<p>Background: The global human resources for health crisis has affected Uganda deeply as is evidenced by grossly inadequate medical doctor to population ratios. Strategies to increase training and retention initiatives have been identified as the most promising ways to address the problem. In Uganda, the dual track tuition policy of higher education (called the Private Students Scheme or PSS) at the University of Makerere was initiated in the academic year 1993/94, to boost student intake and to supplement university revenue. However, the impact of this scheme on the enrolment and graduation of medical students at this University is unknown. Aim: This study aimed to assess the effect of the PSS on enrolment, time to completion, attrition and number of graduated medical students at Makerere University Medical School after (post-)&nbsp / the Private Students Scheme (PSS). Study design: A quantitative cross-sectional descriptive&nbsp / study based on a retrospective review of enrolment and graduation records of medical students was conducted comparing records of students enrolled five years before and after the&nbsp / privatisation scheme. Numbers enrolled, attrition rates, time to completion and graduation numbers were analysed. Results: There were 895 students enrolled in the study period, 612 (72.2%) males and 236 (27.6%) females. Pre- and post-PSS periods had 401 and 494 enrolments respectively (a net increase of 93 students). During the post-PSS period, 447 (90.5%) government&nbsp / sponsored students were enrolled - 351 (71.1%) males and 143 (28.9% females) / in the same period, 47 (9.5%) private students were enrolled, 30 (63.8%) male and 17 (36.2%) female.&nbsp / Graduation rates for the entire study period were 96% (859), which represented 44% (378) in the pre-PSS and 56% (481) in the post-PSS periods. Private students contributed 8.9% (43) of the graduates 9in the post-PSS period. The majority of students (90.4%) graduated in five years. Thirty four students (3.8%) dropped out in the entire period, constituting significantly more in the pre-PSS - 22 (5.5%) than in the&nbsp / post PSS-period - 12 (2.4%). Males were more likely to drop out: 31 males did so (4.4%) compared with 3 (1.2%) females. In the post-PSS period, males made up 83.3% (10/12) of the attrition&nbsp / rate. Nine of them were government sponsored while three were private students. Conclusions: The PSS resulted in a 10% increase in enrolments when compared to the pre-PSS period.&nbsp / Furthermore the number of private medical student enrolments contributed 8.9% of the total graduations indicating that PSS succeeded in increasing the number of medical doctors graduated at MUSM. More males than females enrolled across all the years which might indicate&nbsp / a tendency for females to pursue non-medical professions which should be discouraged. Attrition of students&nbsp / was low which is encouraging but the finding that males were more likely to drop out than females deserves attention.</p>

<p>In 2007, at its 52nd Conference in Polokwane, the African National Congress (ANC) called for the implementation of a National Health Insurance (NHI) scheme. The announcement resulted in much debate, with critics voicing concerns about the state of the public health system, lack of consultation and the expense of a NHI scheme. However, little attention has been paid to the&nbsp / human resource (HR) needs, despite the fact that 57% of recurrent expenditure on health1 is on HR. This research aimed to identify the HR requirements to support the implementation of an effective and equitable health system funded by a NHI in South Africa. An overview of the current burden of disease and distribution of HR is provided. Through interviewing key stakeholders the study attempted to elicit information about factors which will hamper or assist in developing such a health system, specifically looking at the HR situation and needs. The research explores HR&nbsp / odels and proposes key HR requirements for implementation of a health system funded by a NHI in South Africa, including skills mix and projected numbers of health workers and&nbsp / proposes ways to improve the deficient HR situation. Exploratory qualitative research methods were used comprising in-depth individual interviews, with a purposive sample of key informants, including: public health professionals and health managers (working in rural and urban areas) / researchers / academics and NGO managers. The contents of the interviews were analysed to identify common responses about and suggestions for HR requirements within the framework of a NHI. 1 Personal communication Dr Mark Blecher, Director Social Services (Health), National Treasury, 17 July 2009 The literature review includes policy documents, position papers and articles from journals and bulletins. Key informants were asked to identify literature and research material