Šio magistro baigiamojo darbo tikslas buvo išanalizuoti sveikatos priežiūros žmogiškųjų išteklių politiką ir jos įgyvendinimo ypatumus Lietuvoje. Suformuluotų uždavinių pagalba darbe siekiama pateikti teorinį sveikatos priežiūros žmonių išteklių politikos įgyvendinimo modelį: atskleisti SPŽI politikos sampratą, apibrėžti SPŽI politikos priemones ir įvertinti jų reikalingumą. Remiantis pateiktu teoriniu modeliu, toliau darbe analizuojama sveikatos priežiūros žmogiškųjų išteklių politika Lietuvoje: interpretuojama politikos samprata, apibrėžiamos jos priemonės ir poreikis. Darbe taipogi pateikiami kokybinio tyrimo, kuriuo buvo siekta nustatyti ir įvertinti pagrindines Lietuvos sveikatos priežiūros žmonių išteklių politikos įgyvendinimo problemas, rezultatai. Taip pat tyrimo metu surinkta informacija įgalino nustatyti galimas SPŽI politikos įgyvendinimo problemų priežastis. Tyrimo analizė buvo konstruojama, remiantis Sveikatos apsaugos ministerijos atstovų vertinimais egzistuojančių SPŽI problemų bei įgyvendinamų SPŽI politikos priemonių atžvilgiu. Be to, išryškinami sveikatos priežiūros žmogiškųjų išteklių anketinės apklausos rezultatai, atskleidę specialistų vertinimus politikos priemonių reikalingumo bei optimalumo atžvilgiu. Tyrimo rezultatų interpetacija atskleidė egzistuojančias politikos įgyvendinimo problemas bei leido pateikti rekomendacines priemones, optimizuojančias politikos įgyvendinimo procesą. / The major goal of this paper work was to analize Human Resources for Health Policy and it’s implementation mechanism in Lithuania. The specific objectives were to introduce the comprehensive analytical human resources for health policy framework, which descibes the theoretical concept of human resources for health policy and it’s development measures. This paper, by means of the proposed framework and other primary and secondary sources, identifies the key problems, facing human resources for health in Lihuania. The relevance of those problems suggest the increasing necessity to be paid to the development of human resources for health policy in Lithuania. The paper also represents the consept of Lithuanian human resource for health policy by examining the tools being implemented of Lithuanian administrative institutions in response to important human resources for health imbalances. The research was done in order to identify the main problems, arising in policy implementation process. A key measure of this examination was an assessment of the chosen governmental institutons representative’s and the particular health care providers position to the subject of the research. The research analysis proved the existence of the problems and showed the necessity to improve current administrative measures.

Overview: A global shortage of over 7.2 million health workers poses a threat to service delivery particularly in sub-Saharan Africa. Sub-Saharan Africa bears a quarter of the global burden of disease; yet, it only has three percent of all health workers. Maldistribution and migration both to urban and international destinations pose persistent challenges to service delivery particularly to rural and remote populations. In Kenya, the health human resources are mostly concentrated in urban areas, and in some cases as high 70% of the health workers are serving only 20% of the population. Literature to date, particularly in the context of Kenya, has focused on doctors and more recently nurses. There has been a gap in analysis in exploring mid-level cadres such as clinical officers, a cadre of non-physician clinicians. Research objectives: The objectives of the research were to: 1) conduct a contextual analysis of human resources for health in Kenya; 2) understand the migration perspectives of Kenyan health professionals including doctors, nurses and clinical officers through an online survey; 3) explore the role of mid-level health worker cadre of clinical officers as a promising practice for Kenya. The thesis is presented in three papers congruent with the three research objectives. I interrogated these areas at a macro, meso and macro level using systems thinking theory. Findings: The first paper found significant developments in the policy context of managing health professionals in Kenya all of which have improved the working conditions for health professionals. International migration was found to have decreased over the past decade and was not deemed be a policy priority by government and development partner stakeholders. Health professional representatives, on the other hand, asserted that they continue to be disgruntled with the current situation and would not hesitate to migrate given the opportunity. The second paper found that the factors that discourage health professionals from staying in Kenya are similar to those available in the literature and include: dissatisfaction with remuneration, governance, working conditions and living conditions. Among health professionals considering migration, few had made short-term plans to