Produção Nacional
Revisado por pares
Cost of providing doctors in remote and vulnerable areas: Programa Mais Médicos in Brazil
2018; Pan American Health Organization; Linguagem: Inglês
10.26633/rpsp.2018.11
ISSN1680-5348
AutoresEverton Nunes da Silva, Maíra Catharina Ramos, Wallace dos Santos, Davide Rasella, Aimê Oliveira, Leonor Maria Pacheco Santos,
Tópico(s)Global Health and Surgery
ResumoThere is an estimated shortage of 4 million health workers worldwide (1), a gap that affects both developed and developing countries (2 -5).Imbalances in health worker distribution are greater in rural and remote areas and the rural-urban fringe (6).Overcoming the problem of health worker shortages requires a wide range of actions and involvement of numerous stakeholders, within and beyond the health sector (7).A systematic review of strategies that aim to attract and retain health workers in rural and remote areas found that most focused on educational programs and few on programs that use financial incentives and personal and professional support (8).In order to address physician shortages in remote, highly vulnerable areas, the Government of Brazil implemented the Programa Mais Médicos (PMM; More Doctors Program) in 2013 through Law 12 871 (9).PMM consists of three strategic actions: (i) professional qualification by ABSTRACTObjective.To evaluate the Programa Mais Médicos (More Doctors Program; PMM) in Brazil by estimating the proportional increase in the number of doctors in participating muni cipalities and the program costs, stratified by cost component and funding source.Methods.Official data from the 2013 edition of Demografia Médica no Brasil (Medical Demography in Brazil) was used to estimate the number of doctors prior to PMM.The number of doctors at the end of the fourth PMM recruiting cycle (July 2014) was obtained from the Ministry of Health.Cost components were identified and estimated based on PMM legislation and guidelines.The participating municipalities were chosen based on four criteria, all related to vulnerability.Results.The PMM provided an additional 14 462 physicians to highly vulnerable, remote areas in 3 785 municipalities (68% of the total) and 34 Special Indigenous Sanitary Districts.There was a greater increase of physicians in the poorest regions (North and Northeast).The estimated annual cost of US$ 1.1 billion covered medical provision, continuing education, and supervision/mentoring.Funding was largely centralized at the federal level (92.6%).Conclusion.The cost of PMM is considered relatively moderate in comparison to its poten tial benefits for population health.The greater increase of doctors for the poorest and most vulnerable met the target of correcting imbalances in health worker distribution.The PMM experience in Brazil can contribute to the debate on reducing physician shortages.
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