to support recommendations. The research findings indicate that despite the South African Government&rsquo / s expressed commitment to Primary Health Care (PHC), the National Department of Health has continued to support and sustain a clinical model of health service delivery (Motsoaledi, 2010), primarily utilising doctors and nurses. The clinic based services are limited in their ability to reach community level, and, being focused on curative aspects, are often inadequate with regard to prevention, health promotion and rehabilitation services. While the curricula of health professionals have been through some changes, the training has continued to be curative in focus and the clinical training sites have not been significantly expanded to include peripheral sites. While there are many Community Health Workers in the country, they remain disorganised and peripheral to the public health system. The mid level worker category&nbsp / has not been fully explored. Finally there are no clear strategies for recruitment and retention of health workers in rural and under-resourced areas. In addition to the continued use of a clinical model, transformation of the health system hasbeen hampered by inadequate numbers of health workers, particularly in the rural and periurban townships and informal settlements. There is no clear strategy for addressing the critical&nbsp / health worker shortage in under-resourced areas, particularly rural areas. The last section makes recommendations, which will be submitted to the relevant task teams working on the NHI. It is intended that recommendations arising out of the research will influence the process and decisions about HRH within a NHI funded health system.</p>

<p>Background: The global human resources for health crisis has affected Uganda deeply as is evidenced by grossly inadequate medical doctor to population ratios. Strategies to increase training and retention initiatives have been identified as the most promising ways to address the problem. In Uganda, the dual track tuition policy of higher education (called the Private Students Scheme or PSS) at the University of Makerere was initiated in the academic year 1993/94, to boost student intake and to supplement university revenue. However, the impact of this scheme on the enrolment and graduation of medical students at this University is unknown. Aim: This study aimed to assess the effect of the PSS on enrolment, time to completion, attrition and number of graduated medical students at Makerere University Medical School after (post-)&nbsp / the Private Students Scheme (PSS). Study design: A quantitative cross-sectional descriptive&nbsp / study based on a retrospective review of enrolment and graduation records of medical students was conducted comparing records of students enrolled five years before and after the&nbsp / privatisation scheme. Numbers enrolled, attrition rates, time to completion and graduation numbers were analysed. Results: There were 895 students enrolled in the study period, 612 (72.2%) males and 236 (27.6%) females. Pre- and post-PSS periods had 401 and 494 enrolments respectively (a net increase of 93 students). During the post-PSS period, 447 (90.5%) government&nbsp / sponsored students were enrolled - 351 (71.1%) males and 143 (28.9% females) / in the same period, 47 (9.5%) private students were enrolled, 30 (63.8%) male and 17 (36.2%) female.&nbsp / Graduation rates for the entire study period were 96% (859), which represented 44% (378) in the pre-PSS and 56% (481) in the post-PSS periods. Private students contributed 8.9% (43) of the graduates 9in the post-PSS period. The majority of students (90.4%) graduated in five years. Thirty four students (3.8%) dropped out in the entire period, constituting significantly more in the pre-PSS - 22 (5.5%) than in the&nbsp / post PSS-period - 12 (2.4%). Males were more likely to drop out: 31 males did so (4.4%) compared with 3 (1.2%) females. In the post-PSS period, males made up 83.3% (10/12) of the attrition&nbsp / rate. Nine of them were government sponsored while three were private students. Conclusions: The PSS resulted in a 10% increase in enrolments when compared to the pre-PSS period.&nbsp / Furthermore the number of private medical student enrolments contributed 8.9% of the total graduations indicating that PSS succeeded in increasing the number of medical doctors graduated at MUSM. More males than females enrolled across all the years which might indicate&nbsp / a tendency for females to pursue non-medical professions which should be discouraged. Attrition of students&nbsp / was low which is encouraging but the finding that males were more likely to drop out than females deserves attention.</p>