leave. Family ties and fear of the unknown were found to be strong factors for continuing to work as health professionals in Kenya. Job security was found to be high in the government while recruitment agencies were not found to play a significant role in migration decisions of health professionals. The third paper found that there was general support for the scale of up clinical officers to enhance the Kenyan health workforce. Barriers to scale-up included resistance from medical doctors, who felt that clinical officers were not competent enough to handle complicated cases, and a lack of employment opportunities given a surplus of about 3,000 unemployed clinical officers in Kenya, who could potentially fill in the health workforce gaps. Conclusion: Overall policy developments have been implemented since 2007 presenting a promising future to the management of human resources for health (HRH) in Kenya. Although few health professionals are making concrete steps to migrate out of Kenya they continue to be dissatisfied with the current living and working conditions. Maldistribution and overall shortages of health professionals continue to hamper service delivery to vulnerable rural populations. Mitigating factors include the potential of scaling up the clinical officer cadre particularly through the surplus of 3000 unemployed clinical officers, a process that requires sufficient political and professional will. A holistic multi-level approach to health system planning is crucial to ensure that any new investments are well coordinated and involve an overall scale-up of health professionals.

Magister Public Health - MPH / Background: Adequate human resources for health play a crucial role in improving access to services and quality of care. Human resources for health are often inequitably distributed between rural and urban areas within countries. In Rwanda, almost 88% of physicians and 58% of nurses in the country work in urban areas, despite the fact that 82% of the population lives in rural areas. Kabaya is located in a remote rural area in Ngororero District; its health facilities consist of one hospital and four health centers. Living and working conditions are poor for health workers. This results in constant migration out of health workers, which has negative impacts on service delivery and quality of care provided to the population. Aim and Objectives: This study aimed to assess factors that influence the intention to stay in Kabaya amongst health workers currently in Kabaya's health facilities. The specific objectives were to analyze the associations between the following factors and intention to stay among health workers in Kabaya: socio-demographic and job characteristics; working and living conditions; and financial and non-financial incentives. Study design: An analytical, cross-sectional survey of all health workers from five facilities in Kabaya was conducted. Methods: A self-administered questionnaire, adapted from one used in a study in Uganda (Hagopian, Zuyderduin, Kyobutungi & Yunkella, 2006), was used to collect data. Data were entered in Epi- Info 3.4 and analyzed using SPSS 16.0. Descriptive analyses and inferential statistics (Chisquare,Fisher‟s Exact) were done to test for associations with the main outcome, intention to stay. Results Out of 155 employees working in Kabaya‟s health facilities, 111 (72%) accepted to participate in the study. Of the 111 respondents, 34 (31%) indicated they intended to stay working in Kabaya indefinitely. Intention to stay (bivariate analysis) was associated with:  employment category (p=0.001) and age (p<0.001);  rural background - born in Kabaya (p<0.001); and born (p=0.001), grew up (p=0.001) and studied in a rural area (p<0.001); good quality supervision - encouraging employee development (p=0.029), caring for the employee as a person (p=0.011), and competent and committed facility managers(p=0.039);  presence of workplace friends (p<0.001);  conducive work and living environments - manageable workloads (p<0.001); good infrastructure (p<0.001); access to safe and clean water at work (p<0.001); adequate housing at home (p<0.001); having time to take lunch at work (p=0.001); access to adequate transportation to work (p=0.004); adequate shopping and entertainment(p=0.001);  adequate incentives - sufficient salary (p<0.001); recognition for doing a good work(p<0.001); and adequate training (p<0.001). The small study sample precluded multi-variate analyses and it was therefore not possible to control for potential confounders such as age, sex and profession in the analysis of workplace factors. Conclusions: Intention to stay in Kabaya appears to be influenced by a complex set of factors that include: individual (age, profession, rural background), workplace, human, social, career and salaryrelated factors. Promoting retention in Kabaya‟s health facilities requires multi-faceted interventions, without which the majority of the employees are likely to continue to migrate away from the area.

