Harris Matthew
Institute of Global Health Innovation, Department of Primary Care and Public Health, Imperial College London. 10th Floor, QEQM building, St. Mary's Hospital, Praed Street, London, W2 1NY England.
Cien Saude Colet. 2016 Sep;21(9):2919-23. doi: 10.1590/1413-81232015219.16952016.
The Programa Mais Medicos (PMM) is a national strategy to increase the numbers of Brazilian trained doctors entering primary care and is possibly the most significant human resource intervention in Latin America in recent years. From an English perspective, there are clearly opportunities to learn the PMM. First, PAHO's role in the PMM provides an exemplar for an overarching human resource migration and recruitment role throughout the EU. The role of the WHO in influencing and overseeing the recruitment of doctors throughout the EU could be an opportunity for improved distribution, avoiding a reliance on market forces. Secondly, a centrally-coordinated and governed process following well-established criteria and guidance laid out in law has helped to ensure that doctors are allocated to regions of the greatest need. Finally, the deployment of primary care doctors to ensure that the needs of the whole population are met, including in hard-to-reach areas. However, Brazil should not fall into the trap of doing much, and evaluating little. Brazil is in an exciting position to conduct robust before-after studies regarding the improvement in access, outcomes and equity that the ESF has already been credited with. Evaluation must include the impact of the PMM on Cuba.
“更多医生计划”（PMM）是一项旨在增加进入初级医疗领域的巴西本土培养医生数量的国家战略，它可能是近年来拉丁美洲最重要的人力资源干预举措。从英国的角度来看，显然有机会了解“更多医生计划”。首先，泛美卫生组织在“更多医生计划”中的角色为整个欧盟在人力资源迁移和招聘方面的总体作用提供了范例。世界卫生组织在影响和监督整个欧盟医生招聘方面的作用可能是改善分布、避免依赖市场力量的一个契机。其次，遵循法律规定的既定标准和指导原则进行的中央协调和管理流程，有助于确保将医生分配到最需要的地区。最后，部署初级医疗医生以确保满足全体人口的需求，包括难以到达的地区。然而，巴西不应陷入做得多、评估少的陷阱。巴西处于一个令人兴奋的位置，可以就扩大服务范围、改善医疗结果和公平性方面开展有力的前后对比研究，而这些成果已被归功于巴西统一医疗系统（SUS）。评估必须包括“更多医生计划”对古巴的影响。