<p>In 2007, at its 52nd Conference in Polokwane, the African National Congress (ANC) called for the implementation of a National Health Insurance (NHI) scheme. The announcement resulted in much debate, with critics voicing concerns about the state of the public health system, lack of consultation and the expense of a NHI scheme. However, little attention has been paid to the&nbsp / human resource (HR) needs, despite the fact that 57% of recurrent expenditure on health1 is on HR. This research aimed to identify the HR requirements to support the implementation of an effective and equitable health system funded by a NHI in South Africa. An overview of the current burden of disease and distribution of HR is provided. Through interviewing key stakeholders the study attempted to elicit information about factors which will hamper or assist in developing such a health system, specifically looking at the HR situation and needs. The research explores HR&nbsp / odels and proposes key HR requirements for implementation of a health system funded by a NHI in South Africa, including skills mix and projected numbers of health workers and&nbsp / proposes ways to improve the deficient HR situation. Exploratory qualitative research methods were used comprising in-depth individual interviews, with a purposive sample of key informants, including: public health professionals and health managers (working in rural and urban areas) / researchers / academics and NGO managers. The contents of the interviews were analysed to identify common responses about and suggestions for HR requirements within the framework of a NHI. 1 Personal communication Dr Mark Blecher, Director Social Services (Health), National Treasury, 17 July 2009 The literature review includes policy documents, position papers and articles from journals and bulletins. Key informants were asked to identify literature and research material to support recommendations. The research findings indicate that despite the South African Government&rsquo / s expressed commitment to Primary Health Care (PHC), the National Department of Health has continued to support and sustain a clinical model of health service delivery (Motsoaledi, 2010), primarily utilising doctors and nurses. The clinic based services are limited in their ability to reach community level, and, being focused on curative aspects, are often inadequate with regard to prevention, health promotion and rehabilitation services. While the curricula of health professionals have been through some changes, the training has continued to be curative in focus and the clinical training sites have not been significantly expanded to include peripheral sites. While there are many Community Health Workers in the country, they remain disorganised and peripheral to the public health system. The mid level worker category&nbsp / has not been fully explored. Finally there are no clear strategies for recruitment and retention of health workers in rural and under-resourced areas. In addition to the continued use of a clinical model, transformation of the health system hasbeen hampered by inadequate numbers of health workers, particularly in the rural and periurban townships and informal settlements. There is no clear strategy for addressing the critical&nbsp / health worker shortage in under-resourced areas, particularly rural areas. The last section makes recommendations, which will be submitted to the relevant task teams working on the NHI. It is intended that recommendations arising out of the research will influence the process and decisions about HRH within a NHI funded health system.</p>

Made available in DSpace on 2014-12-17T14:46:38Z (GMT). No. of bitstreams: 1 JoseJAJ.pdf: 4288006 bytes, checksum: 88e1eb3aa202fb2b352400054f55b1ab (MD5) Previous issue date: 2008-10-31 / This study addresses the interdisciplinary training in perspective for the Brazilian Health System (SUS) in view of graduation students in the areas of health of Federal University of Rio Grande do Norte s (UFRN) former students of the course Health and Citizenship (SACI). Emphasizes also the importance of commitment to social policies, particularly with those focused on the area of health. This is a case study with a qualitative approach. There was the lifting of data through documental research, from 14 portfolios of learning, which are weekly records of students from the respective discipline, corresponding to 2005.2 to 2007.2 semesters. From the analysis undertaken, inferred that the methodology problematizing, used by the discipline, enables students to understand that learning is not restricted to the confined university walls. It shows the health from a complex and concrete social reality, allowing students to an interdisciplinary dialogue in search of the transformation of this reality. It means an opportunity to interact with the dynamics of society in their area of activities, developing a relationship of solidarity in the formation of the citizen. Moreover, it was clear the direction of experienced interdisciplinary and recognized by students of various