Note from BW of Brazil: Along with education and income, health care is another area in which the quality of life of the citizens of a particular country can be measured. Health care in Brazil, as in many other countries, is something that must be improved if the nation is to reach the potential that its much improved economy has done in the past decade. According to data of the World Health Report by the World Health Organization in 2000, Brazil was ranked number 125 of the 190 member countries of the organization. A number of studies have also shown the racial inequalities within the country’s national health care system as have been featured on previous posts on this blog. One of the problems within the system is the shortage of doctors per citizen throughout the country. To address this problem, the government recently initiated a program to attract doctors from foreign countries with the aim of making health care more accessible to its citizens that live in smaller, more distance regions of the country where health services are extremely lacking. The program has led to unexpected reactions in the medical establishment; reactions that we will address in the coming days. For now, learn more about the program.
Municipalities (cities) will have 14 days to adhere to the “Mais Médicos” program
by André de Souza of O Globo and the Secretaria de Gestão do Trabalho e da Educação na Saúde
The 1,290 cities in the country with high social vulnerability will have priority in filling vacancies
The program “Mais Médicos para o Brasil (More Doctors for Brazil)”, which was initiated on Monday (July 8th) by the federal government provides a stipend of R$10,000 (US$4,266) paid by the Ministério da Saúde (Ministry of Health) to the professionals who are the regions where there is a shortage of these doctors. The help can be from R$30,000 for those who are working in Amazônia Legal, at the border and in indigenous health districts; R$20,000 (US$8,532) for the Northeast, Midwest (except the Distrito Federal/Federal District or DF) and Vale do Jequitinhonha in the state of Minas Gerais, and R$10,000 in capital cities, metropolitan areas and the DF. In the first two cases, the payment of the aid will be split: 70% at the beginning and 30% after 180 days. In the latter case, the payment will be made all at once.
The call for foreign doctors will be individual, ie , it will not be targeted at any particular country. They will have to fulfill some pre-requisites: be a graduate of a recognized institution of quality standard, have the right to practice medicine in the country of their training, have knowledge in Portuguese; come from a country with more doctors than Brazil. In the case of knowledge in Portuguese, it will be declared by the physician at the time of registration. When arriving in the country, a university will attest to the mastery of the language.
On Tuesday (July 9th) three calls will be made: one for physicians and one for the adhesion of the municipalities, and another to select the public universities to act as supervisory institutions. These institutions are responsible for the specialization course offered to doctors in the program.
There will be priority in filling vacancies: the 1,290 cities with high social vulnerability; 201 capitals or municipalities in the metropolitan areas with more vulnerable populations, the 66 municipalities with over 80,000 inhabitants with low income and high social vulnerability (usually cidades-dormitório or dormitory cities), and 25 distritos sanitários especiais indígenas (special indigenous health districts) (1). But any municipality with a health unit in poorer neighborhoods may subscribe.
Eight municipalities of Rio are on the list of priorities: Duque de Caxias, Guapimirim, Japeri, Magé, Paracambi, Queimados, Rio de Janeiro and Seropédica.
Aming medical entities – the Conselho Federal de Medicina (Federal Council of Medicine or CFM) , Federação Nacional dos Médicos (Fenam or National Federation of Physicians) and Associação Médica Brasileira (AMB or Brazilian Medical Association) – there are several reviews of the positions offered in the most needy areas. In many cases, a high salary is offered, but lacks structure and, after a few months, the city fails to pay that sizable salary.
With the “Mais Médicos”, wages will be paid by the Ministry of Health and compensation will be required of the municipalities. They will be responsible for providing room and board to physicians. Municipalities also need to access resources from the ministry for the construction, renovation and expansion of basic health units. The term of adhesion by the municipalities is from July 9 to July 22.
Doctors will be accompanied by a tutor appointed by a public university, a supervisor from the state or city Department of Health, and one preceptor who now works in that health unit. Where there are no doctors, the preceptor will come from elsewhere.
The president also announced Monday an additional R$5.5 billion (US$2.33 billion) for the construction of 6,000 unidades básicas de saúde (basic health units or UBSs) and renovation and expansion of other 11,800. The money also will be used in the construction of 225 unidades de pronto atendimento (UPAs or emergency units). The government aims to create 35,000 job posts in UPAs and UBSs through 2014. In addition, there will be R$2 billion (US$848 million) for the construction of 14 new university hospitals.
Expansion of medical school and residency spaces
Mais médicos also includes measures previously announced by the government, such as the creation of 11,447 vacancies for medicine graduates until 2017, in 117 municipalities, to the areas that are most in need of these professionals. Of these vacancies, 1,452 should begin in 2014.
In addition, there will be 12,000 new residency vacancies by 2017, of which 4,000 (will be filled by) to 2015. The stipend of R$2,976.26 (US$1,261) will be paid by the Ministry of Health. There will be 1,291 in the North, 4,132 in the Northeast, 934 in the Midwest, 5177 in the Southeast and 838 in the South. Today, of the 23,000 stipends of residence, about 7 thousand are paid by the Ministério da Educação (MEC or Ministry of Education), 3000 by the Ministry of Health and 13,000 by state and charity hospitals.
The goal is to address the lack of specialists. Data from the Ministry of Health show that in public hospitals, the greatest needs are in pediatrics, neurology, anesthesiology, neurosurgery, internal medicine, radiology, cardiology, pediatric ICU, nephrology and psychiatry. In private hospitals, there is a lack of pediatricians, intensivists, neurologists, anesthesiologists, neurosurgeons, clinical physicians, gynecologists, orthopedists, radiologists, cardiologists and general surgeons.
