Continuity and change in human resources policies for health: lessons from Brazil.
Continuity and change in human resources policies for health: lessons from Brazil.
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DOI：
10.1186/1478-4491-9-17
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发表时间：
2011-07-05
影响因子：
4.5
通讯作者：
Dussault G
中科院分区：
文献类型：
--
作者：
Buchan J;Fronteira I;Dussault G
This paper reports on progress in implementing human resources for health (HRH) policies in Brazil, in the context of the implementation and expansion of the Unified Health System (Sistema Unico de Saúde - SUS). The three main objectives were: i) to reconstruct the chronology of long term HRH change in Brazil, and to identify and discuss the precursors, drivers, and enablers for these changes over a long time period; (ii) 研究如何通过描述促进因素和限制因素来实现变革，以及如何调整政策来应对后者； (iii) 报告现状并得出政策影响。 A mixed methods approach was used.使用预先定义的关键词进行文献综述；并联系了利益相关者并要求其提供相关信息、数据和政策报告。 There are two key features of HRH change which are related to the implementation of SUS which merit attention: the achievement of staffing growth, and the improvement in HRH policy making and management.在此期间，员工增长率足以超过人口增长率。结果，工作人员与人口的比例有所改善。 1990年，每1000名居民拥有医生的比例为1.12。 2007年为1.74。实现人员编制增长的另一个关键因素是人权卫士的决策能力和在政治机构中的影响力。政策必须适应不断变化的情况，同时注重旨在实现长期目标的连续改进。我们一直关注改善护理和获得护理的最终目标。 No one Ministry could secure all the resources and impetus for change that has been required, hence the need for inter-ministry, inter-governmental and inter-agency collaboration, and the development of alliances of shared interest.在三十年或更长时间的时间里，并非所有举措都同样成功，但势头一直保持着。 There was no single long term plan or strategy, but in Brazil this has enabled the progress to be adapted and re-oriented as the broader context changed over the years.
This paper reports on progress in implementing human resources for health (HRH) policies in Brazil, in the context of the implementation and expansion of the Unified Health System (Sistema Unico de Saúde - SUS). The three main objectives were: i) to reconstruct the chronology of long term HRH change in Brazil, and to identify and discuss the precursors, drivers, and enablers for these changes over a long time period; (ii) to examine how change was achieved by describing facilitators and constraints, and how policies were adapted to deal with the latter; and (iii) to report on the current situation and draw policy implications. A mixed methods approach was used. A literature review was conducted using pre-defined keywords; and stakeholders were contacted and asked to provide relevant information, data and policy reports. There are two key features of HRH change which are related to the implementation of SUS which merit attention: the achievement of staffing growth, and the improvement in HRH policy making and management. Staff growth rates across the period have been high enough to exceed population growth rates. As a consequence, the ratio of staff to population has improved. In 1990 the physician ratio per 1000 inhabitants was 1.12. In 2007, it was 1.74. Another critical factor in achieving staffing growth has been HRH policy making capacity and influence within the political establishment. Policies have had to adapt to changing circumstances, whilst focusing on sequential improvements aimed at achieving long term goals. The end objectives, of improving care and access to care, have been kept in view. No one Ministry could secure all the resources and impetus for change that has been required, hence the need for inter-ministry, inter-governmental and inter-agency collaboration, and the development of alliances of shared interest. Across the period of thirty years or more, not all initiatives have been equally successful, but a momentum has been maintained. There was no single long term plan or strategy, but in Brazil this has enabled the progress to be adapted and re-oriented as the broader context changed over the years.
影响因子：
4.5
作者：
Peres, Ellen M;Andrade, Ana M;Grande, Nuno R
通讯作者：
Grande, Nuno R
影响因子：
4.5
作者：
Dubois CA;Singh D
通讯作者：
Singh D
影响因子：
4.5
作者：
Ramos de Vasconcellos Coelho, Maria Cristina;Assuncao, Ada Avila;Belisario, Soraya Almeida
通讯作者：
Belisario, Soraya Almeida