professions that make up the discipline. Thus, the SACI in preparation for construction of SUS, helps to form a new professional, more committed to the promotion and with a collective work in health / O presente estudo aborda a interdisciplinaridade na perspectiva da forma??o para o Sistema ?nico de Sa?de (SUS) na ?tica de estudantes da ?rea da sa?de da Universidade Federal do Rio Grande do Norte (UFRN) egressos da disciplina Sa?de e Cidadania (SACI). Ressalta, igualmente, a import?ncia do compromisso com as pol?ticas sociais e, em particular, com aquelas voltadas para a ?rea da sa?de. Trata-se de um estudo de caso com abordagem qualitativa. Realizou-se o levantamento dos dados atrav?s de pesquisa documental, a partir de 14 portf?lios de aprendizagem, que s?o registros semanais dos estudantes da respectiva disciplina, correspondendo aos semestres 2005.2 a 2007.2. Da an?lise empreendida, inferiu-se que a metodologia problematizadora, utilizada pela referida disciplina, possibilita aos estudantes compreender que a aprendizagem n?o se limita aos restritos muros universit?rios. Ela situa a sa?de partindo de uma realidade social concreta e complexa possibilitando aos estudantes um di?logo interdisciplinar na busca da transforma??o desta realidade. Significa uma oportunidade de interagir com a din?mica da sociedade no seu espa?o de a??es, desenvolvendo uma rela??o de solidariedade na forma??o do cidad?o. Por outro lado, ficou evidente o sentido da interdisciplinaridade vivenciada e reconhecida pelos estudantes de diversas profiss?es que integram a disciplina. Desse modo, a SACI na perspectiva de constru??o do SUS, ajuda a formar um novo profissional, mais comprometido com a promo??o e com um trabalho coletivo em sa?de

p. 1-100 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-11T19:40:09Z No. of bitstreams: 1 Diss Claudia Santiago.pdf: 1498564 bytes, checksum: 31a0c4b3718e695a3e7a3a4b37a3a014 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T17:20:48Z (GMT) No. of bitstreams: 1 Diss Claudia Santiago.pdf: 1498564 bytes, checksum: 31a0c4b3718e695a3e7a3a4b37a3a014 (MD5) / Made available in DSpace on 2013-05-04T17:20:48Z (GMT). No. of bitstreams: 1 Diss Claudia Santiago.pdf: 1498564 bytes, checksum: 31a0c4b3718e695a3e7a3a4b37a3a014 (MD5) Previous issue date: 2009 / Esse trabalho descreve a construção da política de recursos humanos em vigilância sanitária (PRH-Visa) para estados e municípios desencadeada pela Anvisa, visando a responder as seguintes indagações: como aconteceu o processo de formulação dessa política? Existe uma política planificada de recursos humanos em Visa para estados e municípios? A análise desse processo foi feita à luz de referências teóricas sobre política, política de saúde, planificação e política de recursos humanos em saúde. Utilizou como categorias de análise certas dimensões correspondentes a etapas da formulação de política de saúde: Imagem-Objetivo, formulação de proposições, análise de proposições, desenho estratégico e formalização da política. A análise documental e de entrevistas com informanteschave permitiu concluir que não existe uma política planificada e formalizada de recursos humanos em vigilância sanitária para estados e municípios. Entretanto, houve iniciativas nessa perspectiva que possibilitaram reflexões e implementação de ações que possivelmente influíram sobre o SNVS. Apesar de não ter sido aplicado método formal de planificação pode-se afirmar indícios da existência de um pensamento e uma postura estratégicos na programação das ações. Foram observadas evidências que apontam para as motivações que demandaram esse movimento e alguns efeitos nos dias atuais. Por fim, apresentam-se algumas considerações para a continuidade desse processo, superando problemas do passado e avançando para a formalização de uma política de RH em Visa, consoante com as políticas de saúde do SUS. / Salvador

Esta dissertação examina em que medida as políticas nacionais para o controle do câncer no Brasil organizam o processo de trabalho na alta complexidade oncológica (ACO), por meio dos recursos humanos em saúde (RHS) oncologistas clínicos, radioterapeutas e físicos médicos vinculados às Redes Estaduais de ACO, a partir das definições estabelecidas pela Portaria SAS/MS N. 741/2005. Trata-se de um estudo de caso exploratório. Nele foi realizado um sucinto panorama da oncologia dentro da conjuntura histórica da saúde; apresentadas as três portarias ministeriais direcionadas ao controle câncer no País, e exemplificado, através de relato técnico e referencial teórico baseado nas três dimensões que permeiam os RHS propostas por Pierantoni: estrutural, gerencial e regulatória, de como aconteceu a divulgação das políticas para o controle do câncer no país, e os primeiros desenhos estaduais das redes de serviços de saúde de ACO. Algumas situações observadas sinalizam que, enquanto alguns dos instrumentos existentes