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The Mais Medicos (More Doctors) Program: assessments and prospects.

Three years after the implementation of the Mais Medicos (More Doctors) Program, the Coordinating Committee of the Research Network on Primary Health Care (PHC) of the Brazilian Public Health Association (ABRASCO), in partnership with the Pan American Health Organization (PAHO), issued a call for papersand organized this thematic issue. The publication of results of research on the Mais Medicos Program, currently present in 4,058 municipalities and 34 Special Indigenous Health Districts, with a contingent of more than 18,000 physicians, set out to report on progress made and challenges faced by this public policy.

In addition to deploying emergency measures for the provision of physicians to ensure access to unattended population groups, the Mais Medicos Program has altered the structure for the training of physicians in Brazil in the medium and long term. It is oriented to the universalization of medical residency, with an emphasis on general practice training in family and community medicine, opening up more places on courses in medicine and making changes in curriculum guidelines, all of which are important initiatives for the consolidation of the Unified Health System (SUS). Thus, the focus on medical professionals for PHC is brought to center stage, being considered the most important initiative of the Brazilian government geared to this end. Never before has medical training for PHC had such prominence in Brazilian health policy.

Selected articles with distinct methodologies and a diversified focus and scope provide a broad overview of the deployment of the Mais Medicos Program and cover issues related to its three components: emergency provision, medical training and infrastructure of the basic health units.

The implementation of the Mais Medicos Program is recent, and its full impact will only be evaluated in the medium and long term. Nevertheless, the following aspects have been revealed in the research presented here: a significant reduction in the number of municipalities with a shortfall of physicians; the predominant deployment in municipalities with greater social vulnerability; an increase in access to PHC services, both in those municipalities that have historically had difficulty including physicians in their Family Health Strategy teams, and also in those where the permanence of these professionals was a hindrance to good performance with the intermittent presence of physicians; a positive impact on production indicators; the convergence with other programs for the improvement of the quality of primary health care; user satisfaction; scope of practice of the participants highlighting the need for structural changes in the Basic Health Units for multifunctional PHC to attain more advanced levels; and reflections on the training and mentoring processes and how they have a positive impact on the daily life of the teams. Challenges remain and are highlighted as the partial replacement of the physicians of already existing teams, regional inequalities in distribution, the precarious nature of stable ties for retaining professionals in remote and under attended areas and the lack of career stability of PHC physicians in the SUS.

At this present juncture, bearing in mind the recent changes and uncertainties in the Brazilian political scenario with initiatives that threaten the right to health and the prospects for progress in the empowerment of the SUS, with the threat of withdrawal of funding and the constitutional stipulation of limits for health expenses within the context of chronic underfunding of the SUS, we are concerned about the sustainability of the Mais Medicos Program. If we want a national health system based on robust, effective and quality PHC it is essential to ensure the continuity of the Mais Medicos Program, especially with strategies that involve the provision of professionals and training focused on general medical practice.

DOI: 10.1590/1413-81232015219.18952016

Luiz Augusto Facchini [1], Sandro Rodrigues Batista [2], Aluisio Gomes da Silva Jr [3], Ligia Giovanella [4]

[1] Departamento de Medicina Social, Universidade Federal de Pelotas

[2] Faculdade de Medicina da Universidade Federal de Goias

[3] Instituto de Saude Coletiva, Universidade Federal Fluminense

[4] Escola Nacional de Saude Publica Sergio Arouca, Fundacao Oswaldo Cruz.
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Title Annotation:texto en ingles
Author:Facchini, Luiz Augusto; Batista, Sandro Rodrigues; da Silva, Aluisio Gomes, Jr.; Giovanella, Ligia
Publication:Ciencia & Saude Coletiva
Article Type:Editorial
Date:Sep 1, 2016
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Next Article:Primary care in Brazil, and the Mais Medicos (More Doctors) Program in the Unified Health System: achievements and limits.

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