LAURA BÉCQUER PASEIRO

BRAZIL is constantly gaining more recognition as a world economic power. However, like the majority of so-called Third World nations, there remains much to be done to overcome the effects of underdevelopment, forged by slave-holding colonialism and subsequent neoliberalism. Health is one of the sectors for which there have been strong aspirations since the coming to power of the Workers’ Party (PT), first with President Luiz Inácio Lula da Silva and then with the current leader, Dilma Rousseff.

Popular protests which took place in June of this year accelerated the approval of various measures under discussion in Congress, which were being met with a certain resistance. Among them, that of directing 75% of oil income to education, and 25% to health, in response to citizens’ demands for better health care.

The following month, a proposal was approved for the health program Mais Médicos, with a view to meeting the shortage of professionals in the sector, a systemic problem which is not exclusive to medicine and was aggravated by former neoliberal governments more concerned by IMF prescriptions than the population’s quality of life.

However, in the Brazilian case, the problem is not only the lack of qualified personnel, but their territorial distribution. A large portion of professionals in the country won’t work in remote, poor areas of the interior, in their majority in the north and northeast, usually citing the lack of infrastructure.

Brazil is among countries with the lowest rate of medical density per inhabitant, with just 1.8 doctors for every 1,000 persons. The most affected regions are in the north and northeast, historically backward in relation to the south. There, the states with the lowest density are Maranhão (0.58), Amapá (0.76), Pará (0.77) and Piauí (0.92). The states with the highest density are: the Federal District (3.46), Río de Janeiro (3.44), Sao Paulo (2.49) and Rio Grande do Sul (2.23).

The concentration of doctors in the richest areas of the south is compounded by the fact that the generation of open positions there is higher than the number of professionals in training. In 2011 alone, close to 19,000 jobs were created, but only 13,000 students of Medicine graduated, according to official figures.

Data from the Brazilian Ministry of Health indicate that in terms of primary health care, more than 1,900 municipalities have less than one doctor per 3,000 inhabitants. A Ministry investigation showed that in rural and suburban areas, where violence rules, the work of doctors is made much more difficult, and to remain working in these places is a tremendous challenge.

The government goal is to reach 2.7 doctors per 1,000 inhabitants, but that requires 168,424 health professionals.

This is where the role of Mais Médicos comes into play. Among other measures, the plan proposes the contracting of foreign specialists to serve citizens in rural and isolated areas, not currently reached by Brazilian specialists.

Doctors contracted from countries such as Cuba, Spain, Portugal, Argentina and Uruguay receive a four-week training course prior to beginning work. These doctors can only work for the Sistema Único de Saúde (Single Health System), which receives a federal budget but is administered by mayoralties.

After signing the law which constituted Mais Médicos, Rousseff emphasized that three months into the initiative, 4.2 million citizens had received medical treatment.

‘Mais Médicos is beginning to change the nation’s health system and its implementation signifies fewer patients in the large hospitals, fewer lines, better attention and less overloaded professionals," she noted.

She also emphasized that by the end of 2013, more than 3,500 doctors will be incorporated into the program.

However, the government is aware that this initiative will not solve the problem. In this context, Brazilian Health Minister Alexandre Padilha, commented, "We know that we are not going to immediately solve the country’s health problems, but this is an important step, which is supported by the people."

That is why government measures include training for a further 2,415 doctors in 2014, and new openings in the states that most need them.