 and Process No. 2017/11040-4; and Paraná State Araucária Foundation - Contract CP 18/2015:024/2016.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to analyze the spatial distribution and temporal trend of human resources for the Brazilian National Health System (SUS) and the Supplemental Health sector.

Methods:

an ecological study was conducted in the country’s 27 Federative Units (FUs); SUS Information Technology Department (DATASUS) data were used relating to the doctor, dental surgeon, nurse and nursing technician personnel categories for the period 2005-2016; Prais-Winsten regression was used to assess the time trend.

Results:

there was an rising trend of Supplemental Health Sector human resources in all personnel categories, with an mean annual increase of 0.054 (95%CI: 0.031;0.076); with regard to SUS, there was an increase in dental surgeons and nursing technicians, with annual increases of 0.008 (95%CI: 0.003;0.011), and 0.066 (95%CI 0.022; 0.087), respectively, while in most FU, nurses showed a stationary trend and doctors showed a stationary or falling trend.

Conclusion:

inequalities were found in human resource distribution, reflecting the health system crisis.

Keywords:
Unified Health System; Supplemental Health; Workforce; Geographic Mapping; Ecological Studies; Time Series Studies

FU^a	SUS^b Doctors		Supplemental Health doctors		SUS^b Dental Surgeons		Supplemental Health dental Surgeons
FU^a	AGR^c * (95%CI^d)	Trend	AGR^c (95%CI)^d	Trend	AGR^c (95%CI)^d	Trend	AGR^c (95%CI)^d	Trend
Rondônia	0.01 (-0.01;0.03)	Stationary	0.04 (0.03;0.04)	Rising	0.01 (-0.01;0.03)	Stationary	0.11 (0.07;0.15)	Rising
Acre	0.00 (-0.02;0.02)	Stationary	0.06 (0.01;0.11)	Rising	0.01 (0.00;0.02)	Rising	0.05 (0.02;0.07)	Rising
Amazonas	0.00 (-0.033;0.041)	Stationary	0.05 (0.02;0.09)	Rising	0.01 (0.00;0.02)	Rising	0.07 (0.03;0.10)	Rising
Roraima	-0.00 (-0.02;0.02)	Stationary	0.09 (0.03;0.17)	Rising	0.01 (-0.01;0.02)	Stationary	0.17 (0.07;0.27)	Rising
Pará	-0.01 (-0.02;0.01)	Stationary	0.05 (0.03;0.07)	Rising	0.02 (0.01;0.03)	Rising	0.10 (0.06;0.15)	Rising
Amapá	-0.01 (-0.04;0.02)	Stationary	-0.04 (-0.07;0.00)	Stationary	0.04 (0.01;0.06)	Rising	0.06 (0.03;0.08)	Rising
Tocantins	-0.00 (-0.02;0.01)	Stationary	0.03 (0.02;0.04)	Rising	0.01 (0.01;0.02)	Rising	0.04 (0.02;0.05)	Rising
