Challenges facing the More Doctors program (Programa Mais Médicos) in vulnerable and peri-urban areas in Greater Brasilia, Brazil

Abstract Background 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 employ...

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Autores principales:	Helena Eri Shimizu, Leonor Maria Pacheco Santos, Mauro Niskier Sanchez, Thomas Hone, Christopher Millett, Matthew Harris
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Human resources Remote areas Physicians Primary health care Vulnerable populations Medicine (General) R5-920 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/78670317fb0545e0b1a0e480c97bec07
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spelling	oai:doaj.org-article:78670317fb0545e0b1a0e480c97bec072021-11-08T11:15:51ZChallenges facing the More Doctors program (Programa Mais Médicos) in vulnerable and peri-urban areas in Greater Brasilia, Brazil10.1186/s12960-021-00672-21478-4491https://doaj.org/article/78670317fb0545e0b1a0e480c97bec072021-11-01T00:00:00Zhttps://doi.org/10.1186/s12960-021-00672-2https://doaj.org/toc/1478-4491Abstract Background 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. Methods 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. Results 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. Conclusions 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.Helena Eri ShimizuLeonor Maria Pacheco SantosMauro Niskier SanchezThomas HoneChristopher MillettMatthew HarrisBMCarticleHuman resourcesRemote areasPhysiciansPrimary health careVulnerable populationsMedicine (General)R5-920Public aspects of medicineRA1-1270ENHuman Resources for Health, Vol 19, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Human resources Remote areas Physicians Primary health care Vulnerable populations Medicine (General) R5-920 Public aspects of medicine RA1-1270
spellingShingle	Human resources Remote areas Physicians Primary health care Vulnerable populations Medicine (General) R5-920 Public aspects of medicine RA1-1270 Helena Eri Shimizu Leonor Maria Pacheco Santos Mauro Niskier Sanchez Thomas Hone Christopher Millett Matthew Harris Challenges facing the More Doctors program (Programa Mais Médicos) in vulnerable and peri-urban areas in Greater Brasilia, Brazil
description	Abstract Background 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. Methods 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. Results 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. Conclusions 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.
format	article
author	Helena Eri Shimizu Leonor Maria Pacheco Santos Mauro Niskier Sanchez Thomas Hone Christopher Millett Matthew Harris
author_facet	Helena Eri Shimizu Leonor Maria Pacheco Santos Mauro Niskier Sanchez Thomas Hone Christopher Millett Matthew Harris
author_sort	Helena Eri Shimizu
title	Challenges facing the More Doctors program (Programa Mais Médicos) in vulnerable and peri-urban areas in Greater Brasilia, Brazil
title_short	Challenges facing the More Doctors program (Programa Mais Médicos) in vulnerable and peri-urban areas in Greater Brasilia, Brazil
title_full	Challenges facing the More Doctors program (Programa Mais Médicos) in vulnerable and peri-urban areas in Greater Brasilia, Brazil
title_fullStr	Challenges facing the More Doctors program (Programa Mais Médicos) in vulnerable and peri-urban areas in Greater Brasilia, Brazil
title_full_unstemmed	Challenges facing the More Doctors program (Programa Mais Médicos) in vulnerable and peri-urban areas in Greater Brasilia, Brazil
title_sort	challenges facing the more doctors program (programa mais médicos) in vulnerable and peri-urban areas in greater brasilia, brazil
publisher	BMC
publishDate	2021
url	https://doaj.org/article/78670317fb0545e0b1a0e480c97bec07
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Challenges facing the More Doctors program (Programa Mais Médicos) in vulnerable and peri-urban areas in Greater Brasilia, Brazil

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