I summarize
Medicine, as social practice, is a professional profession that fears great social relevance, bearing in mind its implications for the conditions of life of people and communities. Considering public health and education policies, how do we see historically shaping what are the fundamental characteristics of medical training in Cuba and not Brazil? Both countries have universal health systems proposals, organized in such a way as to strengthen basic care, kept as different political and economic differences, at least different from territorial areas and the population contingent. To what origin did this project originate: As a small country with limited resources like Cuba, did I get a surplus of medical professionals trained as shipping to Brazil, a country that is much higher and richer? Assim,The general objective of this study was to carry out a comparative analysis of the medicine race between Cuba and Brazil, considering the articulation with the health policies at present, not the political-economic and social context of both countries. As specific objectives, the historical configuration of medical training in Cuba and not Brazil is intended to be analyzed and analyzed in different historical periods (1959-2015), considering the health and training policies of two doctors; show and analyze or profile two some (social class to which it belongs, school course, entry mechanisms in the medical course, vague offer / inhabitant and students / inhabitant, number and distribution of medical schools / courses). To this end, bibliographic surveys will be used and used as official documents together with competent bodies from both countries.From the analysis given given that some indicators can be generated that guide or outline the public policies of medical training.
Educational policies in the education of phisicians in Cuba and Brazil
Abstract
Medicine, as a social practice, is one of the careers that have great social relevance in view of its implications on the livelihoods of people and communities. Considering the public health policies and education, as has represented historically and what are the key features of medical training in Cuba and Brazil? Both countries have universal health systems proposals, arranged in order to strengthen primary care, kept the political and economic differences, beyond differences of territorial areas and population quota. The question that gave rise to this project: As a small country with limited resources like Cuba can have a professional trained in medicine over the point of sending them to Brazil, a much larger country and richer? Thus, the aim of this study is to conduct a comparative analysis of medical career between Cuba and Brazil,considering the relationship with the current health policies in political, economic and social context of both countries. The specific objectives are intended to describe and analyze the historical setting of medical training in Cuba and Brazil, in different historical periods (1959-2015), considering the health and education of health policies; display and analyze the profile of the students (social class they belong to, educational background, input mechanisms in medical school, the number of vacancies / inhabitant and trainees / inhabitant, number and distribution of medical schools / courses). This will be made bibliographic and used official data from the competent bodies of both countries. From the analysis of these data can be generated some indicators that guide the design of public policies for training doctors.
As educational public policies in the training of doctors in Cuba and not Brazil
Introduction
Since past school efforts have been made for the provision of medical education, there have been great changes in the way of thinking to the formation of two professionals. Such changes correspond to the interests of the society I have in view adequate training that you have the valuable to care for the health of the human being. No field of medicine, it has had many pedagogical proposals and a constant struggle between the various training trends in the area. Nesse felt a significant historical framework or “Relatório Flexner”, from 1910.
Vicedo (2002) shows some considerations about this report, stating that some of the recommendations made by Flexner were essential with relative facilitation of the medical community, and I have reached a point of surpassing generalization. Among these, the following stand out: a four-year curriculum, two years of laboratory science (basic science); two years of clinical training in hospital and clinical services; linkage of the school of medicine to the university and the adoption of entrance requirements in mathematics and science.
Furthermore, a set of recommendations was not reported, but its implementation level was more limited, namely: integration of basic sciences and clinical sciences for four years; encouragement to active learning; Apprenticeship is not just about fatos, development of critical thinking and problem solving skills when two educators will clarify together with medical students who have learned a lot of work for life (VICEDO, 2002).
Also for the same author, the reasons pelas quais or the second group of recommendations do not have more than the first time that I respect the fact that we will demand more time and effort from two professors, apart from the fact that the investments have been superior in "scientific reform" in relation to "educational reform" of medical schools.
O Flexner's paradigm is criticized because, in spite of valuing or humanism, a paradigmatic structure with which work is essentially individualistic, biological, hospital-centric and with a nas nas specialization (LAMPERT, 2002). For this author, a traditional way of teaching Medicine not the context called the Flexnerian paradigm tem as characteristics:
- Predominance of theoretical classrooms, focusing on teaching and fragmented training in disciplines. Process of teaching focused on non-professors in expository and demonstration classrooms. Part of practice carried out predominantly in hospitals. Teaching training focused solely on scientific technical competence. diagnosis and routing and charge your honorariums sem intervenções of third parties.
This model emphasizes early specializations even after graduation, making it difficult for two doctors to train generally. Graduam-se, com frequência, “pseudo-specialists” (LAMPERT, 2002).
Assim, in spite of the central ideas of the Flexner Relatório terem su importance not historical moment in which fora geradas, show limitation tendo em Vista important changes not delineamento das diretrizes for an organization do ensino medical. Starting from this report, for two years I have been attached to the present, we have moved with political health, at an international and local level, I have in view transformations of a political-economic and social order, with the need for changes in our graduation courses. health, including medicine.