To achieve Sustainable Development Goal 3 in developing countries, Good health and wellbeing for all, the health workforce is vital however the unpopularity of rural medical practice results in widening healthcare inequalities between urban and rural areas. This study determined the heterogeneity in valuations for rural facility attributes by final year medical students at one South African public university to inform cost-effective recruitment policy recommendations. Focus groups conducted identified facility attributes, a D-efficient design was generated with 15 choice sets, each with two rural hospital alternatives and no opt-out option. An online, unlabelled discrete choice experiment (DCE) was conducted, the results effects coded, and mixed logit models applied. The final sample size was 193 (86,16% of the class), majority female 130 (66.33%), with urban origins 176 (89.80%), unmarried 183 (93.37%) and without children 193 (98.47%). Most had undergraduate rural medicine exposure 110 (56.12%) and intended to specialise 109 (55.61%). The main-effects mixed logit found advanced practical experience, hospital safety, correctly fitted personal protective equipment (PPE) and availability of basic resources the highest weighted attributes with their mean utilities increasing by 0.82, 0.64, 0.62 and 0.52 respectively (p=0.000). In contrast, increases in rural allowance and the provision of housing provided smaller mean utility increases of 0.001 (p<0.01) and 0.09 (p<0.05) respectively. The interaction terms; female, general practise and prior rural medicine exposure, were associated with higher weighting for hospital safety, mean utility increases 1.59, 1.82, 1.42 respectively (p=0.000). Participants were willing to pay ZAR 2636.45 monthly (95%CI: 1398.55;3874.355) to gain advanced practical experience (equivalent to 65.91% of current rural allowance). Medical students’ facility preferences have been found to be influenced by their gender, career aspirations and prior experienced with rural medicine. The policy recommendations derived from this research include publicising rural health facility “draw-cards” among medical graduates, such as the opportunity to gain practical experience, improving the physical and occupational safety at rural health facilities and providing greater transparency about rural facility attributes to medical graduates.

Background: To address the huge human resources for health (HRH) crisis that Zambia and other low and middle income countries (LMICs) are experiencing, most LMICs have engaged the services of small scale community-based health worker (CBHW) programmes. However, several challenges affect the CBHWs’ ability to deliver services. Integration of national CBHW programmes into health systems is an emerging innovative strategy for addressing the challenges. Integration is important because it facilitates recognition of CBHWs in the national primary health care system. However, the integration process has not been optimal, and a more comprehensive understanding of the factors that shape the integration process is lacking. This study aimed at addressing this gap by analysing the integration process of national CBHW programmes in health systems in LMICs, with a special emphasis on Zambia. Methodology: This was a qualitative study that used case study and systematic review study designs. The case study focused on Zambia and analysed the integration processes of Community Health Assistants (CHAs) into the health system at district level (Papers I-III). Data collected using key informant interviews, participant observation, in-depth interviews and focus group discussions were analysed using thematic analysis. The systematic review analysed, using thematic and pathways analysis, the integration process of national CBHWs into health systems in LMICs (Brazil, Ethiopia, India and Pakistan)-(Paper IV). The framework on the integration of health innovations into health systems guided the overall analysis. Results: Factors that facilitated the integration of CHAs into the health system in Zambia included the HRH crisis which triggered the willingness by the Ministry of Health to develop and support implementation of the integration strategy-the CHA strategy. In addition, the attributes of the CHA strategy, such as the perceived competence of CHAs compared to other CBHWs, enhanced the community’s confidence in the CHA services. Involvement of the community in selecting CHAs also increased the community’s sense of programme ownership. However, health system characteristics such as limited support by some support staff, supply shortages as well as limited integration of CHAs into the district governance system affected CHAs’ ability to deliver services. In other LMICs, as in Zambia, the HRH problems necessitated the development of integration strategies. In addition, the perceived relative advantage of national CBHWs with regard to delivering health services compared to the other CBHWs also facilitated the integration process. Furthermore, the involvement of community members and some politicians in programme processes enhanced the perceived legitimacy, credibility and relevance of programmes in other LMICs. Finally, the integration process within the existing health systems enhanced programme compatibility with health system elements such as financing. However, a rapid scale-up process, resistance from other health workers, ineffective incentive structures, and discrimination of CBHWs based on social, gender and economic status inhibited the integration process of national CBHWs into the health systems. Conclusion: Strengthening the integration process requires fully integrating the programme into the district health governance system; being aware of the factors that can influence the integration process such as incentives, supplies and communication systems; clear definition of tasks and work relationships; and adopting a stepwise approach to integration process.

