“More Doctors” Program Policy cycle analysis: Brazil Cuba cooperation and health workforce management in primary care. Juliana Braga de Paula Marcia Faria Westphal Departamento de da Faculdade de Saúde Coletiva da Universidade de São Paulo

Context Brazilian Continental proportion Social inequality – huge gap between the rich and the poor Double burden of diseases– the neglected ones and the non-communicable diseases Problems of health care decentralization Low number of Family physicians with residency on the area Shortages or lack of physicians in remote areas Unequal distribution of the workforce Primary care access – problems of coverage and quality Streets protest in 2013

Policy More Doctors Programme Provision Infrastructure Investment on education – universality of Family health training and opening new courses of medicine

Research question What are the possible effects of Cuba Brasil cooperation on the medical workforce in Brasil? How this policy was designed, implemented and who were the key actors who played a role in the policy cycle What would be the learning opportunities for both Brazilians and Cuban doctors under the umbrela of this Project? Is it considered an innovation for Human Resource Planning in the Americas?

Contexto de influência Research Framework Cooperação Trabalho Médico Políticas Contexto da política Contexto de Prática Inovação? Contexto de influência

Data collection and analysis Qualitative design Triangulation of methods and sources 30 interviews of policy makers, physicians, supervisors, tutors, other health professionals, academic institutions Case study – field research work, supervision observation, interview of local authorities and health professionals Document analysis Content analysis of Bardin Code work with Nvivo

Results – policy Importação de conhecimento Articulação com as corporações médicas e outros atores Articulação com os atores internos (MEC) PMM Medida provisória

Results Results: In the macrolevel, the interviews show that medical education and practice are focused on specialized care, Market oriented, over using high technological resources, compared to Cuban doctors. That could be explained by the difference of education strategies, the majority of family physicians in Brazil are not Family doctors by education. All the Cuban in Brazil were educated as General Practitioners. Also the Cuban socialist model could influence. The Cuban doctors bring new perspective to Brazilian health professionals on the way the build linkage to the users, the way the deal with poverty and inequity. On the micro level, both groups are benefited of ongoing learning strategies, supervisions in locus, distant learning courses, and round table on main health problems, group practice sharing, and interchange on health local planning. The main problems are that it is a temporary provision strategy, it is not well settled with the Brazilian medical corporations and union, the supervisions are not always well organized by Universities, and some evaluation of impact do not show quality of primary care significant changes. It also shows the fragilities of health workforce management in Brazil by the municipalities alone, without the federal and state government interference.