1. “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

2. 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

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

4. 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?

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

6. 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

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

8. 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.