Magister Public Health - MPH / In response to the increasing burden with regard to treatment of HIV/AIDS in Mozambique, the Ministry of Health has developed a national strategic plan for HIV and AIDS. This provided for broader access to Antiretroviral Therapy (ART) by decentralizing and integrating ART services into the essential services provided at the primary care level. In keeping with this initiative,medical technicians are now responsible for first-line ART prescription and management at primary-level care health centres in the country. The ART programme was introduced in Mozambique in 2003 alongside other health services offered in hospitals; it was decentralized to PHC health centres in 2006.This study aimed to explore the experiences and perceptions of medical technicians regarding the decentralization and integration of ART services into PHC health centres in Beira. An exploratory qualitative study was conducted using in-depth interviews, key informant interviews and focus group discussions. A sample of 15 medical technicians was distributed across two focus groups for the purpose of discussion. In addition there were four in-depth individual follow-up interviews with four medical technicians, drawn from the two focus groups. Three key informant interviews were also held to collect data. The data was analysed using content analysis.The study revealed that the decentralization process was viewed by many of the medical technicians as a very positive initiative for the country. However a number of operational and managerial issues need to be addressed to ensure the effectiveness of the comprehensive approach that was institutionalized and adopted by all PHC health centres. Key amongst the issues that needed to be addressed were the workloads of the health care personnel, and of medical technicians in particular. Their workloads have increased without any corresponding increase in the health workforce needed to manage the patient load. The medical technicians felt that this adversely affected the quality of care they were able to provide to patients, and specifically to those requiring ART medication. The recommendations that emerge from the study are intended to promote the development of policy that will improve of working conditions and assist medical technicians to provide a better service to their patients.

Although Skilled Birth Attendance has been universally acknowledged as essential to progress in the field of maternal health (WHO, 2004), Human Resources for Health (HRH) deficits are currently impeding the sustainability of essential maternal health interventions on a global scale. Over the past 30 years, the Shoklo Malaria Research Unit (SMRU), along with other agencies such as non-governmental organizations and community-based organizations, have developed a self-contained health system, which provides health services, including maternity care, to migrants and refugees at the Thailand-Myanmar Border. The staff necessary to the provision of care in SMRU’s clinics are mostly recruited from within the migrant and refugee populations, and trained internally by SMRU. In the last decade, SMRU has experienced high-turnover rates and shortages of Skilled Birth Attendants (SBA). Consequently, their current maternity workforce is characterized by an acute shortage of SBAs who have attained senior status, and a higher concentration of SBAs at the assistant and junior levels. As a response to these HRH challenges, this case study aimed to conduct a multi-level analysis of obstacles and enablers to professional development amongst Skilled Birth Attendants working for SMRU. This single descriptive case study with embedded units of analysis, which incorporated non-participant observation, a template-based personnel file review, individual interviews, and focus groups at two of SMRU’s Birthing Units, represented a unique opportunity to observe and analyze the multiple influences that interact at various levels of a relatively self-contained health system. By highlighting the obstacles and enablers present within the system, this study purposed to identify means by which to empower lower level SBAs, support their professional development, and create a more sustainable maternity workforce. The study found that SMRU has been successful in providing its SBAs with the appropriate midwifery skills to fulfill a limited scope of practice, and in fostering strong intra-professional relationships that allow the SBAs to motivate and mentor each other. Achieving workforce sustainability with a model of care that implements task-shifting requires a balance of appropriate and constructive consultation structures without enabling the stagnation of SBAs’ skills and confidence. This study also reveals the importance of context and culture to a health system’s capacity to optimally plan and implement its HRH functions. Finally, in the case of SMRU, persistent recruitment and retention concerns underscore that workforce sustainability cannot be achieved through professional development alone. Therefore, this study reveals a need for further inquiry into the complexities of maternal health workforce planning in contexts of protracted displacement, and the challenges associated with developing appropriate supervisory structures for lower level health professionals.