na área da oncologia ainda são poucos utilizados pelos gestores no seu processo de planejamento e gestão, outros precisam ser aprimorados. O estudo de caso foi sobre a Rede de Atenção Oncológica do Município do Rio de Janeiro de 2008, composta por hospitais federais, estaduais, municipais, universitários e filantrópicos, todos na gestão municipal. No plano das análises destacam-se três elementos: a caracterização desses serviços de saúde; os parâmetros de cobertura assistencial e produção ambulatorial de quimioterapia e radioterapia e o número e carga horária dos RHS. O Cadastro Nacional de Estabelecimentos de Saúde do Departamento de Informação do SUS (DATASUS) e o Sistema de Informação Ambulatorial são utilizados como fontes de dados por representarem um banco de dados que podem contribuir para a gestão da área oncológica, ampliando, assim, sua utilidade para o SUS. Por fim, os achados possibilitam uma reflexão tanto pela ótica da gestão do trabalho quanto da gestão da educação em saúde, de como está se configurando a alta complexidade oncológica e quais os atuais limites e possibilidades para incluir o dimensionamento das categorias profissionais estudadas nos instrumentos normativos ministeriais. / This dissertation examines at which level the national policies for cancer control in Brazil organize the work process in oncological high complexity, through human resources in health (HRH) - clinical oncologists, radiotherapists and medical physicists - bound to the State oncological high complexity network, from the definitions established by the SAS/MS Order # 741/2005. It is an exploratory case study, which brings a brief overview of Oncology in the historical context of health. The three ministerial resolutions directed to the control of cancer in the country are presented and, through technical report and theoretical referential based on the three dimensions that permeate the HRH proposed by Pierantoni (structural, management and regulatory), exemplify how the dissemination of the cancer control policies in the country and the first State sketches of the oncological high complexity network came to be. Some situations encountered indicate that while some of the instruments in the area of oncology are still little used by the managers in their planning and management process, others need to be improved. The case study was on the Oncological Care Network in Rio de Janeiro 2008, composed of federal, state, municipal, university and philanthropic hospitals, all under municipal management. In terms of analysis, three elements stand out: the characterization of these health services, the parameters of care coverage and ambulatorial production of chemotherapy and radiotherapy and the number and workload hours of the human resources in health. The National Registry of Health Facilities of the SUS Information Department (DATASUS) and the Ambulatorial Information System are used as data sources, as they represent a data bank that may contribute to the management of the oncological area, this way widening its utility to the SUS. Finally, the findings allow a reflection from both the perspectives of work management and management education in health, on how is the oncological cancer care configuring itself and what are the actual limits and possibilities to have the dimensioning of the studied professional categories included in the ministerial normative instruments.

Esta dissertação examina em que medida as políticas nacionais para o controle do câncer no Brasil organizam o processo de trabalho na alta complexidade oncológica (ACO), por meio dos recursos humanos em saúde (RHS) oncologistas clínicos, radioterapeutas e físicos médicos vinculados às Redes Estaduais de ACO, a partir das definições estabelecidas pela Portaria SAS/MS N. 741/2005. Trata-se de um estudo de caso exploratório. Nele foi realizado um sucinto panorama da oncologia dentro da conjuntura histórica da saúde; apresentadas as três portarias ministeriais direcionadas ao controle câncer no País, e exemplificado, através de relato técnico e referencial teórico baseado nas três dimensões que permeiam os RHS propostas por Pierantoni: estrutural, gerencial e regulatória, de como aconteceu a divulgação das políticas para o controle do câncer no país, e os primeiros desenhos estaduais das redes de serviços de saúde de ACO. Algumas situações observadas sinalizam que, enquanto alguns dos instrumentos existentes na área da oncologia ainda são poucos utilizados pelos gestores no seu processo de planejamento e gestão, outros precisam ser aprimorados. O estudo de caso foi sobre a Rede de Atenção Oncológica do Município do Rio de Janeiro de 2008, composta por hospitais federais, estaduais, municipais, universitários e filantrópicos, todos na gestão municipal. No plano das análises destacam-se três elementos: a caracterização desses serviços de saúde; os parâmetros de cobertura assistencial