Education for Health

COMMENTARY
Year
: 2007  |  Volume : 20  |  Issue : 2  |  Page : 75-

Community-Action Councils: A Pathway to Embrace Towards Unity for Health (TUFH) The challenge of improving health and medical care through undergraduate medical education "Pro-saude"


Jose R Ferreira1, Francisco E Campos2, Ana Estela Haddad2, G Cury3,  
1 Pan American Health Organization, Rio de Janeiro, Brazil
2 Ministry of Health, Brazil
3 Federal University of Minas Gerais, BH - Minas Gerais, Brazil

Correspondence Address:
Jose R Ferreira
Av. Brasil, 4365 - Manguinhos, Rio de Janeiro CEP: 21040-360
Brazil




How to cite this article:
Ferreira JR, Campos FE, Haddad AE, Cury G. Community-Action Councils: A Pathway to Embrace Towards Unity for Health (TUFH) The challenge of improving health and medical care through undergraduate medical education "Pro-saude".Educ Health 2007;20:75-75


How to cite this URL:
Ferreira JR, Campos FE, Haddad AE, Cury G. Community-Action Councils: A Pathway to Embrace Towards Unity for Health (TUFH) The challenge of improving health and medical care through undergraduate medical education "Pro-saude". Educ Health [serial online] 2007 [cited 2020 Aug 14 ];20:75-75
Available from: http://www.educationforhealth.net/text.asp?2007/20/2/75/101613


Full Text

For many decades Brazil has suffered from a significant misdistribution of health professionals, namely physicians, with a concentration in urban areas. Brazil’s current Constitution, signed in 1988, established a National Health System whose pillars are universality, equity and a holistic approach, with strong decentralization at all levels of the Government. Health professions education has been a key element, capitalizing on the Latin-American approach of integration of education and service, although in the past heavily tilted towards university hospitals with their inevitable biases (Ferreira et al., 1988).

Since 1994, the Ministry of Health adopted a new strategy, called the “Family Health Program”, which relies on teams composed of one physician, two nurses and up to six health aides, rather than on “family physicians”. A team is expected to look after about 2000 families. Presently, it is estimated that 25 000 teams are at work, covering about 60% of the Brazilian population. The training of these teams is still a challenge: as of today, it is limited to short periods of orientation in “primary care poles” in selected medical schools, which is insufficient. However, the traditional trend towards specialization has been gradually replaced by an orientation on primary health care, multi-professional practice and community participation, consistent with the Alma-Ata Declaration.

In 2002, the program PROMED was introduced by the Ministry of Health, in consultation with the Ministry of Education, to reorient undergraduate medical education for a better exposure to more relevant practice patterns (Campos et al., 2001). Twenty medical schools were selected on a voluntary basis and received government funding to pilot these new approaches: 60% of them succeeded in establishing a relatively good partnership with the health services, providing students with learning opportunities at different levels of the health care system. However, very often, the academic leadership remained reluctant in promoting this approach.

Finally, in 2005, the new program PRO-SAUDE (Pro-Health) was launched adding the training of nurses and dentists to that of doctors (MS/ME 2005a, MS/ME 2005b). This new perspective was to take advantage of the potential market as the Government was determined to expand the number of family health teams to 40 000 by the end of the decade. Schools were invited to present proposals to implement a strategy characterized by three components:

Curriculum reorientation:  Greater emphasis should be put on social determinants of health, health research, critical thinking and continuing education;

Diversification of practices:  Throughout the curriculum students should be offered learning opportunities at all levels of the health system, with a priority on the primary health care level and interaction with the community;

Active learning:  Students should be immersed in an active learning environment, where they will be required to critically review a variety of health issues they are likely to encounter in their future practice, whether clinical cases or health service management cases. In this, they would be required to learn by themselves while the teaching staff would serve as tutors.

Out of the 180 projects presented by schools from different regions of the country, 93 were selected for immediate implementation: 30 from Nursing, 38 from Medicine and 25 from Dentistry, representing a total of 46 000 students during this first phase of the program. It is hoped that close collaboration between educational institutions and health services, along with government funding for joint improvement of health professions education, health care facilities and working conditions at the community level, PRO-SAUDE will have a visible impact on people’s health 5 to 10 years after the graduation of the new health professionals.



References

Campos, F.E.; Ferreira, J.R.; Feuerweker, L; Sena, R.P.; Batista Campos, J.J.; Cordeiro, H. & Cordoni Jr. L. (2001). Caminhos para Aproximar a Formação de Profissionais de Saúde das Necessidades de Atenção Básica. Revista Brasileira de Educação Médica, Rio de Janeiro, 25: 53–59.

Ferreira, J.R.; Coelho-Neto, A.; Collado, C.B.; Linger, C.; Luna, R.; Purcallas, D. & Yepez, R.F. (1988). El Análisis Prospectivo de la Educación Médica. Educación Médica y Salud (OPS). 22(3): 350-366.

Ministério da Saúde / Ministério da Educação (2005a). Programa Nacional de Reorientação da Formação Profissional em Saúde – Pró-Saúde – para os cursos de graduação em Medicina, Enfermagem e Odontologia. Portaria Ministerial n. 2.101.

Ministério da Saúde / Ministério da Educação (2005b). Pró-saúde : programa nacional de reorientação da formação profissional em saúde. Série C. Projetos, Programas e Relatórios Brasilia, DF.