O Sistema Único de Saúde (SUS) avançou muito desde o seu surgimento, entretanto, ainda existem muitos desafios que precisam ser superados. Entre eles, encontram-se a qualificação e a formação dos profissionais de saúde. Os cursos de graduação em saúde têm privilegiado uma formação tecnicista e fragmentada, incapaz de formar a força de trabalho necessária à resolução dos problemas de saúde da população brasileira. Neste sentido, há necessidade de desenvolver instrumentos direcionados ao incentivo de mudanças curriculares no ensino superior em saúde, tendo como um dos eixos a interação com os serviços de saúde. Cita-se, nesse contexto, o Programa de Educação pelo Trabalho para a Saúde (PET-Saúde). A presente investigação se propôs a avaliar o PET-Saúde instituído na Universidade de São Paulo (USP), campus Capital. Os sujeitos do estudo foram tutores, preceptores e alunos de odontologia que integraram o Programa em algum momento da sua existência. Foi utilizada uma abordagem qualitativa, sendo a coleta de dados realizada com o auxílio das técnicas Delphi e de Grupo Focal. O tratamento do material coletado foi orientado pela análise de conteúdo. Os dados levantados evidenciaram que, apesar das mudanças já implementadas, o modelo formador em odontologia apresenta fragilidades no sentido de atender completamente as Diretrizes Curriculares Nacionais (DCN), visto que é persistente a tendência tecnicista, biologicista e fragmentada. Os sujeitos reforçaram que a aproximação dos estudantes com os cenários de prática é capaz de auxiliar no processo formativo de alunos e na qualificação de profissionais inseridos nos serviços e professores dos cursos de graduação em saúde. Além disso, o PET-Saúde proporciona a ampliação do olhar do estudante em direção ao processo saúde/doença e o despertar para atuação futura no âmbito do SUS. A imersão no Programa foi responsabilizada pela quebra de pré-conceitos e pela consequente compreensão da organização da Atenção Primária e do trabalho desenvolvido no setor. Uma das vantagens apontadas pelos moldes de interação ensino-serviço do PET-Saúde consiste no estabelecimento da interdisciplinaridade no processo formador o que, dentre outras características, o conforma como um modelo de interação ensino-serviço mais próximo do ideal almejado. Como principais limites foram apontados a incompatibilidade de horários entre os protagonistas do programa, a distância dos cenários de prática em relação às unidades de ensino, além da ausência de diretrizes operacionais claras e da heterogeneidade de organização das atividades pelas unidades de saúde. Os resultados do estudo traduzem o PET-Saúde como um poderoso instrumento de indução de mudanças na concepção dos profissionais de saúde, contribuindo para uma formação condizente com as necessidades do SUS. / The Unified Health System of Brazil has advanced greatly since itsestablishment, but there are many challenges that need be overcome. Among them are the qualification and the education of health workers. Health courses have privileged a technicist and fragmented education, that is unable to create the workforce needed to solve the health problems of the Brazilian population. So there is a need to create instruments directed to the encouragement of curriculum changes in the higher health education , based on the interaction with health services. In this context, the Education Program of Work for Health is pointed out. The research evaluated the Education Program of Work for Health established at the University of São Paulo, Brazil. The study subjects were dental students, preceptors and tutors in the program. A qualitative approach was used and data collected using the Delphi technique and focus group. The material obtained was treated by Bardin analysis of content . Data collected evidenced that despite changes already implemented, dentistry education model presents fragilities onfully meeting the National Curriculum Guidelines since much students keep the technicist, fragmented and biologicist tendency. The subjects reinforcedthat students approximation with practice scenarios is able to assist in the formation process of students and qualification of professionals inserted in services and of health courses professors. Moreover, the Education Program of Work for Health provides a wider view