Mais Médicos pays BRL 1 million, but needy areas are a challenge – 06/01/2023 – Health

Even with a remuneration that can exceed R$ 1 million in four years, the federal government must face the same challenges of the past to retain professionals from the new Mais Médicos in municipalities far from the main centers of Brazil.

Extreme poverty and little infrastructure discourage the permanence of primary care professionals, especially in remote areas of the North and Northeast regions, which concentrate most of the vulnerable municipalities.

The problems are critical, including the lack of sanitation and garbage collection and long boat trips to a capital city or an airport.

The government classified 102 cities in the profile with the greatest difficulty in fixing. Of these, 78 are in the Legal Amazon (Northern states, Mato Grosso and part of Maranhão). Carauari, Eirunepé, Tonantins (AM), Chaves, Melgaço (PA) and Godofred o Viana (MA) are some of them.

Carauari, for example, is 788 km from Manaus. The distance increases to 1,411 km by boat, in a trip that lasts six days. A quarter of the population of 28,000 inhabitants live in extreme poverty, more than a third do not have running water and 4 out of 10 residents suffer from inadequate sanitary supply and sewage, according to data from Atlas Brasil and the IDHM (Human Development Index). Municipal) based on the Census.

There are other municipalities with better access to the capital, such as Godofredo Viana (MA), a seven-hour drive from São Luís. Although 70% of the population of 12,000 people has piped water, only half has adequate drainage. A mining town, it has suffered problems such as soil contamination and the presence of toxic substances in the water in recent years.

One of the areas with the greatest benefits offered to physicians is the Alto Solimões health micro-region, on the outskirts of Tabatinga (AM), on the country’s border with Peru and Colombia. Of the 9 cities, 7 are part of the most difficult profile to establish: Amaturá, Atalaia do Norte, Benjamin Constant, Fonte Boa, Jutaí, São Paulo de Olivença and Tonantis.

The share of the population with running water in these cities is no more than 67% in Fonte Boa. Extreme poverty affects 48% of the population in São Paulo de Olivença, and 72% of households do not have adequate water supply and sewerage in Tonantins.

The new More Doctors provides a bonus of BRL 120,000 for those who stay for 48 months in the most vulnerable cities. This is equivalent to 20% of the total accumulated grant received, of BRL 12,386.50 per month – not including housing and food allowances paid by city halls, which increase the amount to up to BRL 15,000 per month.

If professionals have graduated with the help of Fies (Student Financing Fund), the benefit increases to an extra R$475,000 at the end of the period, increasing the gain to more than R$1 million. The 345 vacancies offered in municipalities with this profile correspond to 6% of the total.

Historically, the promise of good incomes has not attracted enough professionals to work in these regions.

“We have city halls paying BRL 50,000, BRL 100,000, up to BRL 135,000 in salaries for specialist doctors, with the municipality making up the difference [em relação ao que pagam os governos estadual ou federal]and even so they cannot fill the necessary posts”, says the president of the Amazonense Association of Municipalities and mayor of Rio Preto da Eva (AM), Anderson Souza (União Brasil).

As shown to Sheet, the disparity in the supply of professionals in the Amazon and in the rest of the country decreased in the first phase of Mais Médicos, under the Dilma Rousseff (PT) administration, but grew again with the program’s dehydration. Currently, the region registers a delay of 15 years, considering the proportional rate per population.

The situation is worse in the poorest areas or those furthest away from the capitals. This new analysis shows that 35 health microregions have rates lower than one third of the national average of 1.66 SUS physicians per thousand people. Of these areas, 23 are in the Legal Amazon.

According to the Amazonian Association of Municipalities, the public notice vacancies correspond to three quarters (74%) of the minimum necessary to complete the family health and primary care teams that today work without doctors in the state.

Furthermore, the presence of physicians is just one of the demands, says demographer Márcia Castro, professor at the School of Public Health at Harvard University and columnist for the Sheet. She observes that basic conditions are also necessary to be able to exercise the profession, such as inputs and medicines.

The lack of infrastructure is an aggravating factor. “It’s no use coming and giving worms. You’ll even eliminate the critical situation, but a year later the worms come back, because the water quality is still bad. And it’s not the Ministry of Health that’s going to put pipes for running water and sewage. The actions have to be multiple”, exemplifies Castro.

“As a strategy, it makes sense to prioritize the region, especially when we look at which areas lost the most doctors after the program’s extinction. There is an understanding that they were discovered and everything that happened in recent years has negative consequences for the health of these populations, such as environmental dismantling policies. But just bringing in doctors is not enough”, says the specialist.

In addition to registering many of the worst health indicators in the country, the Amazon is home to most of the indigenous population, which depends on assistance in remote areas. The departure of Cuban doctors from Brazil in 2018 led to an 81% drop in the staff of the Special Secretariat for Indigenous Health.

“More Doctors was absolutely critical in indigenous territories. They were the areas that suffered the most when the program was discontinued. In this sense, it is important to prioritize”, ponders Castro.

The representative of the mayors of Amazonas says he “misses the Cubans”. For him, foreigners are more willing to work in vulnerable and distant areas — the priority in Mais Médicos is for Brazilians, but graduates abroad may be called for vacancies not filled in the last case.

Souza says that two Cuban doctors continue to work in his city, Rio Preto da Eva, receiving a salary of R$10,000 plus room and board allowances paid by the municipality.

“Most prefer to earn less and work close to a capital city or in a place where they can take a car or a plane and go spend the weekend with their family. It’s different a city where you can only arrive by boat, from 6 am to 13 days of travel, or 3 to 4 hours of flight with very expensive tickets, and you will be isolated there for months”, says the mayor.

Another alternative defended by him is the obligatory permanence of graduate students in local universities for a minimum period after graduation. “People come from all over the state to compete for a place at the university and then leave.”

As it is not the most sought after medical specialty in residency, the area of ​​family health needs to be more valued and have adequate training, evaluates Gabriela dos Santos Marques, a family doctor in Santa Catarina.

“When we talk about a difficult job, with low demand and high difficulty in securing, foreign doctors end up occupying these vacancies. It would be important to strengthen the training of Brazilians”, says Marques.

The Mais Médicos scholarship is compatible with the earnings of professionals with less experience. The average monthly income of those aged up to 30, including those who do not work in the SUS, was BRL 12,259 in 2020, according to the most recent survey by the Associação Médica Brasileira in partnership with USP.

Young professionals are one of the preferred targets of Mais Médicos, as, in addition to the financial scholarship, the program offers advantages for residency, specialization and master’s degrees.

The new notice of Mais Médicos opened a call for 5,970 professionals in the last week, with vacancies in 1,994 municipalities in all regions. The initial number was 6,252, but some prefectures did not renew membership or opted for partial completion, according to the Ministry of Health.

According to the government, the intention is to reach a total of 28,000 professionals by the end of the year. Currently, there are about 14,000, including the contracts of Médicos Pelo Brasil, announced as a replacement for Mais Médicos in the Bolsonaro administration.