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Almost three months after Cuba stopped cooperating with Brazil because of criticism of President Bolsonaro and the return of more than 8,300 professionals working at Mais Médicos, the federal government decided to set an end date of program, created in 2013 by the then president, Dilma Rousseff, to provide basic badistance in vulnerable municipalities. As expected by EL PAÍS Monday afternoon, professionals recruited in the opinion of Más Doctors open must abide by its three-year contracts, but no new calls will be issued. To replace Más Doctors, the government is studying a new program, with a federal career, to attract professionals to municipalities that generally do not attract interest. The result is a victory for the clbad entities that represent the Brazilian doctors, who have always opposed most doctors and brought the Bolsonaro government together since the campaign.
The successive postponements of the current announcement deadlines were already an omen of influence of the category lobby in the direction of the program. As early as the government's transition period, even before Bolsonaro officially took office, the new government opened a direct path to discuss public policies with different medical entities already calling for the closure of the program and rejected the performance of doctors without diploma revalidated. in the country concerning the proposal for a special revalidation of the basic attention that would cover Cubans. "The Federal Medical Council has long been unrelated to the federal government, and the new leadership has opened this opportunity to medical entities," said Hermann Von Tniesehause, First Secretary of the Federal Medical Council. He says the government has shared the proposals and heard the medical profession, but that does not alter the vigilance and autonomy of the entity to evaluate national health policies.
The heart of the stalemate on the More Doctors program is the Revalidate, exam required for all internationally educated professionals to practice medicine in Brazil. The program created under Dilma Rousseff was the only exception in the revalidation application, as the PT administration claimed that it was only then and with a special agreement with Cuba that it would be It is possible to serve populations in remote cities and rural areas, which historically had difficulty repairing doctors.
CFM and other medical entities have always rejected this model. Von Tniesehause of CFM argues that Revalida is the result of the need for doctors to demonstrate their ability to act in accordance with the Brazilian program and reality. Also in January, the representative informed the report that the creation of a secretariat for front-line care and the development of a new program in the recruitment strategy planning program doctors in vulnerable cities would be on the ministry's agenda. still undefined. "We continue our critical badysis [sobre o Mais Médicos] and we hope that the government will terminate this program once this last contract is completed, without doctors duly revalidated, and develop a new program."
On the afternoon of May, Mayra Pinheiro, coordinator of Mais Médicos, confirmed that the program would be replaced by a new one, also offering professionals in vulnerable areas a federal career to attract professionals, but not did not give details about it. The new program will be announced by the CFM. According to the CFM, this federal career plan only includes doctors with revalidated degrees. The practitioner starts in a more vulnerable place and can progress in terms of salary and position, migrating to larger counties throughout his career.
The last edict of Mais Médicos – opened in November urgently by the Temer government – does not require revalid the two postponements of calls to doctors abroad seemed to constitute an alert for municipal health secretaries, who have delayed the creation of vacant positions to influence medical entities in federal management. Since the announcement in November of last year, efforts are being made to fill these positions with Brazil-trained doctors, who are given priority under the law that created the program.
The Temer government even created a force. and get in touch with the registrants to encourage them to run in the municipalities while the Bolsonaro government opens a new appeal and extends the deadline for these professionals. Nevertheless, 17% of vacancies remained vacant. At present, the 1,400 vacant posts are to be filled by 3,700 internationally educated Brazilian doctors for which registration has been approved. They would choose the municipalities that would act Thursday and Friday, but the Ministry of Health announced a further postponement due to the high number of enrollees in the system. The new schedule will be released this Thursday. As the number of registered members is much higher than the number of vacancies, the government expects that there will be more vacancies for foreign doctors, including Cuban professionals. who decided to stay in the country after the end of cooperation with Cuba.
At the time of its launch, the public notice of replacement of the vacancies of Mais Médicos anticipated a conclusion for the beginning of the month of January. Problems in the registration system and even the opening of the new appeal for Brazilians have caused delays in the process, which should now be completed in February. The latest change in deadlines for the choice of cities by doctors without a revalidated degree was announced by the coordinator of Mais Doctors at the end of January. At the time, she explained that the postponement had occurred because the period of reception of these professionals would take place during the carnival. "The change will not bring about any change in the way cities are chosen by licensed professionals," he said.
However, the justification given at the time was no longer convincing for some municipal directors. "I think it's because of pressure from medical entities," said Chairman of the Council of Municipal Secretaries of Health (Cosems) of Amazonas, Januario Carneiro. The director drew attention to the increase in the time of badysis of the documents with the reports and criticized the delay taken by the Ministry of Health to publish the list of vacancies, which does not should happen only Thursday. Last week, the file only published the list of municipalities interested in the program, without the number of places available in each of them. Acre Cosems President Daniel Herculano Filho also believes that medical entities have played a key role in trying to force Brazilian professionals to fill vacancies. "This has already become a joke, the population is threatened by the lack of doctors," he criticizes.
Brazilian doctors educated abroad and abroad also appeared in joint groups in WhatsApp and Telegram, fearing that edict doctors who working for the program – as well as those who will choose vacancies in the coming days – will not interrupt the public announcement, Mayra Pinheiro, in an interview with EL PAÍS last December, had already announced that 39 she was studying ways to reintegrate Cuban doctors who had decided that they could remain in office until the end of their contract, lasting for three years
stay in Brazil in the program – a promise made by President Bolsonaro when Cuba announced the end of cooperation – of a special Revalida focused on primary care. The manager has, however, always stressed that the new management would give medical councils the prerogative to validate degrees and that options would be discussed with medical entities. Since the transition period, Health Minister Luiz Henrique Mandetta and Mayra Pinheiro have met with representatives of the entities to discuss new policies and have already announced that meetings would be frequent in the coming years.
however, never accepted these proposals that would serve the Cubans and would help the government to contain a crisis of service, especially in the cities that are not serviced. "A Revalidate for basic care only is out of the question for the Federal Medical Council, whether for Brazilian doctors trained abroad or for foreigners.The doctors must follow the obligatory steps of Revalida. 'There is no special examination,' said Hermann Von Tniesehause at the end of January. The exam, led by Inep, is in two phases and has no exact date. The results of the 2017 edition of Revalida should be published in February.
Last month, the Federal Council of Medicine published some surveys suggesting that the Mais Médicos program had been used to reduce municipal spending, because investment in health has not evolved according to the increase municipal revenues, nor has the number of primary care physicians increased as expected. According to calculations made by the entity, with data from the Ministry of Transparency, there were 47,000 doctors before the program, which has hired 18,000 additional participants in recent years. Today, 54,525 doctors are active in this segment. "It was to have 65,000 professionals and now 54,000, or the dismissal of doctors by the prefectures, because the money came from the federal government.
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