e produção ambulatorial de quimioterapia e radioterapia e o número e carga horária dos RHS. O Cadastro Nacional de Estabelecimentos de Saúde do Departamento de Informação do SUS (DATASUS) e o Sistema de Informação Ambulatorial são utilizados como fontes de dados por representarem um banco de dados que podem contribuir para a gestão da área oncológica, ampliando, assim, sua utilidade para o SUS. Por fim, os achados possibilitam uma reflexão tanto pela ótica da gestão do trabalho quanto da gestão da educação em saúde, de como está se configurando a alta complexidade oncológica e quais os atuais limites e possibilidades para incluir o dimensionamento das categorias profissionais estudadas nos instrumentos normativos ministeriais. / This dissertation examines at which level the national policies for cancer control in Brazil organize the work process in oncological high complexity, through human resources in health (HRH) - clinical oncologists, radiotherapists and medical physicists - bound to the State oncological high complexity network, from the definitions established by the SAS/MS Order # 741/2005. It is an exploratory case study, which brings a brief overview of Oncology in the historical context of health. The three ministerial resolutions directed to the control of cancer in the country are presented and, through technical report and theoretical referential based on the three dimensions that permeate the HRH proposed by Pierantoni (structural, management and regulatory), exemplify how the dissemination of the cancer control policies in the country and the first State sketches of the oncological high complexity network came to be. Some situations encountered indicate that while some of the instruments in the area of oncology are still little used by the managers in their planning and management process, others need to be improved. The case study was on the Oncological Care Network in Rio de Janeiro 2008, composed of federal, state, municipal, university and philanthropic hospitals, all under municipal management. In terms of analysis, three elements stand out: the characterization of these health services, the parameters of care coverage and ambulatorial production of chemotherapy and radiotherapy and the number and workload hours of the human resources in health. The National Registry of Health Facilities of the SUS Information Department (DATASUS) and the Ambulatorial Information System are used as data sources, as they represent a data bank that may contribute to the management of the oncological area, this way widening its utility to the SUS. Finally, the findings allow a reflection from both the perspectives of work management and management education in health, on how is the oncological cancer care configuring itself and what are the actual limits and possibilities to have the dimensioning of the studied professional categories included in the ministerial normative instruments.

Orientador: Solange L'Abbate / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T01:40:18Z (GMT). No. of bitstreams: 1 Sol_NuncioAntonioAraujo_D.pdf: 30048278 bytes, checksum: 049f92b5a39004870d7b6253fa32095e (MD5) Previous issue date: 2011 / Résumé: Cette thèse a comme objectif général sauver, à travers l'Analyse Institutionnelle Socio-Historique, le processus de constitution de la Médecine Générale et Communautaire (MGC) brésilienne à partir de quelques expériences municipales. Important faire ressortir la forte implication de l'auteur avec ce travail être ex-residente de médecine générale communautaire de l'Hôpital Monsenhor Horta dans Mariana/MG. La MCG au Brésil présente de multiples et complexes influences sociales, politiques et culturelles, caractérisée par des éléments idéologiques et conceptuels divers et beaucoup de fois conflictuelles, originaires, au un premiers moments, de scénarios internationaux qui, à accosteront au Brésil, souffrent un processus assimilation " tropicalizada ", lié au choc entre La normatization d'état et de fondations internationales et sa il accomplit de la mise en oeuvre à partir des réalités locales où ils ont été implantés. Nous pourrions supposer l'existence d'un modèle brésilien de MGC? Ainsi, l'hypothèse centrale de ce travail est ce dont MGC au Brésil a présenté des caractéristiques propres qui la diffèrent du modèle original américain, en prévalant, dans le processus d'implantation et de mise en oeuvre, la flexibilité et les innovations de caractère local. S'analyse la mise en oeuvre de la Médecine Générale Communautaire au Brésil dans les décennies de 70 à 90, en élaborant une possible genèse conceptuelle et sociale de MGC à travers l'analyse de trois expériences dans MGC - les Du Centre de Santé-École Murialdo et de Grupo Hospitalier Conceição les deux à Porto Alegre /RS et encore opérant, et ce de l'Hôpital Monsenhor Horta dans Mariana/MG, interrompue en 1984. Il s'agit d'une étude de nature