Beginning in 2013, Brazil addressed geographic disparities in access to health services through a multi-faceted workforce program called Mais Medicos (More Doctors). Prior to Mais Medicos, the distribution of physicians ranged from 0.71 to 3.09 physicians per 1000 people throughout the country, with significant disparities between states.1 Brazil had historically experienced challenges retaining doctors due to poor infrastructure and job security as well as the absence of clear career development pathways.

The first component of Mais Medicos involved increased recruitment of primary care physicians, many from Cuba. Physicians were provided incentives, lodging, and three-year work contracts, and all municipalities were invited to take part although priority was given to regions with extreme poverty, those that were historically deprived, or areas with indigenous populations.1 Within two years, the government of Brazil had recruited more than 18,000 physicians, mostly through a collaboration with the Pan-American Health Organization and the Government of Cuba.2 To further expand access, Brazil coupled these efforts with two other reforms. The first focused on increased infrastructure. Municipalities were invited to apply for funds to improve facilities or secure necessary equipment.  The second – and long-term - strategy within the Mais Medicos program was the development of medical school programs in rural regions or regions with few doctors. Priority for this program was given to areas more than 75km from a medical school. Through these three components of Mais Medicos, Brazil doubled the number of municipalities with greater than 1 doctor for every 1000 individuals between 2013 and 2015 and increased coverage of PHC services from 77.9% to 86.3% in the same time period.1 While the strategy of recruiting foreign physicians successfully improved geographic access to care in this context, it remains to be seen whether this strategy is sustainable over time.

References:

  1. Santos LMP, Oliveira A, Trindade JS, Barreto IC, Palmeira PA, Comes Y, et al. Implementation research: towards universal health coverage with more doctors in Brazil. Bull World Health Organ. 2017 Feb;95(2):103–12.
  2. Campos GW de S, Pereira NJ. Primary care in Brazil, and the Mais Medicos (More Doctors) Program in the Unified Health System: achievements and limits. Cien Saude Colet. 2016 Sep;21(9):2655–63.