Pesquisa de natureza qualitativa com objetivo de analisar a proposta pedagógica do Curso de Graduação da Faculdade de Enfermagem da PUC-Campinas, identificando em que medida seu Projeto Pedagógico atende aos pressupostos doutrinários do SUS (Sistema Único de Saúde), bem como às Diretrizes Curriculares Nacionais para o ensino na área. Para tanto foi adotado o estudo documental, utilizando os recursos teóricos e metodológicos da análise de conteúdo. O Corpus Documental constituiu-se por Documentos da Universidade e Faculdade de Enfermagem; Legislação para ensino na área e recomendações da Associação Brasileira de Enfermagem (ABEn), todos relativos ao período compreendido entre 1980 e 2004. A demarcação cronológica refere-se ao início do Projeto Pedagógico da PUC-Campinas, bem como, às inúmeras transformações na área da saúde e da formação de profissionais de saúde. A investigação permitiu identificar que, desde o início, a proposta de ensino da Faculdade mostrou-se de vanguarda na área, em decorrência, dentre outros fatores, da organização das políticas de saúde em Campinas, bem como dos propósitos contidos no Projeto da Universidade. Com relação ao currículo vigente, observamos necessidades de ajustes...
Two econometric models that can be used to study health manpower policies are described. Both are models of the entire health care system, treating both demand for and supply of health services and health manpower. The first is a macroeconometric model utilizing aggregate data to investigate issues in comprehensive health planning at the national, state, and substate levels. The second is a microsimulation model treating the interactions of individuals, health manpower personnel, health service institutions, and health professions educational institutions in the analysis of health manpower policies for the nation as a whole. The conceptualization of both models is presented and their current implementation status discussed.
Manpower projections for oral health are generally held to be more accurate than those for other health sectors since the diseases involved and their treatment times can be predicted more precisely. Nevertheless most oral health manpower projections are either overestimates or are not in line with the resources of individual countries, especially in developing countries. Zimbabwe was taken as the study case, and oral health manpower projections were made using two of the most commonly employed methods and one new approach. The projections obtained using the three methods were all different, and even the lowest projection is beyond the resources of the country. It is recommended that in making oral health manpower projections, the facilities available to accommodate these personnel should also be taken into account.
Health manpower developments of the past decade have resulted in an absolute increase in the number of health personnel, the expansion of the roles of some traditional categories of personnel, and the introduction of new professional categories. Inherent in these developments has been the acceptance of the principal that the relative and absolute increase in manpower would result in an increased availability of health services. Unfortunately, in the last decade, the correlation between increased numbers and increased services is not a strong one. The failure to link manpower needs to specific service objectives and to identify appropriate rates of substitution among professional types has resulted in a wastage of funds and energies.
The health workforce plays a key role in
increasing access to health services for the poor in
developing countries. Recent evidence has demonstrated an
important link between staffing levels and both service
delivery and health outcomes. Various global and
country-level estimates have also shown that current
staffing levels in developing countries, particularly in
Sub-Saharan Africa, are often well below those required to
deliver essential health services. This study focuses on two
main aspects of health workforce policy. First, it examines
how overall government wage bill policies affect the size of
the health wage bill, the hiring of health workers in the
public sector, and the related policy options. This focus is
important because despite the importance of fiscal
constraints on the wage bill, and the persistent debate at
the global level, very little documented evidence describes
how health wage bill budgets in the public sector are
determined, how this action is linked to overall wage bill
Public health systems in India have
weakened since the 1950s, after central decisions to
amalgamate the medical and public health services, and to
focus public health work largely on single-issue programs -
instead of on strengthening public health systems broad
capacity to reduce exposure to disease. Over time, most
state health departments de-prioritized their public health
systems. This paper describes how the public health system
works in Tamil Nadu, a rare example of a state that chose
not to amalgamate its medical and public health services. It
describes the key ingredients of the system, which are a
separate Directorate of Public Health - staffed by a cadre
of professional public health managers with deep firsthand
experience of working in both rural and urban areas, and
complemented with non-medical specialists with its own
budget, and with legislative underpinning. The authors
illustrate how this helps Tamil Nadu to conduct long-term
planning to avert outbreaks, manage endemic diseases,
prevent disease resurgence...
This study aims mainly at understanding
the performance of primary health care (PHC) providers in
four Nigerian states and the variables driving this
performance. The study is primarily based on quantitative
surveys at the level of primary health care facilities,
health care personnel, and households in their vicinity.
