Universidade de Brasília, Brasília, DF, Brazil.
Imperial College, London, UK.
Hum Resour Health. 2021 Nov 1;19(1):134. doi: 10.1186/s12960-021-00672-2.
A shortage of physicians, especially in vulnerable and peri-urban areas, is a global phenomenon that has serious implications for health systems, demanding policies to assure the provision and retention of health workers. The aim of this study was to analyze the strategies employed by the More Doctors Program (Programa Mais Médicos) to provide primary care physicians in vulnerable and peri-urban parts of Greater Brasilia.
The study used a qualitative approach based on the precepts of social constructivism. Forty-nine semi-structured interviews were conducted: 24 with physicians employed as part of the More Doctors program, five with program medical supervisors, seven with secondary care physicians, twelve with primary care coordinators, and one federal administrator. The interviews occurred between March and September 2019. The transcripts of the interviews were submitted to thematic content analysis.
The partnership between the Ministry of Health and local authorities was essential for the provision of doctors-especially foreign doctors, most from Cuba, to assist vulnerable population groups previously without access to the health system. There was a notable presence of doctors with experience working with socioeconomically disadvantaged populations, which was important for gaining a better understanding of the effects of the endemic urban violence in the region. The incentives and other institutional support, such as enhanced salaries, training, and housing, transportation, and food allowances, were factors that helped provide a satisfactory working environment. However, the poor state of the infrastructure at some of the primary care units and limitations of the health service as a whole were factors that hampered the provision of comprehensive care, constituting a cause of dissatisfaction.
More Doctors introduced a range of novel strategies that helped ensure a supply of primary care doctors in vulnerable and peri-urban parts of Greater Brasilia. The inclusion of foreign doctors, most from Cuba, was crucial for the success of the health services provided for the local communities, who subsist in violent and socioeconomically deprived urban areas. However, it became clear that barriers from within the health service itself hampered the physicians' capacity to provide a satisfactory service. As such, what is needed for primary care to be effective is not just the recruitment, training, and deployment of doctors, but also investment in the organization of the whole health system.
医生短缺，尤其是在脆弱和城市周边地区，是一个全球性现象，对卫生系统有严重影响，需要政策来确保卫生工作者的供应和留用。本研究的目的是分析“更多医生计划”（Programa Mais Médicos）在脆弱和城市周边地区提供初级保健医生的策略。
本研究采用基于社会建构主义原则的定性方法。共进行了 49 次半结构化访谈：24 次与作为“更多医生计划”一部分的医生进行，5 次与项目医疗主管进行，7 次与二级保健医生进行，12 次与初级保健协调员进行，1 次与联邦行政人员进行。访谈于 2019 年 3 月至 9 月进行。访谈记录经过主题内容分析。
卫生部与地方当局之间的伙伴关系对于提供医生至关重要——特别是来自古巴的外国医生，以帮助以前无法获得卫生系统服务的弱势群体。这里有许多有经验为社会经济弱势群体服务的医生，这对于更好地了解该地区地方性城市暴力的影响很重要。激励措施和其他机构支持，如提高工资、培训以及住房、交通和食品津贴，是提供满意工作环境的因素。然而，一些初级保健单位的基础设施状况不佳以及整个卫生服务的局限性是阻碍提供全面保健的因素，也是不满的原因。
“更多医生计划”引入了一系列新策略，有助于确保在大巴西利亚脆弱和城市周边地区提供初级保健医生。包括大多数来自古巴的外国医生对于为当地社区提供的卫生服务的成功至关重要，这些社区生活在暴力和社会经济贫困的城市地区。然而，显然卫生服务本身的障碍阻碍了医生提供满意服务的能力。因此，初级保健要有效，不仅需要招聘、培训和部署医生，还需要投资于整个卫生系统的组织。