qualitative, de fond simultanément théorique ET empirique, sur base d'entrevues et de recherche documentaire. Des résultats montrent que les trois expériences analysées présentent des différences importantes, tant nous leurs processus d'implantation qu'aussi nous leurs liens institutionnels, politiques et idéologiques. Se détache aussi la variété des expériences concernant la formation de médecins résidants dans le secteur de MGC / Resumo: Esta tese tem como objetivo geral resgatar, através da Análise Institucional Sócio-Histórica, o processo de constituição da Medicina Geral e Comunitária (MGC) brasileira a partir de algumas experiências municipais. É importante salientar a forte implicação do pesquisador com este trabalho por ser ex-residente de medicina geral comunitária do Hospital Monsenhor Horta em Mariana/MG. A MCG no Brasil apresenta múltiplas e complexas influências sociais, políticas e culturais, caracterizada por elementos ideológicos e conceituais diversos e muitas vezes conflituosos, oriundos, num primeiro momento, de cenários internacionais que, ao aportarem no Brasil, sofrem um processo de assimilação "tropicalizada", decorrente do embate entre a normatização estatal e de fundações internacionais e sua efetiva implementação a partir das realidades locais onde foram implantadas. Poderíamos, então, supor a existência de um modelo brasileiro de MGC? Assim, a hipótese central deste trabalho é a de que a MGC no Brasil apresentou características próprias que a diferem do modelo original americano, prevalecendo, no processo de implantação e implementação, a flexibilidade e as inovações de caráter local. Foi analisada a trajetória da Medicina Geral Comunitária no Brasil nas décadas de 70 a 90, elaborando uma possível gênese conceitual e social da MGC através da análise de três experiências em MGC - o do Centro de Saúde-Escola Murialdo e do Grupo Hospitalar Conceição ambos em Porto Alegre/RS e ainda atuantes, e a do Hospital Mons. Horta em Mariana/MG, interrompido em 1984. Trata-se de um estudo de natureza qualitativa, de fundo simultaneamente teórico e empírico, com base em entrevistas semi-estruturadas e pesquisa documental. Os resultados mostram que as três experiências analisadas apresentam diferenças relevantes, tanto nos seus processos de implantação como também nos seus vínculos institucionais, políticos e ideológicos. Destaca-se também a variedade das experiências em relação à formação de médicos residentes na área de MGC / Abstract: This dissertation aims at rescuing, by Socio-Historical Institutional Analysis, the process of constitution of Brazilian General Medicine Community (GMC) from some municipal experiences. It is important to point out the strong implication between the researcher and this study, since he was a former-resident of GMC of Monsenhor Horta Hospital in Mariana/MG. The GMC in Brazil presents multiple and complex social, cultural and political influences, it is also characterized by diverse ideological and conceptual elements and many times conflictive, deriving, at the first moment, from international settings that, when arriving in Brazil, suffered from a process called "tropical like" assimilation, resulting from the shock between the state normalization and international foundations and its effective implementation through the local realities where they were implanted. So, could we suppose the existence of a Brazilian model of GMC? Thus, the central hypothesis of this work would be that the GMC in Brazil presented proper characteristics that differ from the American original model, prevailing, in the process of implantation and implementation, the flexibility and the innovations of local feature. The study analyzed the implementation of Brazilian General Medicine Community in the decades of 70 the 90, elaborating possible conceptual and social genesis of the GMC through the analysis of three different experiences in GMC - Center of Murialdo Health-School and the Conceição Hospital Group, both still operating in Porto Alegre /RS and Mons. Horta Hospital in Mariana/MG, interrupted in 1984. This is a qualitative study of theoretical and empirical background simultaneously, based on semi-structured interviews and desk research. Results point out that the three experiences show relevant differences not only in their insertion processes but also in their institutional, political and ideological bonds. The research also highlights the variety of experiences for the training of medical residents in the area of GMC in Brazil / Doutorado / Ciências Sociais em Saúde / Doutor em Saude Coletiva