These surveys were implemented in four states: Bauchi, Cross
River, Kaduna, and Lagos. This study represents the second
phase of the Nigeria Health, Nutrition, and Population
Country Status Report (CSR). The first phase aimed at
analyzing the health situation of the poor and how the
health system was performing in terms of meeting their
needs. This first phase identified PHC as the weakest chain
in the entire health sector and the level of care the poor
use the most. This second phase of the CSR is therefore
focused on the analysis of the delivery of PHC services. In
contrast to the first phase, this study is mainly based on
primary data, data collected through facility, health
Thailand's health system is a
dynamic entity that continues to change and grow. The
country's health policies greatly affect the health
workforce, the choices they make, their numbers and their
availability. This paper explores the relationship between
Thai health workers and the policies that affect them.
For its level of socioeconomic
development, China has widely been perceived as a country
with an enviable record in public health. Recently, there
are encouraging signs that health has become an important
priority in the government s agenda, bringing multiple
government agencies into a more cooperative relationship,
and providing the Bank greater opportunity to engage the
country in policy dialogues to more effectively in improve
health outcomes and financing in a more equitable and
sustainable way. Since China became a member in 1980, the
World Bank's program of assistance for health has
consisted of 11 projects (involving commitments of 808
million dollars of International Development Association
(IDA) credits and 139 million dollars of International Bank
for Reconstruction and Development (IBRD) loans) and 3
economic and sector work (ESW) reviews. This was
complemented by the China network for training and research
in health economics and health financing set up in 1991, and
jointly funded by the Chinese Government and World Bank
Institute (WBI). There have also been various initiatives
supported by the health anchor some of which include tobacco
The development of a comprehensive data base for hospital-based ambulatory care has made possible the accurate determination of each community's use of hospitals in New York City and permits a reliable estimation of all ambulatory care received by residents of Health Manpower Shortage Areas (HMSAs). In spite of the city's abundant supply of private practitioners and widespread Medicaid coverage, residents of HMSAs in New York City are heavily dependent on hospital-based ambulatory care. Contrary to commonly held notions, however, HMSA residents do not appear to overuse hospital-based ambulatory care. Rather, that use appears to be quite modest, given their poorer health status.
The Census Bureau's occupational classification scheme and concept of the “health services industry” are inadequate tools for analysis of the changing job structure of health manpower. In an attempt to remedy their inadequacies, a new analytical framework—drawing upon the work of James Scoville on the job content of the U.S. economy—was devised.
Este estudo objetivou analisar o envolvimento de equipes da Atenção Básica à Saúde nas ações de controle da tuberculose, ante a percepção dos coordenadores do Programa de Controle da Tuberculose de nove municípios prioritários do Estado de São Paulo. Trata-se de uma pesquisa qualitativa, cujos dados foram coletados em junho/2005 por meio de entrevista semi-estruturada com nove coordenadores e analisados pela técnica de análise de conteúdo-modalidade temática. Os resultados apontaram dificuldades para incorporação das ações de controle da tuberculose, na atenção básica, relacionadas à debilidade quantitativa e qualitativa de recursos humanos e à visão centralizada e fragmentada da organização dessas ações no sistema de saúde. A integração das atividades de controle da tuberculose na atenção básica será possível mediante organização do sistema de saúde, seguindo os princípios da atenção primária e elaboração/implementação de uma política de recursos humanos que garanta formação e capacitação contínua das equipes de saúde.; En este estudio se tuvo por objetivo analizar el involucramiento de los equipos de Atención Básica a la Salud en las acciones de control de la tuberculosis...
This article makes an the evaluation of the satisfaction, among students of the course: "Training and development of manpower in Health " - CADRHU 2002" , that was offered by the Health State Secretary and Public Health School/USP. In order to do that, the authors used the technical devices of the Discourse of the Collective Subject (Lefèvre e Lefèvre, 2000), a methodology for the organization and computerized tabulation of qualitative data obtained from interviews. Basically using the theory of Social Representation, the proposal consists in presenting the results in many synthesis-speeches, written in the singular first person of the singular, in order to express the thought of the community, as if this community were a speech subject. In a general way, the students made a positive evaluation of the CADRHU methodology as a support for the participation, as well as for exchanging learning experiences and for the development of critical thought.; O presente artigo traz uma avaliação da satisfação dos alunos dos cursos de especialização "Capacitação e Desenvolvimento de Recursos Humanos em Saúde- CADRHU-2002", que foram oferecidos pelo convênio firmado entre a Secretaria de Estado da Saúde e Faculdade de Saúde Pública/USP. Para tanto utiliza a técnica do Discurso do Sujeito Coletivo (Lefèvre e Lefèvre...
The authors argue that "health for all" is not achievable in most countries without health sector reform that incorporates a process of coordinated health and human resources development. They examine the situation in countries in the Eastern Mediterranean Region of the World Health Organization. Though advances have been made, further progress is inhibited by the limited adaptation of traditional health service structures and processes in many of these countries. National reform strategies are needed. These require the active participation of health professional associations and academic training institutions as well as health service managers. The paper indicates some of the initiatives required and suggests that the starting point for many countries should be a rigorous appraisal of the current state of human resources development in health.
