MAPPING OF NURSING COURSES AND INTERFACES WITH THE INCLUSION OF INDIGENOUS STUDENTSABSTRACT
Objective: to analyze the distribution of undergraduate nursing courses at public federal universities from the perspective of the inclusion of indigenous people in higher education in Brazil.
Method: a quantitative, descriptive and documentary study, whose sources included the Ministry of Education, the Brazilian Institute of Geography and Statistics and other bodies, technical reports from Indigenous Health Districts and information on nursing courses at federal higher education institutions, through research carried out between November and December 2023.
Results: for this study, 74 undergraduate nursing courses from public federal universities were selected, distributed among 50 institutions, with 4,341 authorized vacancies, of which 17 offer vacancies in nursing courses through 27 specific selection processes.
Conclusion: there are barriers to equitable access for indigenous people to higher education, observed in the different selection mechanisms, which are not equitable, highlighting the need for greater alignment between the distribution of vacancies offered to indigenous people and the regions’ demands.
DESCRIPTORS:
Nursing; Public policy; Diversity; Equity, inclusion; Indigenous peoples; Geographic mapping; Higher education policy
RESUMO
Objetivo: analisar a distribuição de cursos de graduação em Enfermagem de universidades federais públicas na ótica da inclusão de indígenas no ensino superior do Brasil
Método: estudo quantitativo, descritivo e documental, cujas fontes incluíram o Ministério da Educação, o Instituto Brasileiro de Geografia e Estatística e outros órgãos, relatórios técnicos de Distritos Sanitários Indígenas e informações de curso de Enfermagem de instituições federais de ensino superior, através de pesquisa realizada entre novembro e dezembro de 2023.
Resultados: elencou-se, para este estudo, 74 cursos de graduação em Enfermagem de universidades federais públicas, distribuídos entre 50 instituições, com 4.341 vagas autorizadas, dos quais 17 ofertam vagas em cursos de Enfermagem, por meio de 27 processos seletivos específicos.
Conclusão: existem barreiras no acesso equitativo de indígenas ao ensino superior, observadas nos diferentes mecanismos das seleções, que não são equânimes, apontando a necessidade de um maior alinhamento entre a distribuição de ofertas de vagas a indígenas e as demandas das regiões.
DESCRITORES:
Enfermagem; Políticas públicas; Inclusão; Diversidade e equidade; Populações indígenas; Mapeamento geográfico; Política de educação superior
RESUMEN
Objetivo: analizar la distribución de cursos de pregrado en enfermería en universidades públicas federales desde la perspectiva de la inclusión de los indígenas en la educación superior en Brasil.
Método: estudio cuantitativo, descriptivo y documental, cuyas fuentes incluyeron el Ministerio de Educación, el Instituto Brasileño de Geografía y Estadística y otros organismos, informes técnicos de Distritos Sanitarios Indígenas e informaciones de cursos de enfermería de instituciones federales de educación superior, a través de investigaciones realizadas entre noviembre y diciembre 2023.
Resultados: para este estudio se enumeraron 74 carreras de pregrado en enfermería de universidades públicas federales, distribuidas en 50 instituciones, con 4,341 plazas autorizadas, de las cuales 17 ofrecen plazas en carreras de enfermería a través de 27 procesos de selección específicos.
Conclusión: existen barreras al acceso equitativo de los indígenas a la educación superior, observadas en los diferentes mecanismos de selección, que no son equitativos, lo que apunta a la necesidad de un mayor alineamiento entre la distribución de vacantes ofrecidas a los indígenas y las demandas de las regiones.
DESCRIPTORES:
Enfermería; Política pública; Diversidad; Equidad e inclusión; Pueblos indígenas; Mapeo geográfico; Política de educación superior
INTRODUCTION
Undergraduate nursing education is undergoing a period of significant transformation in Brazil, driven largely by the 2012 Quota Law, which reserves vacancies for indigenous people in universities and federal institutes, and by the growing awareness of the importance of ethnic-racial diversity and identity affirmations1. The relevance of these aspects in ethnic-racial representation in higher education1 is notable, as they contribute to training healthcare professionals from different groups, who form the workforce of specific services of the Brazilian Health System (SUS - Sistema Único de Saúde), such as the Indigenous Peoples’ Healthcare Subsystem (SASISUS - Subsistema de Atenção à Saúde dos Povos Indígenas)2, which includes indigenous health workers, for instance.