Maranhão	-0.01 (-0.02;-0.00)	Falling	0.00 (-0.01;0.02)	Stationary	0.01 (-0.00;0.03)	Stationary	0.06 (0.03;0.08)	Rising
Piauí	-0.02 (-0.03;-0.01)	Falling	0.04 (0.03;0.05)	Rising	0.02 (0.01;0.02)	Rising	0.07 (0.04;0.11)	Rising
Ceará	-0.00 (-0.02;0.02)	Stationary	0.03 (0.02;0.04)	Rising	0.01 (0.01;0.02)	Rising	0.04 (0.02;0.06)	Rising
Rio Grande do Norte	-0.01 (-0.03;0.00)	Stationary	-0.01 (-0.03;0.00)	Stationary	0.01 (0.00;0.01)	Rising	0.04 (0.02;0.06)	Rising
Paraíba	-0.02 (-0.03;-0.00)	Falling	0.00 (-0.00;0.01)	Stationary	0.01 (0.00;0.01)	Rising	0.02 (0.01;0.04)	Rising
Pernambuco	-0.01 (-0.03;0.00)	Stationary	0.01 (-0.01;0.03)	Rising	0.00 (0.00;0.01)	Rising	0.05 (0.02;0.08)	Rising
Alagoas	-0.02 (-0.03;-0.00)	Falling	0.03 (0.01;0.05)	Rising	0.00 (-0.00;0.01)	Stationary	0.10 (0.04;0.17)	Rising
Sergipe	-0.01 (-0.03;0.01)	Stationary	0.02 (0.01;0.03)	Rising	0.00 (-0.00;0.01)	Stationary	0.06 (0.02;0.09)	Rising
Bahia	-0.02 (-0.03;-0.00)	Falling	0.02 (0.01;0.02)	Rising	0.01 (-0.00;0.02)	Stationary	0.03 (0.02;0.05)	Rising
Minas Gerais	-0.01 (-0.02;0.01)	Stationary	0.05 (0.02;0.07)	Rising	0.00 (-0.00;0.00)	Stationary	0.05 (0.03;0.07)	Rising
Espírito Santo	-0.02 (-0.03;0.00)	Stationary	0.01 (-0.01;0.03)	Stationary	-0.00 (-0.01;0.00)	Stationary	0.04 (0.02;0.06)	Rising
Rio de Janeiro	-0.01 (-0.03;0.01)	Stationary	0.02 (0.01;0.03)	Rising	0.01 (-0.00;0.03)	Stationary	0.08 (0.05;0.19)	Rising
São Paulo	-0.01 (-0.03;0.01)	Stationary	0.04 (0.01;0.06)	Rising	0.00 (-0.00;0.00)	Stationary	0.08 (0.03;0.12)	Rising
Paraná	-0.01 (-0.02;0.01)	Stationary	0.04 (0.02;0.06)	Rising	-0.00 (-0.01;0.00)	Stationary	0.04 (0.02;0.06)	Rising
Santa Catarina	-0.00 (-0.02;0.02)	Stationary	0.04 (0.02;0.06)	Rising	-0.00 (-0.01;-0.00)	Falling	0.03 (0.02;0.05)	Rising
Rio Grande do Sul	0.0 (-0.02;0.02)	Stationary	0.04 (0.02;0.07)	Rising	0.01 (0.01;0.01)	Rising	0.09 (0.04;0.14)	Rising
Mato Grosso do Sul	0.00 -0.01;0.02	Stationary	0.03 (0.01;0.05)	Rising	0.01 (0.00;0.02)	Rising	0.03 (0.02;0.04)	Rising
Mato Grosso	-0.01 (-0.03;-0.00)	Falling	0.05 (0.02;0.08)	Rising	0.01 (0.00;0.01)	Rising	0.07 (0.03;0.12)	Rising
Goiás	-0.01 (-0.03;0.00)	Stationary	0.04 (0.03;0.05)	Rising	0.01 (0.00;0.01)	Rising	0.07 (0.03;0.11)	Rising
Federal District	-0.02 (-0.04;0.00)	Stationary	0.04 (0.03;0.05)	Rising	-0.01 (-0.02;-0.01)	Falling	0.01 (-0.02;0.03)	Stationary

