O Programa Mais Médicos: análise do processo de implementação, desdobramentos e perspectivas em Mato Grosso do Sul

Abstract

This work has as general objective to analyze the process of implementation of the More Doctors Program in Mato Grosso do Sul. It is a federal program implemented in 2013 by the government of the President Dilma Rousseff and structured to act, simultaneously and complementarily, in three "Axes of action", named: Emergency Provision; Education; and Infrastructure. This study analyzes the Medical Program within a historical process of struggles and social achievements that aimed the universalization of the public health system, materialized in the Unified Health System (SUS) and expressed in the Constitution of 1988. It is emphasized that public health policies - in this case of health - emerge from problems that are not innate, but produced. The issue of the shortage of physicians emerged as a consensus among politicians and was pointed out by several studies as one of the main public health problems in Brazil. In this way, the Program hired 13,862 professionals. In relation to the actions in the Education axis, it was verified the implementation of a plan for the expansion of undergraduate and medical residency, with important pedagogical changes in the training path of medical professionals and specialists through the creation of 11,5 thousand new graduation vacancies and 12.4 thousand places of residence until 2017. It was verified in the research that investments in infrastructure exceeded R $ 5 billion, aimed in the financing of 26 thousand works in almost 5 thousand Brazilian cities through the Program Requalifica UBS. Another significant aspect of the program was the hiring of foreign professionals, an initiative that - ideologically and mediatically - generated protests and dozens of legal actions by medical councils and medical associations, which irresponsibly requested the closure of the More Doctors Program. It was found that in Mato Grosso do Sul the actions implemented included 60 cities - out of the 79 existing ones - with the hiring of 339 doctors through the More Doctors for Brazil Project, during the fourteen cycles launched between 2013 and 2017. It was verified that the cities of Campo Grande, Dourados and Três Lagoas were contemplated with the opening of 208 new places in medical courses in public universities, in addition to the recent approval of the implementation of two new courses - September 2017 - to be taught by private institutions - in the cities of Corumbá and Ponta Porã - another 27 Brazilian cities will also receive private courses -. Thus, the market is appropriating of a successful public policy - now in another context - post-coup - in national history. It is evident for this research that Mato Grosso do Sul was contemplated with investments in the order of R $ 57 million for 151 actions in expansion, construction or rebuild of Basic Health Units in 58 cities. It is a program that brought historical advances in the area of public health, but which contradictorily faced medical corporatism and made possible the implementation of significant changes in thinking / acting in public health, with the humanization of training and practice of medicine and, above all , internalizing investments and public assistance in the sector. However, this new historical context - with freezing of public investments and expansion of the private sector - signifies that the More Doctors has been silently dismantled in its founding principles, but also in its materialities and actions.