from students toward the health/disease process and also an awakening for later operating in the Unified Health System. The immersion in the program was responsible for breaking preconceptions and for the consequent understanding of the organization of Primary Care and of work in the sector. One of the advantages pointed by the model of interaction between teaching and service by the Education Program of Work for Health is the establishment of interdisciplinarity in the formation process that, among others characteristics, conforms it as a model of interaction between teaching and service closest to the desired ideal. The incompatibility of schedules between the protagonists of the program, the distance of the practice scenarios in relation to teaching units besides the absence of clear operational guidelines and diverse organization of activities by health units were pointed as the main limitations. The study results reflect the Education Program of Work for Health as a powerful tool to induce changes in the conception of health professionals, contributing to an education consistent with the needs of the Unified Health System.

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No. of bitstreams: 2 Tese - Valquiria Coelho Pina Paulino - 2016.pdf: 860942 bytes, checksum: 6d5cacf017c6629cb84860a5d389a67e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-03-23 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / The overall objective of the study was to analyze the teaching identity, practice and training of teachers of undergraduate courses in public and private nursing in the state of Goiás. Methodology: Field research, descriptive cross-sectional. The sample consisted of 213 teachers which corresponds to 74.2% of professionals in undergraduate courses in Nursing, 60 linked to public and private courses to 153. For collection, we used a questionnaire addressing the teacher identity in personal, professional and administrative dimensions. Data were tabulated in Microsoft ® Excel 2010 program and the statistical analysis by SPSS program for Windows, version 16.0. Results: In the personal dimension the predominant age group was 30-51 years, and the oldest are in public institutions. In the professional dimension, the prevailing academic courses in Pubic was the doctorate and private in the Masters. As for specific training for teaching 85% of teachers were public courses and 73.8% in private. In the administrative dimension, public courses, the working time average in higher education was 11.13 years, 81.7% statutory, 81.7% worked exclusively at the university, with average weekly working hours of 38.53 hours, and 11.3 hours for education, 7.97 hours for planning and 19.3 hours for research and extension activities, 55% earned more than 8 times the minimum wage. Among the participants, 86.7% have published at least one article in a scientific journal and 70% in conference proceedings in the last three years. The greatest difficulty pointed to the teaching exercise was the workload and demand for production and qualification (31.6%). In private courses, the working time average in higher education is 8.95 years, 79.1% were hourly, with weekly working hours of 42.46 hours, and the average in education 23.7 hours and 6.76 hours of planning, having no specific time for research. As for workplaces, 39.2% worked in two or more institutions and 28.1% earned over 8 minimum wages, 22.9% have published at least one work in conference proceedings and 37.3% in the journal three years. The greatest difficulty pointed to the teaching exercise was the lack of interest and intellectual training of students (37.2%). Conclusions: There are differences in the teaching identity, practice and training of teachers of public and private institutions in this respect confirming the first hypothesis established for the study. The second hypothesis was refuted because, teachers in both types of courses studied, most have specific training for teaching and there is a search movement of teachers for qualifying. / O objetivo geral do estudo foi analisar a identidade docente, prática e formação dos professores dos cursos de graduação em Enfermagem públicos e privados do Estado de Goiás. Metodologia: Pesquisa de campo, descritiva do tipo transversal. A amostra constitui-se de 213 