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12th WORLD CONGRESS ON PUBLIC HEALTH Management
of workforce in the Brazilian public health system
Celia Regina Pierantoni, MD, PhD Associate
Professor Social Medicine Institute Rio de
Janeiro State University (Brasil)
Istanbul, Turkey April, 2009
Ministério da Saúde
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BRAZIL

• Total area 8,511,965 km2.
• 190 million inhabitants.
• Federative republic
• - 5 geographic regions
• - 26 states (federative intermediary level)
  and
• a federal district - the nacional capital
  city, Brasília)
• - 5,565 municipalities
• - states and municipalities have political
  and
• administrative autonomy.
• Gross Domestic Product (GDP) approximately US
  5,830 (2006).
• Expenditures with public health 3.4 of GDP
  (2006).

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National Healthcare System

• Public Unified Healthcare System (SUS)
• Private Supplementary system
• Unified Healthcare System (SUS)
• Based on principles of universal coverage,
  integral 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 high complexity procedures / year.
  
• HRH 2.600 million healthcare workers in the
  country
• public sector 1,448,749

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Purposes

• Standardize Human Resourses for Health (HRH)
  management processes and organizational structure
  in Brazil
• Verify the results of the HRH policies changes
  induced by Federal Government - with focus in
  health work and education management.

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Methodology (1)

• Primary data colletion (2007-08)
• 337 Healthcare Departments of large urban centers
  municipalities and Brazilian states.
• (Where lives about 70 of national population).

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Methodology (2)

• Survey with 74 questions, answered by 253 HRH
  managers.
• Focal Groups to the analytical and comparative
  work (five).
• Results compared results of the actual research
  with a previously research done by HRH 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
• 48 of the Healthcare Departments had changes
  after the new HRH unit of the Ministry of Health
  was created (2003).

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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 specifc career
  plan for the healthcare division and 29 for all
  public workers.
• Labour negotiation program of labour resolution
  conflicts 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
  labour rights or social protection).
• 42 of the managers do not know 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 agencies in
  healthcare departments, training health
  professionals for HRH management and development
  of a national HRH information system.
• most known program by the HRH managers (77).
• HRH information system
• 63 of the health departments have an
  information system for HRH, mainly based on
  payrolls.

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Results (4)

• Education Management Actions
• Permanent education in health professional
  training program for healthcare workers in order
  to promote changes in healthcare practices.
• 46 of the Health Departments participate of
  this program.
• Re-orientation of professional education in
  healthcare to medical, nursing and dentistry
  undergraduates (other courses are now being
  included - 2ª phase).
• 60 of HRH managers do not know 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 demanded
• - health community workers
• - nursing technicians
• - dental technicians 

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Conclusions

• The research also revealed
• the importance of state Healthcare Departments
  (federative intermediary level) cooperating with
  work plans and education for management in the
  local HRH units at the municipal level.
• the importance of the managerial role of the HRH
  system at the federal level to induce changes for
  HRH on the others administrative levels including
  financial, administrative and technical
  processes
• the need to continue monitoring and evaluation
  of HRH policies by the federal instance for
  changes, local adaptations and to induce news,
  specially for education area.

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Observatory Network HRH-IMS/UERJ Work
StationPAHO/WHO Colaborating CenterLeader
cpierantoni_at_gmail.com

• Leader
• Celia Regina Pierantoni
• Researchers
• Ana Claudia Pinheiro Garcia
• Maria Ruth dos Santos
• Tania França
• Thereza Christina Varella
• Valéria de Oliveira Monteiro

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Observatory Network HRH-IMS/UERJ Work
StationPAHO/WHO Colaborating CenterLeader
cpierantoni_at_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

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www.observarh.org.br/ims
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Thank you!