The primary care area will need a special look from the Luiz Inácio Lula da Silva (PT) administration, according to the opinion of the president of the Brazilian Society of Family and Community Medicine, Zeliete Linhares Leite Zambon.
According to her, there is a lack of professionals, career incentives and investments.
According to the expert, for good health management, the government should invest in primary care, community health agents, training of family and community doctors, as well as increase the resolution of primary care and return to Nasf professionals ( Family Health Support Center).
Are family doctors missing in the SUS? In the SUS alone, the deficit ranges from 45,000 to 65,000 family and community doctors. We have only 10,000 of these professionals.
What is the deficit attributed to? First, there was no such professional within the degree. Since 2014, with the modification of the national curricular address for medicine courses, a specialist professor in family and community medicine has become mandatory, including the subject of primary care transversal to the entire course. If we calculate, it will take at least ten years to train the necessary number of these specialists.
When we graduate, we’ll need more, because the population is increasing. The specialty turned 41 on December 5th [Dia Nacional do Médico de Família e Comunidade], but the format was different. Since 2002, it has started to be in the care format, to solve all primary care problems, which are equivalent to 85% of people’s health problems. The role of primary care has also changed. Before we had a vision of prevention. Today it is prevention, treatment, diagnosis, rehabilitation.
How could the country encourage the option for family medicine? We have an urgent need for medical supplies in primary care. This urgency has led to several programs, such as Mais Médicos and Provab (Program for the Evaluation of Primary Care Professionals), in which graduates leave their degree and receive a scholarship of much higher value than the residency grant, R $ 4,000 . Provab was R$10,000; Mais Médicos exceeded R $ 11,000; and Doctors for Brazil [substituto do Mais Médicos], approximately R $ 15 thousand. This discourages recent graduates from continuing with the family and community medicine residency.
How do you evaluate the Bolsonaro administration in relation to the health of the family? Horrible. As regards the family health strategy, there was a decline in investment. Also due to the freeze on funds for health and education, investments in resolvability have decreased, because it has cut funds for the flow of family health support. This in itself has already diminished the incentive for primary care.
In family and community medicine, for the first time since the beginning of the Pró-Residência residency scholarships have not been encouraged in this specialty [Programa Nacional de Apoio à Formação de Médicos Especialistas em Áreas Estratégicas]. This makes it clear that the government had no intention of valorising family and community medicine. Within Médicos pelo Brasil, the Agency for the Development of Primary Health Care was created with the motto of training in family and community medicine. In fact, it took a long time to start the course, which happened recently. Even so, there should be ongoing evaluation of this process by Doctors in Brasil. The programme, which is a mix of provision with training and ultimately qualification of community and medicine specialists, took some time to implement. Just throwbacks.
What is the impact of the health crisis on family medicine? As there was no planning for what this job would look like, there was no investment, improvement or maintenance of existing policies. This has led to people going to the emergency room more often, suffering from chronic diseases such as high blood pressure and diabetes, and having more strokes and heart attacks.
The economy spends more in the secondary and tertiary sectors, because there is no care in managing people’s health. Family and community medicine started to become very private. There was already an appeal from the private system for this professional, who was highly valued there. In addition to no longer training family doctors and reducing primary care spending, the government has lost family and community medicine specialists to the private sector, which has significantly worsened the quality of primary care.
What are the institution’s expectations of the Lula government? We know it will be a difficult year due to budget issues. We hope this government is clear that primary care must be the coordinator of the entire health system. There is a need to invest in primary care, family and community physician training, scale up primary care resolution, return to Nasf practitioners, and invest in community health workers, innovation and information systems. This is the logic of good health management.
And we hope this government listens to the experts in family and community medicine. Activate us, search for the Society [Brasileira de Medicina de Família e Comunidade], that we have indications to give. We hope that family and community medicine specialists are valued, have a career plan, training incentives.
Just as we encourage emergency physicians with larger grants, we must encourage those doing family medicine residency to also have larger grants, a medical career process, and fixation within the Family Health Strategy.
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Zeliete Linhares Leite Zambon
President of the Brazilian Society of Family and Community Medicine. Graduated in medicine from the Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, family and community doctor, master’s degree in health teaching sciences from Unifesp. He holds an Executive MBA in Health Management from Einstein. She is the teaching coordinator of the medical course at the Faculdade São Leopoldo Mandic.
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