Desafios para atração e permanência de médicos na Estratégia de Saúde da Família nos municípios da Região Centro-Sul do Estado do Rio de Janeiro

Abstract

Introduction: The supply of doctors is a major challenge for health managers, particularly for the Family Health Strategy (FHS), which relies on this professional to manage population care and is regarded as the health system's priority gate. Some of the factors limiting the expansion and maintenance of Family Health Care teams in municipalities include a shortage, high turnover, and working conditions. The study's goal is to look into the challenges for attracting and retaining medical professionals in the Family Health Strategy in municipalities in the State of Rio de Janeiro's Center-South Region. The thesis was guided by the following questions: What factors contribute to the attraction and retention of medical professionals in the FHS? What policies have been put in place in the municipalities to attract and retain doctors in the FHS? The study is justified by the need to analyze and develop alternatives to the municipalities' struggles in attracting and retaining these professionals in the care network. According to the literature review, this is a global challenge, motivating agencies and governments to develop policy options, as occurred in Brazil in 2013 with the Mais Médicos Program and in 2019 with the Doctors for Brazil Program. Method: First, we conducted an integrative literature review, which resulted in the selection of 18 articles. The study looks at turnover, attraction, and retention of medical professionals within the Family Health Program (PSF), which is now known as the Family Health Strategy (ESF), a strategy for reorienting the primary care model. It was also possible to analyze data from a survey of FHS doctors from 11 municipalities in the state of Rio de Janeiro's South-Central region, where there are 148 FHS teams. The survey was completed by 11 coordinators (100%) and 108 doctors (70%). Furthermore, data from the National Register of Health Establishments (CNES) and the E-SUS were analyzed, as well municipal legislations on actions for the retention and maintenance of doctors in the region. Conclusions: The high turnover of doctors (more than 50%) in the ESF has made keeping this link difficult and has weakened the health services provided to the population. Changes in the internal environment, with short and medium-term actions by managers responsible for the implementation of health actions and services, and in the external environment, with higher education more focused on PHC and adequate public funding to improve the working conditions of professionals and health service managers, are among the strategies for greater retention and attraction of doctors.