professores o que corresponde a 74,2% destes profissionais nos cursos de graduação em Enfermagem, sendo que 60 vinculados aos cursos públicos e 153 aos privados. Para a coleta, utilizou-se um questionário que abordou a identidade docente nas dimensões pessoal, profissional e administrativa. Os dados foram tabulados no programa Microsoft ® Excel 2010 e a análise estatística realizada pelo programa SPSS® for Windows®, versão 16.0. Resultados: Na dimensão pessoal a faixa etária predominante foi de 30 a 51 anos, sendo que os mais velhos estão nas instituições públicas. Na dimensão profissional, a formação acadêmica predominante nos cursos púbicos foi o doutorado e nos privados o mestrado. Quanto à formação específica para a docência 85% dos professores eram dos cursos públicos e 73,8% nos privados. Na dimensão administrativa, nos cursos públicos, a média de tempo de trabalho no ensino superior era de 11,13 anos, sendo 81,7% estatutários, 81,7% trabalhavam exclusivamente na universidade, com média de carga horária semanal de 38,53 horas, sendo 11,3 horas para o ensino, 7,97 horas para o planejamento e 19,3 horas para atividades de pesquisa e extensão, 55% ganhavam acima de 8 salários mínimos. Entre os participantes, 86,7% publicaram no mínimo um artigo em revista científica e 70% em anais de congressos nos últimos 3 anos. A maior dificuldade apontada para o exercício docente foi a sobrecarga de trabalho e exigência por produção e qualificação (31,6%). Nos cursos privados, a média de tempo de trabalho no ensino superior é de 8,95 anos, 79,1% eram horistas, com carga horária semanal de 42,46 horas, sendo a média no ensino 23,7 horas e 6,76 horas de planejamento, não tendo tempo específico para a pesquisa. Quanto aos locais de trabalho, 39,2% atuavam em duas ou mais instituições e 28,1% ganhavam acima de 8 salários mínimos, 22,9% publicaram no mínimo um trabalho em anais de congressos e 37,3% em revista científica nos últimos três anos. A maior dificuldade apontada para o exercício docente foi a falta de interesse e de preparo intelectual dos alunos (37,2%). Conclusões: Existem diferenças quanto à identidade docente, prática e formação dos professores das instituições públicas e privadas confirmando neste aspecto a primeira hipótese estabelecida para o estudo. A segunda hipótese foi refutada, pois, os professores nos dois tipos de cursos estudados, a maioria tem formação específica para a docência e existe um movimento de busca dos docentes para a qualificação.

The strength of health systems predict access to medicines that prevent death from pregnancy related complications (essential maternal health medicines). But little is known about the relative impact of each health system building block on access. This quantitative cross-sectional study applied Ishikawa model to examine the relative effect of health systems governance, facilities, service delivery, financing and medicine procurement and distribution (independent variables), on availability, affordability and accessibility (dependent variables) of maternal health medicines in resource poor settings. Data analyzed was pulled from 37 WHO pharmaceutical country profiles and USAID MCHIP survey that assessed national programs for the prevention and management of Postpartum hemorrhage and Pre-Eclampsia/Eclampsia. Data analysis included bivariate and multivariate logistic regressions. All independent variables, except for quality of health services showed statistically significant association with access to maternal health medicines and achieved a p-value < .05 in bivariate analysis. Only three predictors however explained 27% of the variance (R2 =.266, F(5,162)=13.12, p<.01). The strength of medicine procurement and distribution systems significantly predicted access to essential maternal health medicines (β= -.41, p<.001), as did robustness of health system financing (β= -.51, p<.001), and quality of health facilities (β= -.34, p<.05). Authorities may prioritize investments in quality improvement, supply chain strengthening programs, and incentives for private sector financing and public-private partnerships for health system strengthening. This study contributes to positive social change by identifying key health system considerations that can inform future efforts to close geographical gaps in MCH outcomes.