In this context, we are configuring a new "paradigm" that seeks to be contrasted with the hospital-centric model, focused on the proposal of preventive medicine. In the world arena, in the Declaration of Alma-Ata, in the 70s, with the motto "Saúde para Todos no ano 2000", as a starting point in primary care at the Otawa Conference (1986) that officially emphasizes on the subject of Promoção da Saúde, Relating saúde to quality of life, these are important frameworks to which are also considered not the scope of the two professions of health. No Brazil, or the Sanitary Reform movement marks or the beginning of new tempos, drawing important political and organizational repercussions for the health services as well as for professional training (LAMPERT, 2002).
In the internal economy of the setor da saúde, or a new model, it was only contrasted with the private ideologies of a neoliberal, not macro-political and economic sphere, as well as the flexnerian paradigm, or the development of actions for a construction of the comprehensive paradigm, assim called, tendo em In view of its objective of approaching the training of health professionals for the needs of basic health care (LAMPERT, 2002).
It is worth noting the importance of medicine as a professional career that fears great social relevance, in virtue of its implications for the conditions of life of people and communities. Reflect on the ethical-political values that have been fundamental, I have a direct relationship with the purposes of the profisão not the social context. To what is it placed on the basis of what values to medical training can be structured in order to promote or develop practices that seek to face social inequalities and that promote life conditions of heavy weight?
It is worth noting that, nesse artigo, a medical training focused on the understanding of medicine as social practice. Authors such as Machado (1995) and Schraiber (1989) have important relationships between a professional and medical training and a capitalist mode of production, demarcating the possibility of discussions in a critical and contextualized way.
Many schools of medicine are not defined as their miss. Some schools review their study programs on a few occasions, which remain controlled at the departmental level or are determined from abroad. As consequências dessa situação são instituições e doctors que assum uma passiva position vis-à-vis the challenges of training and professional training (WORLD SUMMIT OF MEDICAL EDUCATION, 1993).
This sense, or institutional behavior, of the medical schools needs to be studied, with special attention to the formulation and implementation of their mission. At the same time, the teaching bodies of medical schools must develop and implement general medical education programs that respond more to local needs (WORLD SUMMIT OF MEDICAL EDUCATION, 1993).
In view of these aspects, the procedures for or entering the medical schools must be based on their mission, on the capacity of the institution and on the objectives set for the national labor force, not for health. The selection procedures are still essential in many schools of medicine as well as arbitrary and very chaotic procedures (WORLD SUMMIT OF MEDICAL EDUCATION, 1993).
Second to the World Health Organization (WHO), in the last few years, we have made efforts to expand or reach the ethical analysis in health care, as a goal to focus more directly on public health questions. A public health ethic focuses not on the application of measures for vigilance and the time of the public health. A public health ethic also transcends health care, considering the essential conditions that promote or hinder or develop Saudi societies (COLEMAN; BOUESSEAU; REIS, 2008).
The case of Brazil and Cuba has, obviously, made some differences and semelhanças between the Health Systems of both countries. A provocative question that guides this work is knowing how a small country and with limited resources, such as Cuba, trains doctors in sufficient quantity to make available professionals for Brazil, which is a much richer country. Além disso, Cuba also sends doctors to other countries such as Bolívia, Equador, Venezuela and Africa. A missão of the federal program "Mais Médicos", not Brazil, is an example of the strength of the Cuban health system. On the other hand, or what explains the chronic lack of doctors, not Brazil, especially not the public health system?
In this context, considering public health and education policies, how do we see historically shaping what are the fundamental characteristics of medical training in Cuba and Brazil?
I tend to look at the importance of attention to the health of two countries and the relationships between the professional training of doctors with macro-structures and economic guidance, demarcating the historical character of this training, with the intention of comparing this study with some relative data à medical training in Cuba and Brazil and their articulations with the health policies atuais not political-economic and social context of both countries.
Some characteristics of the health system and medical training in Cuba
The Ministry of Public Health of Cuba directs, executes and controls the application of State policy regarding public health through the Cuban National Health System (SNS). There are plans for medical care, assistance to patients and people with special needs, epidemiological control, training of professionals and the production and distribution of medicines (Infomed, 2015).
O Cuban health system is universal, free and accessible to all citizens. It is based on the family medicine model and it is organized in a network of non-national, non-territorial assistance units. to mulher eo idoso, as well as to prevention and control of communicable diseases and non-transmissible diseases that can affect Cuban years (EcuRed, 2015).
Cuba has developed a group of care programs to guarantee health for the population. It is worth noting: programs for prevention, diagnosis and treatment of cancer, care for people with kidney failure, cardiac pathologies, early diagnosis of prenatal congenital conditions, and other diseases.