O estudo teve como objetivo analisar o desempenho do primeiro serviço de saúde procurado para o diagnóstico da tuberculose (TB), em São José do Rio Preto (2009), na percepção do doente. Trata-se de estudo epidemiológico descritivo, tipo inquérito, que adotou como eixo metodológico os componentes de avaliação de serviços de saúde estrutura e processo. Participaram do estudo 99 doentes de TB, maiores de 18 anos e em tratamento, entrevistados por meio de um instrumento elaborado com base no Primary Care Assessment Tool (PCAT), adaptado para avaliar a atenção aos doentes de TB, e que contemplou questões das dimensões de porta de entrada e acesso ao diagnóstico. A análise dos dados foi realizada por meio de distribuição de frequência absoluta/relativa e da construção de indicadores, utilizando proporções e intervalos de confiança, de acordo com o tipo de serviço de saúde procurado pela primeira vez, quando da percepção dos sinais/sintomas, sendo esses agrupados em: Atenção Básica (AB), Pronto Atendimento (PA) e Serviços Especializados (SE). O perfil epidemiológico dos doentes entrevistados evidencia o predomínio dos casos novos de TB pulmonar entre indivíduos do sexo masculino, em idade produtiva e reprodutiva, com baixa renda e escolaridade. A principal porta de entrada no município foi o PA. Em relação ao componente estrutura, encontrou-se que o PA e, principalmente, a AB se constituíram como os serviços mais próximos ao domicílio dos doentes, entretanto, a AB não foi a mais acessível, uma vez que a maioria daqueles que a procuraram não conseguiu consulta no prazo de 24 horas. Quanto ao componente processo, houve baixa suspeição de TB nos três tipos de serviços analisados. A maior proporção de exames solicitados para o diagnóstico ocorreu no SE, seguido pelas unidades de AB. Houve baixa proporção de encaminhamento para a realização de baciloscopia de escarro, nos três tipos de serviços. O PA e a AB encaminharam a maioria dos doentes para realização de raio-x e para consulta médica em outro serviço, principalmente os casos extrapulmonares. Doentes com TB, que buscaram primeiramente a AB, necessitaram procurar mais vezes os serviços de saúde e mais de 50% desses tiveram atraso no diagnóstico. O PA foi o serviço que menos diagnosticou os usuários suspeitos, sendo o SE (especialmente os hospitais) os que apresentaram melhor desempenho, principalmente para o diagnóstico dos casos extrapulmonares. Para o controle efetivo da doença, os serviços de saúde, que se configuram como porta de entrada do sistema, devem estar preparados para a suspeição e diagnóstico e que sejam criadas estratégias de fluxo de referência e contrarreferência entre o primeiro serviço de saúde procurado e os outros serviços que compõem a rede de atenção, de modo que seja assegurada a continuidade da assistência. / The study aimed to analyze the performance of the first health care sought for the diagnosis of TB, in Sao Jose do Rio Preto (2009), according to the patients perception. A descriptive inquiry epidemiological study was conducted, which adopted as methodological framework the components of health services assessment: structure and process. The study included 99 TB patients, aged 18 years and in treatment, interviewed using a questionnaire based on the Primary Care Assessment Tool (PCAT), adapted to assess TB care and that included dimensions of first contact care and access to diagnosis. Data analysis was performed using absolute and relative frequency and indicators development, by ratios and confidence intervals, according to the type of health service sought by the first time when the perception of signs / symptoms, grouped as follows: Primary Health Care (PHC), Emergency Services (ES) and Specialized Services (SS). The epidemiological profile of patients interviewed shows the prevalence of new cases of TB among males, in productive and reproductive age with low income and low education. The main first contact care in the city was the ES. Regarding the structure component, we found that the ES and, especially, the PHC are identified as services closest to the patients home, however, PHC was not accessible, since most of those failed to get a medical appointment within 24 hours. Regarding the process component, there was a low suspicion of TB in the three types of services examined. The greatest proportion of diagnosis exams requirement occurred in SS, followed by PHC. There was a low proportion of referrals to performing sputum smear test, in the three types of services. ES and PHC refer the majority of patients to perform x-ray and medical examinations to another service, especially extrapulmonary cases. TB patients, who sought first the PHC, needed to look for more health services and over 50% of these had a delay in diagnosis. The ES was the one who less diagnosed TB suspect case, and the SS (especially hospitals) showed the best performance, particularly for the diagnosis of extrapulmonary cases. For effective control of this disease, first contact care should be prepared for suspicion and diagnosis, and strategies of reference between the first health care sought and other services need to be developed, building a network of care so that it ensured the continuity of it.