Emerich Tatiana Breder, Cavaca Aline Guio, Santos Neto Edson Theodoro Dos, Oliveira Adauto Emmerich, Siqueira Carlos Eduardo
Programa de Pós-graduação em Saúde Coletiva, Universidade Federal do Espírito Santo, Vitória, Brazil.
Escola de Governo, Fundação Oswaldo Cruz, Brasília, Brazil.
Cad Saude Publica. 2020;36(5):e00043219. doi: 10.1590/0102-311x00043219. Epub 2020 Jun 1.
The study aimed to assess the implementation of the More Doctors Program (PMM in Portuguese) based on a case study of the Espírito Santo State, Brazil. The first stage involved analyzing the documents that launched the PMM, allowing the creation of a logic model. In the second stage, data on the PMM in Espírito Santo State were analyzed (2013-2016) based on population brackets, creating indicators for the proportion of physicians before and after the Program with the following parameters: unacceptable (0 to 0.99 physicians/1,000 inhabitants); acceptable (1 to 1.99); and desirable (2.0 or more). Data were analyzed with the Wilcoxon and Kruskal-Wallis non-parametric tests. The model included the size, inputs, activities, outputs, results, and impact of the PMM, orienting analysis of the Program's implementation. Of all the physicians in the emergency supply to Espírito Santo State (432), the majority (63.8%) were cooperative exchange physicians (Cubans), while 31.2% were regional board-accredited Brazilians. The Brazilian and individual exchange physicians were allocated mainly in medium and large municipalities, while the Cubans were distributed more heterogeneously in municipalities of all population sizes and were thus more common in areas with greater social vulnerability and lower social capital. There was a significant increase in the number of physicians in Espírito Santo State, but the supply to the extremely poor population did not reach the desired level, presenting an unacceptable mean rate in municipalities with up to 10,000 inhabitants and an acceptable rate in municipalities in the other population brackets.
该研究旨在基于巴西圣埃斯皮里图州的案例研究,评估“更多医生计划”(葡萄牙语为PMM)的实施情况。第一阶段包括分析启动PMM的文件,从而创建一个逻辑模型。第二阶段,基于人口分组对圣埃斯皮里图州的PMM数据(2013 - 2016年)进行分析,为该计划实施前后的医生比例创建指标,指标参数如下:不可接受(0至0.99名医生/1000居民);可接受(1至1.99);理想(2.0或更高)。使用威尔科克森和克鲁斯卡尔 - 沃利斯非参数检验对数据进行分析。该模型包括PMM的规模、投入、活动、产出、结果和影响,为该计划实施情况的分析提供指导。在圣埃斯皮里图州应急供应的所有医生中(432名),大多数(63.8%)是合作交流医生(古巴人),而31.2%是巴西地区委员会认可的医生。巴西医生和个人交流医生主要分配在中大型城市,而古巴医生在各种人口规模的城市分布更为分散,因此在社会脆弱性较高和社会资本较低的地区更为常见。圣埃斯皮里图州的医生数量显著增加,但向极端贫困人口的供应未达到理想水平,在居民人数达10000人的城市中平均比率不可接受,在其他人口分组的城市中比率可接受。