RESUMO
PROBLEM BEING ADDRESSED: Brazil, Chile, and Canada are among the countries where development and deployment of human resources have been central to health reform; however, it is unclear how the education and training of primary care workers is best accomplished. OBJECTIVE OF THE PROGRAM To implement a model of in-service training in primary health care for interdisciplinary teams of primary health care professionals from Brazil and Chile. PROGRAM DESCRIPTION: This 5-module program targeted primary care providers from various disciplines who had at least 3 months of front-line experience. The program was offered in 2 formats: intermittent "in-country" training or an intensive course taught in Canada. In Brazil, the in-country training took place over a period of 8 to 12 months, during which 5 modules of 2 to 3 days each were interspersed with 2-month "action periods." The intensive course taught in Canada was delivered to Chilean participants in Toronto, Ont, where 3 modules were offered to a group of 12 to 20 primary health care professionals over a 6-week period. The educational methodology combined short didactic presentations, whole group learning exercises, and small group problem-based learning sessions, including team projects that were completed in between each module and presented at the beginning of the next one. During the course, the participants learned how to perform computer database searches and assess the best evidence in the management of common problems. CONCLUSION: Pretests, posttests, and evaluations of student projects demonstrated that participants had increased knowledge, as well as increased capacity to use the best evidence to address common problems in their communities. This is a promising model, adapted to the context of primary care reform in Latin America, with strong potential to support health human resource development and multidisciplinary care by front-line providers in other countries.
Assuntos
Saúde da Família , Necessidades e Demandas de Serviços de Saúde/organização & administração , Capacitação em Serviço/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde/organização & administração , Desenvolvimento de Programas/métodos , Brasil , Canadá , Chile , Educação Continuada em Odontologia , Educação Médica Continuada , Educação Continuada em Enfermagem , Reforma dos Serviços de Saúde/organização & administração , Humanos , Comunicação Interdisciplinar , América Latina , Avaliação de Programas e Projetos de SaúdeRESUMO
Se realizó una revisión de los artículos publicados, con el fin de presentar una descripción de losantecedentes históricos de las reformas en salud en América Latina y así establecer una brevepresentación del proceso de descentralización en países como Colombia, Brasil, Chile, Méxicoy Costa Rica. De esta forma se ilustran las diferentes tendencias en las transformaciones de lossistemas de salud de la región.Esta revisión de la literatura reveló la necesidad imperiosa de contar con más estudios sistemáticosen esta área. Aunque en teoría, la descentralización puede considerarse un mecanismopoderoso en la promoción de la equidad en la salud, puede resultar insuficiente o prejudicial enel contexto de políticas inciertas que promueven la equidad por parte del Estado. Igualmente,se debe discutir tanto el papel de otros fenómenos afines, por ejemplo la privatización, como laescasez de fondos estatales en salud. Sin embargo, la evidencia respecto de los resultados de ladescentralización en América Latina y el Caribe es aún contradictoria y ambigua: no es claroque sus logros puedan alcanzar sus intenciones de mejoras en equidad en salud en la región.
A literature review of published articles were done to set a description of the historical background of health reforms in Latin America and to provide a brief description of the process ofdecentralization in countries such as Colombia, Brazil, Chile, Mexico and Costa Rica in order to illustrate different tendencies in the transformations of the health systems in the region. Thisliterature review demonstrated the increasing need of more systematic studies in this area. Althoughdecentralization in theory may be a powerful mechanism to promote equity in health, it may be insufficient or prejudicial in the context of unclear policy intended to promote equity by the state. Moreover, the role of other concomitant phenomena like privatization and shortage of state funding of health must also be discussed. However, the evidence regarding the results of decentralization in LAC is still contradictory and ambiguous. It is not clear that its achievements could reach its intentions of improved equity in health in the region.