There is a significant indigenous population in the national territory, made up of different ethnicities, composed of approximately 1,694,886 individuals, as evidenced by the Brazilian Institute of Geography and Statistics (IBGE - Instituto Brasileiro de Geografia e Estatística)3, which may reflect on the training and performance of indigenous nurses in different ways2,4. Indigenous nurses’ work involves the cultural and ethnic diversities and pluralities present in the SASISUS territories and in its 34 Indigenous Health Districts (DSEI - Distritos Sanitários Indígenas), forming part of the villages that offer Primary Healthcare (PHC) and that have Multidisciplinary Teams in Indigenous Health (MTIH), of which nursing is a member5.
The implementation of the Quota Law and its impact on the composition of nursing courses is little explored, especially with regard to regional differences in Brazil, considering that this reserve of vacancies in federal universities. This inclusion initiative has repercussions on educational institutions and also on services and policy implementation in the SUS1,4,6. According to the notes, inclusion and diversity policies shape spaces, considering their potential to influence the social and cultural dynamics of institutions that include indigenous people in training and in action, taking into account their educational character1.
Thus, when discussing this scenario, it is possible to point out implementations and provide support to educators and healthcare professionals, contributing to the construction of more in-depth dialogues on equity and inclusion, based on the Brazilian National Policy for Healthcare for Indigenous Peoples (PNAISPI - Política Nacional de Atenção à Saúde de Povos indígenas)6. When addressing different scenarios, similarities and disparities are identified, which requires different approaches from nursing training, pointing out paths for such developments, based on regional needs and practices, which can impact the constitutions of indigenous and non-indigenous nurses4.
Furthermore, it is possible to converge initiatives for the professionalization of indigenous nursing assistants and PHC, ensuring an understanding of local realities and indigenous peoples’ specific needs, through the dynamics carried out in DSEI and the Indigenous Support Houses (CASAI - Casas de Apoio Indígena)4,7, which have the potential to generate connections between universities and services. Other possibilities for improving professional training include the construction of discussions on processes and demands, which must be perceived by higher education institutions, considering their functions of promoting critical knowledge and reflexivity to transform society and to guarantee equity, according to the reality of student insertion8.
Given this scenario, the following questions were asked: how are the distribution of nursing courses in universities and the inclusion of indigenous students in higher education being conducted and what are the possible impacts? In order to answer this question, this study considered the relationship between nursing training, the provision of healthcare services in villages and existing infrastructure, such as Indigenous Health Support Centers and DSEI. In short, this study aimed to analyze the distribution of undergraduate nursing courses in relation to the inclusion of indigenous people in higher education at federal universities.
METHOD
This is a documentary and descriptive study, with a quantitative approach9, carried out based on document analysis10. Data collection was carried out in government databases and included the electronic portal of the Ministry of Education (e-MEC), IBGE, technical reports from the DSEI and the electronic portals of higher education federal universities (HEFU).
Data collection was carried out between November and December 2023, with the extraction of the following variables of interest: geographic; distribution of courses; and aspects related to the offer of vacancies to indigenous students. The variables analyzed in the study were categorized as follows: geographic variables were organized according to the five major regions of Brazil (North, Northeast, Midwest, Southeast and South), with an additional distinction between capitals and municipalities in the countryside; the distribution of nursing courses was categorized by the location of universities (in capitals or countryside) and by the number of courses offered; regarding the offer of vacancies to indigenous students, the categories included the type of selection process (specific or general) and the number of vacancies available, in addition to the admission criteria used by universities.
The inclusion criterion was the existence of an undergraduate nursing course on the e-MEC portal in November 2023, with a bachelor’s degree and in-person modality, in a federal and public agency, and the exclusion criteria highlighted extinct courses, courses from federal institutes, courses that have not yet started their activities and undergraduate, technological, private and state courses.