For the training of doctors, among other aspects, it is of relevant importance for the maintenance provided for by the Minister of Health. The number of medical doctors has increased considerably in the last few years, because its training has been one of the priorities of the Cuban revolution. This increase is also related to opportunities that the Cuban socialist government offers for the population to remain in school.
In 2011, Cuba had 381 health areas with full coverage of the Family Medical Program, surpassing the figure of 28,000 doctors, distributed throughout the country. Given the Cuban government, it indicates that 99.1% of the Cuban population is covered by a doctor and nurse from the family and coverage of 100% is expected to be achieved in the next few years (CUBA, 2011).
A point that it pays attention to the refere-se à ajuda that Cuba, despite being a small country, is offering many Latin American countries, sending doctors to distant locations. An example is the so-called "Mission Barrio Adentro", developed in Venezuela that, since 2003, atá os dias atuais exceeds the figure of 35,000 Cuban doctors in this country.
The Bolívia, or “Mi Salud” Program of the Cuban Medical Brigade, developed since 2005, started “Operation Miracle” year ago, recovering visually de mais of 661,229 people. Another example is only Cuban doctors, not Brazil, wines through the “Mais Médicos” Program that aims to cover or deficit of non-public professions and praise the attention of the most poor and distant regions of the country. (CUBA, 2011).
A medicine career in Cuba before the triumph of the Revolution was always destined for young people of high social class in Cuban society. Custos com a carreira eram muito alto, or that prevented the entry of young people from families of workers and camponeses. A medicine, then, was or "sonho dourado" economically favored classes in the country, and many young talented young people were less profitable. Since the triumph of the revolution of 1959, one of the main steps of the government that assumes the radical transformation of the carreira, including or teaching medicine (UNIVERSIDADE DE CIÊNCIAS MÉDICAS, HAVANA / CUBA, 2015).
A medical training in Cuba fears its own characteristics. In order to enter a medical career, it is necessary to pass three entrance exams, including Mathematics, History and Spanish and other specialties equivalent to two years of Biology. A carreira lasted six years, with a study plan made up of 66 curricular units that included disciplines, elective and elective courses, with a total of 10,840 hours. (UNIVERSIDADE DE CIÊNCIAS MÉDICAS, HAVANA / CUBA, 2015). Another interesting interest was given to a taxa of inhabitants per doctor 130.7 doctors per 10,000 inhabitants. (YEARBOOK, 2014). Second to WHO, there are 17.6 non-Brazilian doctors for every 10,000 people. A Brazilian tax is a lower average than the remaining two emerging countries - 17.8. Or the Brazilian index is also lower than the Americas average,which is more than 20 doctors for every 10,000 people.
At present, there are some problems with the Cuban health system, such as: lack of basic materials (medicines, sutures and bedding not hospitalized), além disso, has been a major qualification in the presence of medical technologies in the capital in comparison. As the rest of the country, I have as a consequence that many people have to transit from the interior to the capital. Another problem is that two Cuban doctors still do not have enough for them to live with relative comfort.
Some characteristics of the health system and medical training in Brazil
No, Brazil was not considered a social directive before the Federal Constitution of 1988 and the Constitution of the Single Health System (SUS), in 1990. Or the model of health care that was divided divided the population into three categories: those who could pay for private health services; Those who tinham direct to public health because they are assembled by Social Prevention (workers with formal employment) and those who do not have direct nenhum. Nesse context, or ITS theme in order to provide equal attention and promotion of health to the entire Brazilian population (SILVA, 2009).
In 1988, to the Federal Constitution (Brazil, 1988), in addition to consecrating the guiding principles of SUS - to universality, to integrality, to equity and social control - it presents a new convention of health: of the State, guaranteed by means of social and economic policies that aim to reduce the risk of financial damages and to achieve universal and equal access to services and services for their promotion, protection and recovery ”.
These are provided by a public system that is organized in different levels of care (primary, secondary and tertiary), also counting as a complement to the private setor: “O SUS is constituted by the conjugation of the services and services of promotion, protection and recovery health is carried out by federal entities, directly or indirectly, by means of a complementary participation of private initiative, being organized in a regionalized and hierarchical way ”(BRAZIL, 2011)
To organize basic care not in Brazil, we have been attached to the Saúde da Família Strategy (ESF) following the preceitos of SUS. Such a strategy is considered by the Ministry of Health and municipal managers as a strategy for expansion, qualification and consolidation of basic care, because it favors reorientation of the work process with the greatest potential to place the principles, guidelines and foundations of basic care, from expanding to resolutividade and impact in the situation of health and social security, in addition to favoring custo-effetividade relationship.
