The “Médicos Pelo Brasil” program, launched two years ago by President Jair Bolsonaro (non-party) and his then Health Minister, Henrique Mandetta, has so far failed to meet its goal of replacing the related “Mais Médicos” initiative, implemented in 2013.
::A thousand days after the expulsion of the Cubans: the dismantling of Mais Médicos made Brazil an easy target in the pandemic::
Brazilian states and municipalities now live with the lowest supply of primary care for the population, especially in the most remote and vulnerable regions.
Public administrators have developed solutions to fill the need in regions that previously had the coverage of Cuban and Brazilian doctors, whose contracts were not renewed by the Ministry of Health. APS precisely to fulfill the role of recruiting, training and remunerating professionals from universities, and which already has 421 doctors in the state.
A new scenario that Fabiano Ribeiro dos Santos, undersecretary of health for the government of Espírito Santo, considers extremely challenging for the budgets of small towns. “The reduction in the percentage of Health teams in Brazil has dropped a lot. The municipalities did not have, and still do not have, conditions to quickly hire new doctors”, evaluates Santos.
Leandro Bertoldi, a physician and professor at the Federal University of Southwest Bahia (Uesb), highlights the return of the municipal dispute for doctors, based on a real auction of salary offers.
“The municipality of Mansidão, in western Bahia, where I have worked, has one of the lowest GDP per capita in the country (Gross Domestic Product (GDP) per capita, that is, the wealth produced in an administrative unit divided by the number of inhabitants that she has), currently pays R$30,000 to each doctor. In addition to being disproportionate to the average income of the city, this resource could pay how many health professionals?”, he asks.
::What does Brazil lose with the departure of Cuban doctors from Mais Médicos?::
Consequences at the end of the line
The most recent National Health Survey (PNS), carried out in partnership by the Brazilian Institute of Statistical Geography (IBGE) and the Ministry of Health and released last year, points to a considerable reduction in the number of monthly home visits made by health agents. In 2019, 38.4% of registered households received at least one visit, while in 2013, this percentage was 47.2%.
According to former health minister and federal deputy Alexandre Padilha (PT-SP), Brazil went against the grain with the rest of the world by reducing the scope of its health programs. “Even the United States, which has a strong appeal from the private market, reinforced rules to extend the duration of medical contracts during the pandemic”, he compares.
For Padilha, this situation overloads the Unified Health System (SUS) and the private network, leaving a considerable part of the population unattended. “When the pandemic arrived, primary care was already dismantled, as well as care for the poorest neighborhoods, communities and remote areas (…) so, those who had comorbidities and did not receive assistance arrived at the pandemic in a more serious condition, with a factor of additional risk,” he says.
Empty left by Cuban doctors
Cards out of the deck since Jair Bolsonaro’s election to the presidency, Cuban doctors hired in agreement with the Pan American Health Organization (PAHO) began to leave the country at the end of 2018. An extremely felt absence “at the end of the line ”, using a term quite recurrent in Bolsonaro’s vocabulary, especially during the pandemic.
Outdated of more than 8,000 professionals, who worked mainly in the most vulnerable and remote areas of Brazil, the Ministry of Health did not make the necessary efforts to replace this situation. “This shows that the Bolsonaro government has abandoned the idea of taking doctors to the population that suffers most, all thanks to a xenophobic and prejudiced speech towards the people who were taking care of our people”, criticizes Padilha.
::Understand Mais Médicos and the hole left by the 8,000 Cubans who left the country::
The combative posture of the Federal Council of Medicine (CFM), since the arrival in the country of Cuban doctors, contributed to the crusade made by Bolsonaro since the time he was federal deputy. According to Leandro Bertoldi, the main medical entity in the country was a corporatist against the Cubans, which failed to value the qualities of humanized medical care provided by Cubans.
“The respect for the management and the empathy (of the Cuban doctors) with the users was surprising. They liked to do Family Health, unlike most Brazilian doctors. This already came with them, as well as extensive knowledge in different areas of medicine”, says Santos.
In order to negatively contribute to the dismantling of Mais Médicos, the Ministry of Health has also made moves to attract health plans to primary care. In March, the government launched the Certification in Primary Health Care (APS) program, which aims to authorize the private network to provide this type of care, which Bertoldi considers “a disservice, as these professionals would have a very limited view of the users’ lives”. So far, only one health plan – Unimed Litoral – has been certified.
Edition: Vinicius Segalla