In DSEI documents, reports with a base year in 2022 and the Brazilian National Registry of Health Establishments (CNES - Cadastro Nacional de Estabelecimento de Saúde) of 2023 were considered. In HEFU, documents after 2012 were verified, referring to notices of specific selection processes, in which there were indigenous people as the target audience, exclusively or jointly with other groups, excluding the indicators for unified selections, which offer vacancies through the Unified Selection System (SISU - Sistema de Seleção Unificada). In relation to the host cities of HEFU, these were identified, according to their geographic regions, in: North; Northeast; Midwest; Southeast; and South. In relation to the host cities of CASAI, these were identified by CNES.
The data were organized in Microsoft Word and Excel 365 programs. The distribution of the mapping performed, referring to the variables villages, DSEI and indication of nursing courses on the map of Brazil, was represented by figures, which were edited in Canva Pro. After identifying the variables of the notices, a chart and figure were organized on the distribution of characteristics of inclusion processes.
In this study, the variables “distribution of vacancies by region” and “number of courses per university” were analyzed descriptively, being presented in absolute numbers and percentages. Spatial analysis was applied to the variables “location of indigenous villages” and “distribution of nursing courses throughout Brazil”, with geographic representation. To visualize the comparison between “number of general vacancies” and “specific vacancies by region”, we used bar graphs, allowing a clear comparison between the different regions.
As this was a documentary-based study, with publicly accessible data, there was no need for approval by a Research Ethics Committee.
RESULTS
At the end of 2023, 90 courses from federal agencies were identified, of which 74 undergraduate nursing courses were listed, distributed among 50 Brazilian HEFU, observing the eligibility criteria of this study, totaling 4,341 authorized vacancies, according to e-MEC. Two courses, based in the North and Southeast regions, had not started their activities and were disregarded, the same occurring with a course located in the Midest region, which held its last selection before 2012.
Table 1 presents the distribution of courses and vacancies in undergraduate nursing courses, as well as the characteristics of municipalities and indigenous people, according to geographic region.
The region with the largest representation of HEFU was the Southeast, followed by the Northeast, South, North and Midwest. The largest number of courses started and in operation is found in the Northeast region, followed by the Southeast, Midwest, South and North, which was repeated in the offers of vacancies in undergraduate nursing courses in Brazil by HEFU (Table 1).
All capitals had undergraduate nursing courses (with one course), except Brasília, which offered vacancies on different campuses, but in the territory of the capital, Rio de Janeiro and Porto Alegre, with vacancies in two different HEFU. The municipalities in the countryside of the states have more course headquarters than the capitals. There was a greater concentration of indigenous populations in the North, followed by the Northeast, Midwest, Southeast and South (Table 1).
Figure 1 shows the distribution of DSEI in the territory, considering their headquarters and villages, highlighting them according to their location in federal units.
Location of villages and headquarters of Indigenous Health Districts within the boundaries of territories
Concerning the distribution of DSEI in the national territory, the North region has the largest concentration of headquarters, followed by the Northeast, Midwest, South and Southeast, according to geographic delimitation. In this scenario, the state of Amazonas has the largest number of district headquarters, an aspect in which it is similar to Pará, unlike other states, which have only one headquarters or do not have any, such as Piauí, Rio Grande do Norte, Sergipe, Espírito Santo, São Paulo, Rio de Janeiro, Federal District, Goiás and Rio Grande do Sul. Considering the logic of the administrative division of DSEI, it was possible to observe similar numbers for the territories of the 34 DSEI assigned by SESAI (Figure 1).
In relation to the villages, according to data from SESAI, there are records of 6,500 villages served by the 34 DSEI, with the highest concentrations in the DSEI Alto Rio Negro (AM), assisting 677 villages and 27,532 indigenous people, in the DSEI Maranhão (MA), with a number of 42,353 indigenous people, and in the DSEI Yanomami (AM and RO), with 378 villages and 30,920 indigenous people. The universities that offer nursing courses that are located around these DSEI are the Universidade Federal do Maranhão (UFMA) and the Universiade Fedral do Rondônica (UFRO) (Figure 1).