Data from the Ministry of Health indicate a lack of doctors in the country
According to the Ministry of Health, there are currently 1.8 doctors per 1,000 inhabitants in Brazil, below the average and other countries, such as Venezuela (1.9) , Mexico (2) , Canada (2) United States (2.4) , UK (2.7) , Australia (3) , Argentina (3.2) , Italy (3.5) , Germany (3.6) , Uruguay (3.7) , Portugal (3.9) , Spain (4) and Cuba (6.7).
With the measures being taken by the government, it is expected that this rate will reach 2.7 in 2025. This means that the number of doctors working in Brazil would increase from the current 374,000 to 585,000 by then. It is estimated that, if the measures were adopted, the country would have 545,000 doctors here within 12 years.
According to data from the Ministry of Health, there was, in the last ten years, the creation of 146,000 first formal jobs in medicine, but only 93,000 graduates. Also according to the Ministry, there are 700 municipalities in Brazil that do not have a doctor.
President Dilma chose to edit an interim measure to institute the program. This means that it was to take effect on Tuesday, with the publication in the Diário Oficial da União of the medida provisória or provisional measure. Also Tuesday was scheduled to be published ministerial decree (Health and Education) program. On the same day will begin a public consultation notice for the opening of new medical schools by the Ministry of Education.
The provisional measure can be further modified by Congress and must be approved in a maximum of 120 days from its publication. If, at the end of the proceedings in Parliament, there are changes, they will not affect the doctors now selected in the program.
“Programa Mais Médicos para o Brasil (More Doctors for Brazil Program)” (by the Secretaria de Gestão do Trabalho e da Educação na Saúde)
Brazil: Medical Demography and Sistema Único de Saúde (Unified Health System or SUS)
Brazil is a continental country that has a large territory (8,515,767.049 km2), a population of around 200 million people and cultural diversity among its five regions (North, Northeast, Midwest, Southeast and South).
It is one of the eleven countries of the world with a population exceeding 100 million people that adopts a public and free system: the Sistema Único de Saúde (Unified Health System or SUS). SUS consists of a set of actions and health services provided by agencies and public and private institutions, on the federal, state and municipal level. Since its inception in 1986, SUS has already made many advances, but there are still important problems to be addressed to ensure the universality of care and comprehensive care. One is the lack of doctors. Over the last ten years, the number of formal jobs in SUS created for physicians exceeded by 54,000 the number f graduates in the country. From 2003 to 2011, there were 147,000 jobs in this job market against 93 thousand graduates. In this context of a lack of professionals sums up the prospect of hiring 26,311 doctors to work in basic health units of SUS, whose construction is being paid for with funds from the Ministry of Health until 2014. Currently there are 1.9 doctors per thousand in Brazil’s population. With the goal of achieving an average of 2.7 doctors per thousand in the population, a target set by the Ministry of Health, Brazil would need 168,424 more doctors today.
Several measures have been taken by the Brazilian government to cover the gaps existing assistance to ensure access to all people at all levels of health care. These measures are organized in the program called Mais Médicos para o Brasil (More Doctors for Brazil) and one of them is the Chamada Internacional de Médicos (International Call for Doctors).
“Programa Mais Médicos para o Brasil (More Doctors Program for Brazil)”
Objective: Provide physicians in primary care in areas that need such professionals, aiming to increase the coverage of the population.
Strategies for induction of the provision and retention of doctors in Brazil
International Call for doctors: Exchange with professionals trained abroad to work in primary care in priority regions for the Sistema Único de Saúde (SUS).
• Brazil will follow the code of recruitment of health professionals from Organização Mundial da Saúde (OMS or WHO/World Health Organization), of which the country is signatory. Thus, only doctors trained in countries with a proportion of these professionals greater than 1.9/1,000 per inhabitant will participate.
• Accepted will be medical graduates from: Portugal, Spain, Cuba, Argentina and Uruguay from national public universities and institutions accredited by Arco-Sur or even trained in other countries from institutions of recognized international standard and proficient in the Portuguese language
• The foreign doctor that meets the international call will not have automatic validation of diploma but a special permit to operate in the program and in areas predetermined by the Ministério da Saúde (Ministry of Health)
• The program will last for three years
• Medical professionals will have the right of choice of municipalities that are part of the Federal Government priority groups, such as those located in areas of extreme poverty, interior municipalities and difficult access and the periphery of large cities (Capital and metropolitan region).
Official video for the “Mais Médicos para o Brasil” program
Source: O Globo, Secretaria de Gestão do Trabalho e da Educação na Saúde
1. Cidade-dormitório, or suburb, is a designation used to refer to urban areas that emerged on the outskirts of a large city typically to serve as housing for workers in the city-core region. Generally, the division between the suburbs and dormitory towns is inaccurate due to the conurbation of cities. Dormitory towns tend to be connected by means of mass transportation to workplaces of the majority of its residents. A summary of the definition “dormitory city” may be the following: dormitory cities are those in which the activities are not sufficient to employ and fix its active population, which leads most residents to commute daily to the closest city to practice their profession. Source
Distritos sanitários especiais indígenas (special indigenous health districts) cover a geographical area that contains a population with epidemiological and social characteristics, and its necessities and the health resources to meet it. The geographic area is defined for each element and may consist of: • the various districts of a municipality; • various locations in the region. In the process of defining of the territory-district should be considered for its composition relations of flows between municipalities or districts, natural or cultural references established between them in their various activities, mainly in the area of health. Source
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