Analyzing a national health surveillance strategy to reduce mother-to-child transmission of syphilis: The case of Brazilian investigation committees.

Objectives: This study aimed to analyze the relevance of investigation committees in eliminating mother-to-child transmission of syphilis in Brazil. Methods: Questionnaires and interviews were conducted with health managers of 25 Brazilian Federative Units and Brazil's Federal District. Data were analyzed using Bardin's content analysis technique and subsequently compared with the global prescriptions for syphilis response of the Pan American Health Organization, World Health Organization, and recent research publications examining the course of syphilis in Brazil, in Brazilian regions, and globally. Results: While the investigation committees drew on the successful experience of those in reducing maternal mortality, which helped the country achieve the Millennium Development Goals, they are not demonstrated to be sufficient for preventing mother-to-child transmission of syphilis. The committees' systematic and bureaucratic agenda has not been efficient in managing avoidable factors for syphilis, nor do they operate in the scope of the integration of surveillance and care actions, as recommended by the health policy. Conclusion: The committees' model needs to be reviewed in the context of Brazil's National Health System. The research process should be rescaled in order to remain a cornerstone for the induction of health policy that integrates surveillance and healthcare across Brazilian Federative Units. The advancement toward an automated case management model becomes relevant for the country to meet global commitments to eliminate congenital syphilis transmission and achieve the goals outlined in the 2030 Agenda.

Effectiveness of a course on family health in the knowledge of doctors of the Mais Médicos program.

OBJECTIVE: The aim of this study was to analyze the effectiveness of the distance education course in family health in the knowledge of physicians from the Mais Médicos program. METHOD: This is a quantitative, quasi-experimental study, without a pretest and posttest control group, carried out from August 2019 to September 2021. In all modules, physicians responded to a pretest and posttest to verify their knowledge of the subject. RESULTS: There was a statistically significant difference in all modules with higher average scores in the posttests; the modules with the greatest emphasis are child health care: growth and development; approach to cancer in primary health care; and family health strategy and territorialization. CONCLUSION: The effectiveness of the distance education course was verified, as evidenced by the significant improvement of knowledge in all the modules studied.

Effectiveness of a course on family health in the knowledge of doctors of the Mais Médicos program

SUMMARY OBJECTIVE: The aim of this study was to analyze the effectiveness of the distance education course in family health in the knowledge of physicians from the Mais Médicos program. METHOD: This is a quantitative, quasi-experimental study, without a pretest and posttest control group, carried out from August 2019 to September 2021. In all modules, physicians responded to a pretest and posttest to verify their knowledge of the subject. RESULTS: There was a statistically significant difference in all modules with higher average scores in the posttests; the modules with the greatest emphasis are child health care: growth and development; approach to cancer in primary health care; and family health strategy and territorialization. CONCLUSION: The effectiveness of the distance education course was verified, as evidenced by the significant improvement of knowledge in all the modules studied.

The relevance a technology ecosystem in the Brazilian National Health Service's Covid-19 response: the case of Rio Grande do Norte, Brazil. / A relevância de um ecossistema tecnológico no enfrentamento à Covid-19 no Sistema Único de Saúde: o caso do Rio Grande do Norte, Brasil.

Technological advances play an undeniable role in strengthening health systems. With regard to digital technologies, information systems and the analysis of health data are playing a growing role in health surveillance and preparing for and responding to disease outbreaks, the theme addressed by this article within the context of the Covid-19 pandemic in the State of Rio Grande do Norte. This study departs from the assumption that digital health interventions can increase Covid-19 response capacity. We developed a technology ecosystem that integrates different information systems to meet the needs outlined in international regulations governing the response to the pandemic. In addition to the main elements of the ecosystem, this article describes the application of this instrument by different institutional actors. The main decision making tool used in the state government's Covid-19 response, the ecosystem is a model for digital health interventions in Brazil's national health service. This experience in Rio Grande do Norte brings together elements that can contribute to studies investigating the resilience of health systems and analyzing health policies in emergency situations.

É inegável o papel dos avanços tecnológicos para o fortalecimento da saúde. No tocante às tecnologias digitais, trata do uso crescente dos sistemas de informação e análise de dados em saúde nas ações de preparo, vigilância e resposta a surtos epidemiológicos, tema abordado neste artigo no contexto da pandemia provocada pelo vírus Sars-CoV-2 no estado do Rio Grande do Norte. Este estudo parte do pressuposto de que é possível potencializar a gestão da resposta à Covid-19 por meio da saúde digital. Assim, a pesquisa desenvolveu um Ecossistema tecnológico que integra diferentes sistemas de informação para atender as necessidades previstas nas normativas internacionais frente à pandemia. Este artigo descreve, além do Ecossistema e sua estrutura, um conjunto de análises sobre a aplicação desse dispositivo por diversos atores institucionais. O Ecossistema foi a principal ferramenta em uso no estado para o processo decisório em resposta à Covid-19, sendo um modelo para a intervenção de saúde digital no Sistema Único de Saúde. A experiência do Rio Grande do Norte reúne, portanto, elementos que contribuem para os estudos sobre resiliência de sistemas e análises de políticas públicas em saúde em situações de emergência.