Figure 2 presents the distribution of undergraduate nursing courses and Indigenous Health Support Centers in federal units, observing the centralization of indigenous populations in these courses.
Location of undergraduate nursing courses in Federal Higher Education Universities and the Indigenous Support Center in federal units by indigenous population.
Among the indigenous people in the federal unit by region, there is a greater concentration in Amazonas, in the North region, with 490,935 indigenous people; in Bahia, in the Northeast region, with 229,433 indigenous people; in Mato Grosso do Sul, in the Midwest region, with 116,469 indigenous people; in the state of São Paulo, in the Southeast region, with 5,331 indigenous people; and in Rio Grande do Sul, in the South region, with 36,102 indigenous people (Figure 2).
A total of 68 CASAI were identified, with a greater concentration in the North region, presenting a greater number of DSEI headquarters, such as DSEI Porto Velho (six headquarters), DSEI Guamá-Tocantins (five) and DSEI Kayapó do Pará and Rio Tapajós (four). Concerning the grouping of indigenous populations and the presence of nursing and CASAI courses in the states, the largest clusters were noted in Mato Grosso, followed by Amazonas and Pará, whereas the South region has more courses in the area and smaller numbers of DSEI and indigenous populations (Figure 2).
Chart 1 presents the dynamics of Higher Education Federal Institutions (HEFI) with undergraduate nursing courses in relation to general vacancies, vacancies through specific and/or exclusive notices, forms of admission and selection method provided for indigenous candidates.
A total of 17 institutions were identified, which offer vacancies in nursing schools through specific and/or special selection processes. The Universidade Federal do Pará (UFPA) was the one that allocated the largest number of vacancies to indigenous people (four vacancies), followed by the Universidade Federal do Amapá (UNIFAP), the Universidade Federal de Roraima (UFRR), the Universidade Federal de São Carlos (UFSCAR), the Universidade Federal de Minas Gerais (UFMG), the Universidade Federal de Santa Maria (UFSM), the Universidade Federal do Paraná (UFPR) and the Universidade Federal do Rio Grande do Sul (UFRGS) (two vacancies) and the Universidade Federal da Bahia (UFBA), the Universidade Federal do Recôncavo Baiano (UFRB), the Universidade Federal de Goiás (UFG), the Universidade Federal de Catalão (UFCAT), the Universidade de Brasília (UNB), the Universidade Federal do Pampa (UNIPAMPA), the Universidade Federal de Pelotas (UFPel), the Universidade Federal do Rio Grande (FURG) and the Universidade Federal de Santa Catarina (UFSC) (one vacancy) (Chart 1).
Concerning the form of admission, it was noted that, of the 17 institutions, eight have specific notices for indigenous people and nine have joint notices with other groups (quilombolas, migrants, refugees and trans people). Of these, UFRR considers, in the subdivision observed, the aspects of broad competition and family income among indigenous candidates, whereas UFBA, UFRB, UFMG, UFSM, UFPel and UNIPAMPA make vacancies available to indigenous people from villages (Chart 1).
As for the selection modality and/or stages, ten types were identified, with the following number of representations: essay (nine institutions); objective questions of general knowledge (seven); performance in Enem (five); interview (four); descriptive memorial (three); writing of a descriptive memorial (one); defense of a descriptive memorial (one); curriculum analysis (one); oral test (one); and Portuguese test (one). UFRR has a curriculum assessment stage. UFPA, UNB and FURG conduct interviews on ethnic belonging. UFSM requires an essay with an indigenous topic. UNIPAMPA, UFPel and FURG require descriptive memorials based on autobiographies. UFPR conducts an oral Portuguese test. UNIFAP considers the practice of remote stages, from the villages, using internet access resources (Chart 1).
Figure 3 represents the comparison between authorized vacancies and vacancy offers to indigenous students through specific selection according to HEFU and geographic regions.
Distribution of the offer of general vacancies specific to indigenous people in Federal Higher Education Universities, according to geographic regions.
