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SPATIAL DISTRIBUTION OF THE “MAIS MÉDICOS (MORE DOCTORS) PROGRAM” AND SOCIAL VULNERABILITY: AN ANALYSIS OF THE BRAZILIAN METROPOLITAN REGIONS
Equity
Health vulnerability
More Doctors Program
Mais Médicos Program
Saúde Pública
Vulnerabilidade em Saúde
Área Carente de Assistência Médica
Equidade em Saúde
Autor
Afiliación
University of Brasília. Brasilia, DF, Brazil.
Fundação Oswaldo Cruz. Fiocruz Brasília. Brasília, DF, Brasil.
University of Brasília. Brasilia, DF, Brazil.
University of Brasília. Brasilia, DF, Brazil.
Fundação Oswaldo Cruz. Fiocruz Brasília. Brasília, DF, Brasil.
University of Brasília. Brasilia, DF, Brazil.
University of Brasília. Brasilia, DF, Brazil.
Resumen en ingles
Background: The “Mais Médicos (More Doctors) Program” established in 2013 by the Brazilian Government aimed
to reduce inequalities by means of an emergency provision of physicians, the improvement of medical care service
in the Brazilian Unified Health System, and the expansion of medical education training in Brazil. In this context,
equity should be considered when defining priorities and allocating resources. This study describes the distribution
of physicians for the Program in five Brazilian metropolitan regions (MRs) and analyses whether the most vulnerable
areas within each one of these regions had been prioritized in compliance with the legislation framework of the
program.
Methods: This is a quantitative cross-sectional study. Official secondary data was analyzed to verify the relationship
between the Index of Social Vulnerability, set up by the Institute of Applied Economic Research, and the physician
allocation provided by the Program. The data were organized into categories and quintiles. For spatialization
purposes, the QGIS 3.4 Madeira software was used.
Results: There are 2592 primary health care units, (in Portuguese, UBS), within the five MRs studied; 981 of
these hosted at least one physician from the Program. In the Manaus, Recife, and the DF MRs, the 4th and 5th
quintiles (the most vulnerable ones) hosted physicians in more significant proportions than the other quintiles,
namely, 71.4%, 71.4%, and 52.2%, respectively, exceeding the national average (51.7%). It is worth mentioning that
in the São Paulo MR, the units located in the most vulnerable quintiles (4th and 5th) also hosted physicians in
proportions significantly higher than others (45.8%); however, this proportion did not reach 50%. There was no
significant difference in the allocation of physicians in the Porto Alegre MR, indicating that there was no
prioritization of the UBS according to vulnerability. Conclusions: These results appoint to the enormous gaps of vulnerability existing both between the analyzed MRs
and internally in each one of them. It emphasizes the need for criteria for the allocation of physicians so as not to
increase inequities. It also highlights the importance of the continuity of the “Mais Médicos (More Doctors) Program”
in the metropolitan regions, above all, in areas of extreme vulnerabilities. On the other hand, they contribute to the
national debate about the importance of public policies regarding constitutional rights related to access to health
care and the relevance of primary care and the “Mais Médicos (More Doctors) Program” for the reduction of
disparities regarding access to health care, especially for the citizens who live in regions of greater vulnerability,
whether it is inside or outside large metropolitan regions.
Palabras clave en ingles
Public healthEquity
Health vulnerability
More Doctors Program
Mais Médicos Program
DeCS
Consórcios de SaúdeSaúde Pública
Vulnerabilidade em Saúde
Área Carente de Assistência Médica
Equidade em Saúde
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