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báo cáo sinh học:" Continuity and change in human resources policies for health: lessons from Brazil"

Tuyển tập các báo cáo nghiên cứu về sinh học được đăng trên tạp chí sinh học quốc tế đề tài : Continuity and change in human resources policies for health: lessons from Brazil | Buchan et al. Human Resources for Health 2011 9 17 http www.human-resources-health.eom content 9 1 17 HUMAN RESOURCES ulli FOR HEALTH RESEARCH Open Access Continuity and change in human resources policies for health lessons from Brazil James Buchan1 Ines Fronteira2 and Gilles Dussault2 Abstract Background This paper reports on progress in implementing human resources for health HRH policies in Brazil in the context of the implementation and expansion of the Unified Health System Sistema Unico de Saúde - SUS . The three main objectives were i to reconstruct the chronology of long term HRH change in Brazil and to identify and discuss the precursors drivers and enablers for these changes over a long time period ii to examine how change was achieved by describing facilitators and constraints and how policies were adapted to deal with the latter and iii to report on the current situation and draw policy implications. Methods A mixed methods approach was used. A literature review was conducted using pre-defined keywords and stakeholders were contacted and asked to provide relevant information data and policy reports. Results There are two key features of HRH change which are related to the implementation of SUS which merit attention the achievement of staffing growth and the improvement in HRH policy making and management. Staff growth rates across the period have been high enough to exceed population growth rates. As a consequence the ratio of staff to population has improved. In 1990 the physician ratio per 1000 inhabitants was 1.12. In 2007 it was 1.74. Another critical factor in achieving staffing growth has been HRH policy making capacity and influence within the political establishment. Conclusions Policies have had to adapt to changing circumstances whilst focusing on sequential improvements aimed at achieving long term goals. The end objectives of improving care and access to care have been kept in view. No one Ministry could secure all the resources and impetus