The offer of 27 vacancies was observed through specific selection processes, with a predominance of vacancies in the South region (ten vacancies), followed by the North (eight), Southeast (four), Midwest (three) and Northeast (two) regions. Of the HEFI that offered vacancies in nursing through specific and/or special selection processes, when compared to the number of vacancies authorized for higher degree nursing, UFSCAR was the university that presented the greatest contribution in the Southeast, followed by UFPR, in the South, UFPA, in the North, UFBA, in the Northeast, and UFCAT, in the Midwest (Figure 3).
DISCUSSION
The Quota Law has ensured that indigenous people have access to higher education, providing opportunities for the democratization of this access1,11. This cooperates with the principle of equity1, making it possible to reduce inequalities and provide training for healthcare professionals with different cultures and knowledge6, as indicated in global goals12. It is an important instrument for the inclusion of indigenous peoples and their agendas in higher education institutions, contributing to the democratic exercise within HEFU1,11, and is protected by precepts of the Federal Constitution of 1988.
Efforts in this regard are identified in numerous selection processes1, whether through SISU, which guarantees vacancies pre-established by law to indigenous people, or through specific selections, which make other vacancies possible, based on differentiated entry mechanisms, as institutional dialogues on diversity and equity advance.
There is a significant supply of general vacancies, reflecting a possible demand for nursing professionals in the country. It is worth noting that the authorized vacancies are calculated based on performance in the National Student Performance Exam (Enade - Exame Nacional de Desempenho de Estudantes) and the institutional assessment carried out by the Ministry of Education (MEC - Ministério da Educação). Furthermore, the autonomy of universities and university centers in opening new courses, social health needs related to the SUS, and the existence and quality of infrastructure in each region are also highlighted13.
It is noted that the 17 HEFU with specific vacancies provide a total of 27 vacancies, which can be seen as an important inclusion initiative, but also raises questions about the sufficiency and the possibility of access by the indigenous population to these vacancies. One way to respond includes the articulation between data on indigenous populations3, on the 68 Indigenous Health Support Centers and on the 34 DSEI, which provide a context for understanding this population’s health needs4,8. Hence, the geographic and demographic extensions of indigenous healthcare services as well as the potential demand for healthcare professionals, including nurses, stand out4.
The distributions of DSEI and villages show a significant centralization of these in the North region, particularly in the state of Amazonas, reflecting the density of the local indigenous population3 and suggesting a potentially high demand for healthcare professionals with cultural competence4,6 in the region, especially in Amazonas and Pará.
Furthermore, the comparison between the location of DSEI, the number of villages and the distribution of undergraduate nursing courses reveals challenges of access and representation. In the North region, there are large concentrations of villages and DSEI, but fewer specific vacancies for indigenous people in nursing courses compared to other regions. This may indicate a disconnect between the location of the need for healthcare professionals and the availability of nursing education. On the other hand, the existence of specific vacancies and the number of nursing courses are opportunities to increase indigenous representation1,4 and practices oriented towards intercultural dimensions and singularities14.
There is therefore a clear disconnect between the quota policies implemented at the federal level and the reality of offering nursing courses to indigenous students in regions with the highest demand. Although the Quota Law was an important milestone for inclusion, it does not in itself resolve the structural and logistical barriers that prevent indigenous students from accessing higher education1. A coordinated effort is needed between educational institutions and public policy makers to ensure that the offers of vacancies are accompanied by adequate and adapted educational and social support.
An important point is the abundance of forms of admission and selection (such as essays, objective questions, interviews, curriculum analysis and others), which reflect attempts to adapt the selection processes to the needs and contexts of indigenous candidates. Carrying out remote selection stages and considering indigenous people in the context of villages are equally positive aspects in terms of inclusion1.
Although they represent an attempt at inclusion, these formats vary widely in their approaches, from the use of objective tests to interviews and descriptive memory analyses. On the one hand, this diversity allows universities to adapt their processes to local realities, but, on the other, the lack of uniformity can create additional barriers for candidates, especially those from more remote regions, who may have difficulty accessing certain types of tests1. Standardizing some criteria, aligned with cultural and regional adaptations14-15, could strengthen the effectiveness of these inclusion initiatives.
