Celia Regina Pierantoni, Celia Regina Pierantoni, MD, DSCMD, DSCAssociate Professor Social Medicine InstituteAssociate Professor Social Medicine InstituteRio de Janeiro State University (Brazil)Rio de Janeiro State University (Brazil)

Amsterdam – March, 2010Amsterdam – March, 2010

Ministérioda Saúde

Context - Brazil

The fifth largest country in the world: 8.514.876 km2

190 million inhabitants: multicultural and heterogeneous Democratic Federative Republic: - 5 geographic regions; - 26 states (federative intermediary level) and a federal district - Brazil’s Capital City, Brasília); - 5,565 municipalities; - States and municipalities have political and administrative autonomy. Among the ten largest economies in the world [GDP: US$ 1.6 trillion; US$ 9,000 per capita] . Expenditures with public health: 3.4% of GDP (2006).

HRH Observatory Network – IMS/UERJ

North regionNortheast region

Center west region

East region

South region

Brazil’s Map

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National Healthcare System

Public – Unified Healthcare System (SUS)Private – Supplementary System

Unified Healthcare System (SUS)

Based on the principles of universal coverage, full care and equity, included in the Constitution (1988). Decentralized and socially controlled system. Free health care for the whole population. Exclusive coverage: 80% of the population. 1 billion primary health care procedures / year. 132.5 million highly complex procedures / year. 2.5 million healthcare workers (public sector).

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Purposes

To standardize Human Resourses for Health (HRH) management processes and organizational structure in Brazil;

To verify the results of HRH’s policies changes induced by Federal Government - with focus in work and education management HRH.

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Methodology (1)

Primary data colletion (2007-08):

337 Healthcare Departments of large urban centers, municipalities and Brazilian states.

(Where currently live approximately 70% of the Brazilian population).

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Methodology (2)

Survey – with 74 questions, answered by 253 HRH managers.

Focal Groups: for analytical and comparative studies (five). Results: compared results of current research with a previous research carried out by HRH’s management - base line (2004).

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Results (1)

76% of the Healthcare Departments have some type of HRH unit. Most of them follow the federal model – work and education management;

48% of the Healthcare Departments have had changes after creation of the new HRH unit of the Ministry of Health (2003).

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76%

23% 1%

Yes No No answer

Graphic 1: Presence of HRH unit in Decentralized Health Departments Structure. Brazil, 2008.

Source: Management of Labor and Education in Health Research. ObservaRH/IMS-UERJ. Brazil, 2008.

Graphic 2: Changes in structure of HRH unit after creation of Work and Education Management of Health Department-MoH (SGTES). Brazil, 2008.

HRH Unit in City Health Departments (SMS)/ State Health Departments (SES)

Results (1) – cont...

Do not know howto evaluate

19%

No 24%

Yes48%

No answer

9%

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Results (2)

Work Management Actions

Career path system – development of a unified career, with similar structures in all federative instances:

• 20,2% Health Departments have a specific career plan for the healthcare division and 29% for all public workers.

Labor negotiation – program of labor dispute settlement among managers and workers of the public health system.• 27% managers involved.

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Results (3)

Program for the end of precarious work (with no labor rights nor social protection).

42% of the managers are not aware of this program. 23% participate solving problems for recruiting healthcare workers. 17% declared precarious work non-existent.

Qualification and modernization of HRH units (PROGESUS) – modernization of HRH unit in healthcare departments, training health professionals for HRH management and development of a national HRH information system.

most known program by HRH managers (77%).

HRH Information System

63% of the Health Departments have an HRH information system, mainly based on payrolls.

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Information System

ExistenceCapitals SES SMS Total

Frequency (%)

Yes 21 21 118 160 63,2

No 2 5 73 80 31,6

Does not know 0 0 7 7 2,8

No answer 0 1 5 6 2,4

Total 23 27 203 253 100,0

Schedule 1: Existence of an information system in HRH unit in Health Departments from the states, capitals and municipalities. Brazil, 2008.

HRH Information System

Source: Management of Labor and Education in Health Research. ObservaRH/IMS-UERJ. Brazil, 2008.

HRH Observatory Network – IMS/UERJ

Results (4)

Education Management Actions

Permanent Health Education – professional training program for healthcare workers, in order to carry out changes in healthcare practices.

46% of the Health Departments participate in this program.

Re-orientation of Professional Healthcare Education – PRO-SAUDE - for medical, nursing and dentistry course undergraduates (other courses are now being included – 2nd. phase, 354 undergraduate courses and about 96.000 students).

60% of HRH’s managers are not aware of the program.

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Results (5)

Cooperation among the Health Departments and Educational Institutions (67%)

mainly for specialization courses and apprenticeship field; low (31%) articulation among Health Departments and SUS technical schools (responsible for technical education in health).

Technical courses required: - health community workers - nursing technicians - dental technicians

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Cooperation among the Health Departments and Educational Institutions

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

Graphic 3: Cooperation among SMS/SES and education institutions in Health Departments. Brazil, 2008.

Source: Management of Labor and Education in Health Research. ObservaRH/IMS-UERJ. Brazil, 2008.

Internship field Specializationcourses

Regular coursesfor specificthemes andprogrammes

Introductorytraining

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Conclusions

The research also revealed

the importance of State Healthcare Departments (Federative Intermediary Level) in cooperation with work plans and education for management in the local HRH units at city level.

the importance of the managerial role of the HRH system at the federal level, in order to induce changes for HRH on other administrative levels, including financial, administrative and technical processes;

the need to continue monitoring and evaluation HRH’s policies by the federal instance for changes, local adaptations and in order to induce news, especially for the education area.

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Confirmed Hypothesys

Decentralization of public health system in Brazil induces prompt changes in HRH’s units, but the distance between speech x praxis remains with lowinstitutionality* of the HRH area, as well as in the policy and management field.

* Scott, Richard W. Institutions and Organizations. Sage Publ Series. Thousand Oaks, 1995: 178 pp. Passim

HRH Observatory Network – IMS/UERJ

Observatory Network HRH-IMS/UERJ Work StationPAHO/WHO Colaborating CenterLeader: cpierantoni@gmail.com

Leader: Celia Regina Pierantoni

Researchers:

Ana Claudia Pinheiro Garcia Maria Ruth dos Santos Tania França Thereza Christina Varella Valéria de Oliveira Monteiro

HRH Observatory Network – IMS/UERJ

Observatory Network HRH-IMS/UERJ Work StationPAHO/WHO Colaborating CenterLeader: cpierantoni@gmail.com

Internships: Karen dos Santos Matsumoto Michely Alexandrino de S. Pinheiro Tathiana Torres Ribeiro Santos

Technical Support: Sidney Lima Filho Valéria Dias Mattos

Collaboration: Observatory Network of HRH - NESCON/UFMG Work Station Observatory Network of HRH - NERHUS/ENSP Work Station

HRH Observatory Network – IMS/UERJ

http://www.observarh.org.br/ims

http://ccoms-imsuerj.org.br

Thank you!