FU^a	SUS^b Nurses		Supplemental Health Nurses		SUS^b Nursing Technicians		Supplemental Health Nursing Technicians
FU^a	AGR^c * (95%CI)^d	Trend	AGR^c (95%CI)^d	Trend	AGR^c (95%CI)^d	Trend	AGR^c (95%CI)^d	Trend
Rondônia	0.03 (0.01;0.05)	Rising	0.07 (0.04;0.09)	Rising	0.08 (0.06;0.10)	Rising	0.11 (0.07;0.14)	Rising
Acre	0.02 (-0.00;0.04)	Stationary	0.13 (0.08;0.18)	Rising	0.08 (0.07;0.09)	Rising	-0.03 (-0.23;0.19)	Stationary
Amazonas	0.01 (-0.01;0.03)	Stationary	0.14 (0.08;0.19)	Rising	0.03 (0.02;0.04)	Rising	0.12 (0.08;0.15)	Rising
Roraima	0.04 (0.02;0.06)	Rising	0.13 (-0.07;0.33)	Rising	0.14 (0.10;0.18)	Rising	0.16 (0.05;0.28)	Rising
Pará	0.02 (-0.01;0.04)	Stationary	0.08 (0.06;0.10)	Rising	0.07 (0.05;0.09)	Rising	0.12 (0.08;0.17)	Rising
Amapá	0.02 (-0.02;0.06)	Stationary	-0.04 (-0.10;0.02)	Stationary	0.04 (0.02;0.05)	Rising	-0.00 (-0.07;0.06)	Stationary
Tocantins	0.04 (0.02;0.06)	Rising	0.15 (0.11;0.19)	Rising	0.04 (0.03; 0.04)	Rising	0.05 (0.04;0.07)	Rising
Maranhão	0.02 (-0.01;0.06)	Stationary	0.00 (-0.01;0.02)	Stationary	0.06 (0.05;0.08)	Rising	0.01 (0.00;0.02)	Rising
Piauí	0.01 (-0.03;0.05)	Stationary	0.02 (-0.01;0.05)	Stationary	0.06 (0.05;0.08)	Rising	-0.00 (-0.04;0.04)	Stationary
Ceará	0.01 (-0.02;0.04)	Stationary	0.01 (0.01;0.02)	Rising	0.09 (0.08;0.09)	Rising	0.13 (0.11;0.15)	Rising
Rio Grande do Norte	0.01 (-0.03;0.04)	Stationary	-0.04 (-0.08;-0.01)	Falling	0.08 (0.07;0.09)	Rising	-0.02 (-0.06;0.02)	Stationary
Paraíba	0.02 (-0.02;0.06)	Stationary	0.01 (-0.00;0.02)	Rising	0.06 (0.05;0.07)	Rising	0.00 (-0.01;0.01)	Stationary
Pernambuco	0.02 (-0.00;0.05)	Stationary	0.02 (0.01;0.03)	Rising	0.11 (0.07;0.15)	Rising	0.12 (0.10;0.14)	Rising
Alagoas	0.01 (-0.04;0.06)	Stationary	0.11 (0.05;0.18)	Rising	0.08 (0.06;0.09)	Rising	0.17 (0.06;0.28)	Rising
Sergipe	0.00 -0.03;0.04	Stationary	0.05 (0.02;0.08)	Rising	0.06 (0.05;0.07)	Rising	0.08 (0.04;0.12)	Rising
Bahia	0.02 (-0.00;0.05)	Stationary	0.04 (0.03;0.05)	Rising	0.07 (0.05;0.09)	Rising	0.08 (0.07;0.08)	Rising
Minas Gerais	0.03 (0.01;0.05)	Rising	0.05 (0.03;0.08)	Rising	0.06 (0.05;0.07)	Rising	0.07 (0.06;0.09)	Rising
Espírito Santo	0.03 (0.00;0.05)	Rising	0.05 (0.03;0.07)	Rising	0.04 (0.03;0.05)	Rising	0.07 (0.06;0.09)	Rising
Rio de Janeiro	0.03 (0.02;0.05)	Rising	0.04 (0.00;0.07)	Rising	0.07 (0.05;0.08)	Rising	0.05 (0.03;0.07)	Rising
São Paulo	0.02 (0.01;0.03)	Rising	0.06 (0.05;0.06)	Rising	0.06 (0.05;0.08)	Rising	0.08 (0.07;0.10)	Rising
Paraná	0.02 (-0.01;0.05)	Stationary	0.07 (0.06;0.09)	Rising	0.09 (0.08;0.10)	Rising	0.12 (0.08;0.17)	Rising
Santa Catarina	0.02 (-0.01;0.05)	Stationary	0.07 (0.06;0.08)	Rising	0.06 (0.04;0.07)	Rising	0.07 (0.05;0.09)	Rising
Rio Grande do Sul	0.02 (0.00;0.04)	Rising	0.04 (0.04;0.05)	Rising	0.05 (0.05;0.06)	Rising	0.05 (0.03;0.06)	Rising
Mato Grosso do Sul	0.04 (0.01;0.06)	Rising	0.06 (0.06;0.06)	Rising	0.08 (0.06;0.09)	Rising	0.09 (0.06;0.11)	Rising
Mato Grosso	0.03 (-0.00;0.06)	Stationary	0.05 (0.04;0.07)	Rising	0.05 (0.04;0.07)	Rising	0.05 (0.03;0.07)	Rising
Goiás	0.02 (-0.01;0.05)	Stationary	0.06 (0.06;0.07)	Rising	0.04 (0.03;0.04)	Rising	0.07 (0.06;0.07)	Rising
Federal District	0.02 (0.01;0.03)	Rising	0.05 (0.01;0.09)	Rising	0.04 (0.03;0.05)	Rising	0.06 (0.04;0.07)	Rising

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence: Laura Terenciani Campoy - Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Avenida dos Bandeirantes, no. 3900, sala 73, Campus Universitário, Bairro Monte Alegre, Ribeirão Preto, SP, Brasil. CEP: 14040-902 . E-mail: lauratcampoy@hotmail.com