The distribution of vacancies by region shows a greater supply in the South region and a smaller supply in the Northeast region, despite the significant indigenous population present in Bahia. This indicates a possible need to reassess the allocation of vacancies to better reflect the indigenous populations in the different regions. Institutions such as UFSCAR, UFPR, UFPA, UFBA and UFCAT stand out in their respective regions for the exemption of vacancies, demonstrating a regionalized effort for inclusion4,15, which provides opportunities for political-organizational and ethnic mobilizations16, but also points to the need for more institutions to follow such examples, especially in regions with a high density of indigenous populations and with few specific vacancies for undergraduate nursing programs.
Although the study reveals a detailed analysis of the supply of vacancies for indigenous peoples in nursing courses, it cannot be stated that this supply guarantees full compliance with the needs set out in the Brazilian National Curricular Guidelines for Nursing (DCENF - Diretrizes Curriculares Nacionais em Enfermagem)17 by itself. The analysis presented here, however, highlights the importance of greater alignment between regional offers and demands, enabling debates about the need for appointments in DCENF.
Training in this area faces the challenge of overcoming these obstacles4, which have historically been silenced in curricula1. The admission of indigenous students, among other possibilities, enhances discussions about indigenous territories and SASISUS, considering that HEFI would, in theory, be following students’ leading role in their training, as highlighted in DCENF.
In parallel, there is an increase in the number of indigenous populations in Brazil3, reflecting self-declarations, the commitment to register indigenous people living in and outside villages, and the recovery of their identity. The distribution of this population reveals a significant contingent in the North region, followed by the Northeast, both with scenarios of inequities and social vulnerabilities and with ethnic-racial categories marked by socioeconomic inequalities in operational terms14.
In this regard, it can be seen that the articulation between teaching and services4,14 may be opportune to implement actions, contributing to bringing improvements to services18, based on the training processes directed at SASISUS. The development of strategies capable of proposing changes4, based on the needs of the territories and their singularities4,8, can occur by providing students with the necessary tools, enabling them to implement actions from ethnic-racial perspectives and in the work processes of CASAI and DSEI8, generally territorially closer to the headquarters of nursing courses - a unique opportunity to contribute to training nurses from an ethnic perspective.
Concerning the distribution of courses in the capitals and in the municipalities in the countryside of the states, one of the influences was the Federal Universities Restructuring and Expansion Program (Reuni - Programa de Reestruturação e Expansão das Universidades Federais), which expanded their interiorization and, with local development purposes, based on criteria and some indicators, such as the Human Development Index (HDI), the Basic Education Development Index (IDEB) and the priority training areas, which include health training, led to the extension of the number of vacancies in remote regions19, including the surroundings of DSEI, which is reflected in educational opportunities1,4.
The expansion of higher education is important to increase the supply of vacancies to decentralized regions, to address inequalities and to welcome students who have difficulty in traveling and settling in capital cities19. Likewise, the initiative is essential for students eligible for offers of vacancies through affirmative action1, considering that they are characterized by groups that depend on student care programs to maintain their academic education outside their territories1,11.
This factor tends to be worse among indigenous people living in villages, considering in terms of residence, transportation and food maintenance, given that villages are normally located in regions far from the course headquarters, making continuous mobility impossible due to the scarcity of financial and logistical resources, requiring institutional articulations to retain these students, including pedagogical, support and guidance resources1,20.
On the other hand, it is important to address the asymmetrical distribution of nurses in Brazil. Contrary to the proportional needs for the area and population of each state, it is notable that these professionals are concentrated in capital cities, especially in the North region, which have the lowest rates of professionals/1,000 inhabitants, with highlights for Boa Vista, Porto Velho and Macapá12,19. As for the entire North region, in addition to socioeconomic issues, there is a contingent related to migratory flows from the borders that is essential to mention in discussions about the dynamics of training for care for indigenous peoples.
In the academic context, it is important to emphasize that affirmative actions and their consequences produce dynamics that move the structures of educational systems and services1,11,21, given that historically invisible groups and topics gain notoriety, based on entry, inclusion and the different identities they use in institutional spaces1,4,21.