OR SUS is not Brazil and a system and project that we are fighting for its consolidation, I have in view some limits such as the absence of effective human resources policy and public spending is still insufficient to guarantee the constitutional norm of the universality of SUS, (CAMPOS, 2007; MENDES, 2013). It should also be considered, as Campos (2007) comments, the conflicts of interests between or SUS and the liberal-liberal logic that is also very present in attendance in Brazil.
Saúde e negócios não combinam, pois saúde é um direito universal e so that that direito is fulfilled são necessários or planjamento ea management of public systems. Public health policy is opposed to neoliberal logic, with a constant effort to consolidate or not Brazil, once the political-economic system has a decisive influence on the country's public health policy (CAMPOS, 2007).
Insufficient investments are not publicly displayed or disinterested by the government for basic healthcare services, so-called Basic Health Units (UBS), além de ter as consequência a baixa remuneração dos profissionais da saúde, resulting in unsatisfactory medical care. Inquiries made by users on the basis of the major deficiencies of SUS systematically indicate a lack of doctors in the long waiting period for a consultation (SIQUEIRA, 2013).
There are specific programs that present important advances such as those related to organ transplants, hemodialysis services, care for cancer patients, still, disorganization resulting from the lack of effective management mechanisms of the referral and counter-referral system, for consultations of rotina em ambulatórios, ends up generating an image of disorganization of the system (SIQUEIRA, 2013).
Paim et al (2011) comment that SUS, not Brazil, started its implementation in a disadvantaged economic political period, given or advanced by neoliberal ideology, also reinforced by international organizations that did not agree with the decision to direct public financing for health systems. universais. Assim, from his institutionalization, or SUS we see building progress, but also faces limits. Some advances can be cited: extension of access to health care for a large part of the Brazilian population, with universal coverage for vaccination and pre-natal assistance, extension of the understanding of health as a directive; expansion of the human and technological resources. Porém, some entrances são found tendo in view of amplification of the participation of the private setor,As or universal access versus market segmentation, negatively impacting equity, not access to services and health conditions. Mention should also be made of the limitations regarding or insufficient financing.
Two fundamental problems refer to the difficulties of inserting doctors in the most distant and poor areas of the national territory, where there is a great need for doctors. This problem is related to the complex questão do number of trained doctors, professional regulation, as pressões of antepondo às to social needs. In this respect, Feuerwerker (2013) comments that in the absence of doctors, Brazil does not relate to the omission of governments and to the medical corporation and two market agents in health. Or the care model that is intended to build a direct relationship with the number of doctors available and with the profile of their training. São necessárias some definitions defined as: a formação will be oriented to the biological eixo ou pelas necessities two users? It will be focused on procedures,ou na produção do careful? Will it promote subordination, framing and control of the possibilities of production of life? The following table shows, in a more detailed way, baixa medium coverage, not Brazil, considering different regions of the country.
In the face of chronic illness, there is a lack of doctors, but Brazil was not governed by President Luiz Inácio Lula da Silva. Or "Mais Médicos Program" (PMM) that included the participation, among others, of Cuban doctors. This program is part of an effort of the Federal Government, as support of states and municipalities, to help the users of the Unified Health System (SUS). In addition to bringing more doctors to regions where they have been scarce, or absent from professional proficiency, or a previous program, they are also investing in construction, reform and expansion of Basic Units of Health (UBS), in addition to new vague graduates and medical residences to qualify a formação desses profissionais.
Feuerwerker (2013) also considers, at this time, it is necessary to import doctors in view of their scarcity, not subject to basic care as well as emergencies, CAPS, UTIs. Finally, he points out that it is important to expand graduation courses, still not supporting a market, also making it possible for students from two popular bairros, from the rural, indigenous and quilombola worker communities, to occupy a significant number of vague medical courses, in addition to Some from different regions of Brazil, such as the north, for example, onde in the absence of doctors and chronic (FEUERWERKER, 2013).
Compared with other careers, Medicine not Brazil is the one that presents the least vague offer, this being two pains that affects the health of the population not a country. A table 1 to follow illustrates this fact
Table 1
Number of vague offered and entered the higher education of face-to-face graduation, by network,
Number of vague offered and entered the higher education of face-to-face graduation, by network
second some selected courses (Brazil - 2002)
Source: MEC / INEP (PINTO, 2004)
Conclusions:
As doctors of the world, he has always presented a high importance, as professionals who are part of the team of health, so many challenges that fear or human being to maintain health conditions that allow quality of life. Each country fears its own characteristics in the formation of its professionais nesta discipline.
As a question, how can a small country like Cuba provide doctors in quantity to meet the country's demand and provide a surplus to make available to a country of Brazil, much more populous and rich? In response to this question, there must be two countries offering medicine in the organization.
Compared to other careers, the career of Medicine in Brazil is one of the fewest income of applicants afraid of their study, this is one of two hardships that aggravates health in this country. It was possible to take very useful experiences from each study, which would serve to enhance the training of doctors in their respective countries.
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