ID: 15576
Autoria:
Ernani Braga.
Fonte:
Revista de Administração Pública, v. 11, n. 3, p. 57-68, Julho-Setembro, 1977. 12 página(s).
Tipo de documento: Artigo (Português)
Ver Resumo
The author begins by offering his comments on the five reports produced each four years by the World Health Organization on the health situation of member countries in the 1953-72 period. Besides describing the geophysical and socio-cultural characteristics, and the health services of these countries, the reports emphazise the so-called "social diseases" and the difficulties faced by many countries with the scarcety of funds to afford the increasing costs of public-health services. The reports clearly characterize the member countries' preocupation with such a problem and confirm the recent acceptance of the theory that the cost of health is conditioned by the degree of each country's socio-economic development and fundamental decisions on health legislation. The thesis that investing on health is highly profitable is still not largely accepted. As a result, funds to fulfill health needs are scarce. This makes it indispensable that priorities be established in the process of solving health problems. The fifth report, convering the 1969-1972 period, seems to be the most important from the administrative and social viewpoints, for it shows the possibility of rationally associating health technology and modern management methods in order to strengthen and improve health services. According to the author, the period covered by the fifth report was marked in many countries by deep changes in social legislation and health-administration organization. In his opinion no country can claim to have a perfect health system, but he insists that the absence of rationality and good management is the main flaw of health services. In most countries, this makes it impossible for all the population to receive a minimum of health assistance, be it centrally, regionally or locally integrated. This problem can only be solved by adopting plannings models which reflect the capacity, the historical-cultural traditions and the socio-economic characteristics of the countries for which they are developed. In this respect, the author enhances the adoption of the principie of hierarchizing health actions. According to this decentralizing philosophy, the complexity of medico-social resources varies acoording to the community's demographical concentration, nosology and general resources. It also involves the joint participation of public and private institutions. Independently from their political structure or ideology, most countries tend to adopt health services which are coordinated and financed by the government through social insurance, but according to three different approaches: 1. socialist countries - studies are synthetized on three levels: central level (essentially political); technical level (dependent on various administrative instanees); and communitary level (once identified, its health problems will become the general picture to be worked upon); 2. developing countries - the scarce financial and human resources cause the local-level to adopt what has been decided by the central level; and 3. developed countries - a variety of alternatives makes some of them adopt national-seale planning; others are just begining to use central mechanisms to coordinate planning; the remaining ones adopt local -, communitary - or institutional-level planning. The author notices a slow but firm evolution towards the use of legal, financial and technical instruments in the development and implementation of health plans as part of national development plans. The weak point of health planning is the unbalance between the growing demand for qualified human resources and the educational system's production capacity. Therefore, health planning has to consider that the needs, types and characteristics of such personnel vary according to the involved situation. This requires the interdisciplinary action of administrators, health planners and educators, especially in the biomedical sciences. In this respect, the author mentions the recommendation issued by the World Health Assembly in 1971, suggesting the creation of "health manpower surveillance" offices in every country. They should be positioned close to top health-administrations; their job should be to study the problems related to human resources for health, propose relevant measures and follow up their implementation. Agreements have been signed everywhere between universities and health institutions as a result of that recommendation. They will allow the use of predefined health areas and/or regions for learning and teaching purposes on many levels. The milestone of the changes that are now taking place on the Brazilian national level was the issuance of a document on Medical education and health institutions, produced in 1974 by the Medical Education Committee of the Ministry of Education and Culture. At that time, an interministerial group was created by lhe Ministry of Health to study the situation and perspectives of human resources for health, as well as to propose a plan, of action to be incorporated in the II PND (National Development Plan). Three large areas composing a program for strategical training of health personnel were proposed by the group and became the subject of an agreement between the Ministry of Health, the Ministry of Education and Culture and the Pan-American Health Organization. One of these are as is to especially develop projects aiming at the creation of teaching and health attention areas. These will allow the testing of models towards the regionalization of health services, as well as the articulation of health manpower education and training with the health services delivery system.