Regarding the selection of indigenous students in undergraduate nursing courses, considering the specificities of this population4, some strategies can be adopted, such as strengthening communication networks, using indigenous communicators to disseminate information about selection processes, through community radio stations, social networks, websites in indigenous languages, among other methods, democratizing and decolonizing this means of communication21-22.
Furthermore, registration and selection via online platforms can facilitate access to courses for candidates from villages, reducing physical and logistical barriers. Another relevant aspect concerns the flexibility in proving ethnicity, which can be issued by local leaders, which is important for indigenous people who do not live in villages but maintain ties with their communities. There is also the exemption from registration fees for self-declaration, which is a significant financial barrier. All of these points are relevant to the inclusion of these groups in the educational field23.
Selection criteria that consider the trajectory and life experiences of indigenous candidates24. For instance, including a memorial or personal essay as part of the selection process can allow candidates to share their stories, challenges, and unique contributions. This may include considering their participation in community activities, sharing traditional knowledge, indigenous languages spoken, among others. This allows for continuous adjustments to better meet this population’s needs, which can be reflected in training professionals to work in SASISUS4,25.
It is also possible to indicate the workforce dynamics for working with indigenous peoples, whether in villages, CASAI or other structures, since this involves indigenous and non-indigenous nurses. Therefore, SASISUS and the distribution of DSEI throughout the national territory, as well as in villages that comprise it, are elements that should be considered in the country’s nursing training26. This can occur initially through the transversality of the topic in pedagogical projects27, based on teaching plans, extension and research projects, ensuring student participation28, expanding, over time, through specific curricular activities, which guarantee a significant workload for multiple ethnicities2,4.
This process must be established based on the characteristics of each region2,14 and the DSEI that make up the surroundings of HEFU. Since all regions have DSEI and, in general, these are located in the state capitals, there are possibilities of narrowing down by management, given the notorious difficulty in entering the villages. In addition to this, there are CASAI, which require opportunities for training based on health education as well as for decolonizing the university1 and reducing health inequities.
Therefore, this study contributes to the discussion on the redistribution of vacancies for indigenous people, on the need to adapt selection processes and on the measures to be adopted to implement actions for education and services in question. On the other hand, this work is limited to analyzing open access documents, and does not follow internal processes and documents, such as those of academic information centers and specific selection committees.
CONCLUSION
The distribution of undergraduate nursing courses in Brazilian higher education institutions shows a mismatch between the location of the courses and areas with a high indigenous population density, especially in the North, in terms of the offer of specific vacancies. Despite the significant efforts of some universities, there are still significant barriers that prevent indigenous people from having equal access to higher education in nursing, as observed in the different selection mechanisms, which are not equitable, given their linguistic, technological and logistical limitations.
The networks that make up the DSEI are fundamental to indigenous peoples’ health, and these are directly related to the availability of qualified professionals who understand cultural and social particularities, highlighting the need for greater alignment between the distribution of vacancies for indigenous people in nursing courses, inclusive training and regional demands.
Therefore, it is recommended that strategies be verified to facilitate indigenous people’s access to these courses, such as adapted selection processes and training for indigenous health specificities as well as investigations into indigenous nurses who benefit from affirmative actions and work in Indigenous Healthcare Subsystem services, in order to understand the impact of the Quota Law on their presence in the nursing activity.
ACKNOWLEDGEMENT
Eliene Putira Sacuena for guidance on the needs for effective inclusion in indigenous selection processes.
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Source: adapted from Brazilian National Indigenous Foundation and Brazilian Institute of Geography and Statistics - IBGE. Map processed in QGIS 3.10.7 (https://qgis.org/); vector: https://www.ibge.gov.br
Source: adapted from the Brazilian Institute of Geography and Statistics - IBGE. Map processed in Canva Pro (https://www.canva.com); vector: https://www.ibge.gov.br
Source: National Registry of Higher Education Courses and Institutions and portals of Federal Higher Education Universities. (https://emec.mec.gov.br)