Of the 175 million people (2.9% of the world's population) living outside their country of birth in 2000, 65 million were economically active. The rise in the number of people migrating is significant for many developing countries because they are losing their better-educated nationals to richer countries. Medical practitioners and nurses represent a small proportion of the highly skilled workers who migrate, but the loss for developing countries of human resources in the health sector may mean that the capacity of the health system to deliver health care equitably is significantly compromised. It is unlikely that migration will stop given the advances in global communications and the development of global labour markets in some fields, which now include nursing. The aim of this paper is to examine some key issues related to the international migration of health workers and to discuss strategic approaches to managing migration.
The migration of health workers within and between countries is a growing concern worldwide because of its impact on health systems in developing and developed countries alike. Policy decisions need to be made at the national, regional and international levels to manage more effectively this phenomenon, but those decisions will be effective and correctly implemented and evaluated only if they are based on adequate statistical data. Most statistics on the migration of health-care workers are neither complete nor fully comparable, and they are often underused, limited (because they often give only a broad description of the phenomena) and not as timely as required. There is also a conflict between the wide range of potential sources of data and the poor statistical evidence on the migration of health personnel. There are two major problems facing researchers who wish to provide evidence on this migration: the problems commonly faced when studying migration in general, such as definitional and comparability problems of "worker migrations" and those related to the specific movements of the health workforce. This paper presents information on the uses of statistics and those who use them, the strengths and limitations of the main data sources...
This paper draws lessons from a review of primary health care services in Windhoek, the capital of Namibia, undertaken by a regional health management team. The review was carried out because of perceived increases in workload and inadequate staffing levels, arising from the rapid expansion of the city associated with inward migration. A survey of the utilization of government clinics was used to develop a more equitable allocation of primary health care services between localities. The survey revealed disparities between patterns of utilization of the services and the allocation of staff: the poorer localities were relatively underprovided. Decisions made centrally on resource allocation had reinforced the inequities. On the basis of the results of the review, the regional health management team redistributed nursing and medical staff and argued for a shift in the allocation of capital expenditure towards the poorer communities. The review demonstrates the potential for regional and provincial health management teams to make effective assessments of the needs of their populations and to promote the equitable delivery of primary health care services. In order to achieve this they need not only to become effective managers, but also to develop population-based planning skills and the confidence and authority to influence the allocation of resources between and within their regions and provinces.
Between 1988 and 2004, the Global Polio Eradication Initiative grew to become the largest international health effort in history, operating in every country of the world. An estimated 10 million health workers and volunteers have been engaged in implementing the necessary polio supplementary immunization activities (SIAs) on a recurring basis, and at least 35 000 well-trained workers have been conducting polio surveillance. A combination of task simplification, technological innovations and adaptation of strategies to fit local circumstances has allowed the Initiative to use a wide range of workers and volunteers, from both inside and outside the health sector, to deliver the polio vaccine during SIAs and to monitor progress in virtually every area of every country, regardless of the health infrastructure, conflict, geography and/or culture. This approach has required sustained political advocacy and mass community mobilization, together with strong management and supervisory processes. Non-monetary incentives, reimbursement of costs and substantial technical assistance have been essential. Given the unique features of eradication programmes in general, and polio eradication in particular, the implications of this approach for the broader health system must continue to be studied if it is to be replicated for the delivery and monitoring of other interventions.
Increasing the numbers of health workers and improving their skills requires that countries confront a number of ethical dilemmas. The ethical considerations in answering five important questions on enabling health workers to deal appropriately with the circumstances in which they must work are described. These include the problems of the standards of training and practice required in countries with differing levels of socioeconomic development and different priority diseases; how a society can be assured that health practitioners are properly trained; how a health system can support its workers; diversion of health workers and training institutions; and the teaching of ethical principles to student health workers. The ethics of setting standards for the skills and care provided by traditional health-care practitioners are also discussed.
In light of the increasing globalization of the health sector, this article examines ways in which health services can be traded, using the mode-wise characterization of trade defined in the General Agreement on Trade in Services. The trade modes include cross- border delivery of health services via physical and electronic means, and cross-border movement of consumers, professionals, and capital. An examination of the positive and negative implications of trade in health services for equity, efficiency, quality, and access to health care indicates that health services trade has brought mixed benefits and that there is a clear role for policy measures to mitigate the adverse consequences and facilitate the gains. Some policy measures and priority areas for action are outlined, including steps to address the "brain drain"; increasing investment in the health sector and prioritizing this investment better; and promoting linkages between private and public health care services to ensure equity. Data collection, measures, and studies on health services trade all need to be improved, to assess better the magnitude and potential implications of this trade. In this context, the potential costs and benefits of trade in health services are shaped by the underlying structural conditions and existing regulatory...