A relevância de um ecossistema tecnológico no enfrentamento à Covid-19 no Sistema Único de Saúde: o caso do Rio Grande do Norte, Brasil / The relevance a technology ecosystem in the Brazilian National Health Service's Covid-19 response: the case of Rio Grande do Norte, Brazil

Resumo É inegável o papel dos avanços tecnológicos para o fortalecimento da saúde. No tocante às tecnologias digitais, trata do uso crescente dos sistemas de informação e análise de dados em saúde nas ações de preparo, vigilância e resposta a surtos epidemiológicos, tema abordado neste artigo no contexto da pandemia provocada pelo vírus Sars-CoV-2 no estado do Rio Grande do Norte. Este estudo parte do pressuposto de que é possível potencializar a gestão da resposta à Covid-19 por meio da saúde digital. Assim, a pesquisa desenvolveu um Ecossistema tecnológico que integra diferentes sistemas de informação para atender as necessidades previstas nas normativas internacionais frente à pandemia. Este artigo descreve, além do Ecossistema e sua estrutura, um conjunto de análises sobre a aplicação desse dispositivo por diversos atores institucionais. O Ecossistema foi a principal ferramenta em uso no estado para o processo decisório em resposta à Covid-19, sendo um modelo para a intervenção de saúde digital no Sistema Único de Saúde. A experiência do Rio Grande do Norte reúne, portanto, elementos que contribuem para os estudos sobre resiliência de sistemas e análises de políticas públicas em saúde em situações de emergência.

Abstract Technological advances play an undeniable role in strengthening health systems. With regard to digital technologies, information systems and the analysis of health data are playing a growing role in health surveillance and preparing for and responding to disease outbreaks, the theme addressed by this article within the context of the Covid-19 pandemic in the State of Rio Grande do Norte. This study departs from the assumption that digital health interventions can increase Covid-19 response capacity. We developed a technology ecosystem that integrates different information systems to meet the needs outlined in international regulations governing the response to the pandemic. In addition to the main elements of the ecosystem, this article describes the application of this instrument by different institutional actors. The main decision making tool used in the state government's Covid-19 response, the ecosystem is a model for digital health interventions in Brazil's national health service. This experience in Rio Grande do Norte brings together elements that can contribute to studies investigating the resilience of health systems and analyzing health policies in emergency situations.

Health production: analysis of doctors' health actions in the More Doctors program.

OBJECTIVE Analyze the health actions carried out by the Cuban cooperated physicians and their relationship with socioeconomic characteristics of the municipalities, contained in the first supervision visit report, in 2015. METHODS This is a quantitative research that used secondary data from the reports of the 1st supervision visit of the "More Doctors Program". The dependent variables were the health actions, and the independent variables were the type of municipality, Human Development Index (HDI), Investment in Primary Health Care (PHC), health center coverage, rural population, and total population. Multiple correspondence analysis was used to identify the latent variable, related to the profile of the professional with respect to the actions/procedures carried out to which the characteristics of the municipalities were associated through frequency analysis. RESULTS Three profiles of professionals were obtained, who have their practices associated with the professional training, consolidating as a determining factor for carrying out actions compatible with the actual needs of the population. Such findings were associated with the socioeconomic variables, with emphasis on funding, health center infrastructure, and coverage. CONCLUSIONS From the observed results, we suggest strategies to expand the scope of the practices carried out in Primary Health Care, from the perspective of training and continuing education of health professionals, and the focus on the everyday life of the service being of paramount importance.

More Doctors Program: health work process and socioeconomic indicators.

OBJECTIVE: To analyze the working process of the professionals of the More Doctors Program and its relationship with socioeconomic indicators. It is a quantitative study, in which secondary data from supervision reports of PMM were used. The dependent variable was the quality of work processes in Primary Care facilities, and the independent ones were the type of municipality, education, Gini index, Primary Health Care investments, and health facilities coverage. Data were analyzed with multiple modeling based on Poisson regression with robust variance. RESULTS: 16,000 doctors within 3816 municipalities were analyzed. Variables related to the working process the remained significant in the final model were the investments in Primary Health Care and the health facilities coverage. The results expressed the equity principle, as those municipalities with more vulnerable conditions and with higher coverage are prone to perform more activities in their working process. CONCLUSIONS: The implementation of the More Doctors Program and hence the provision of doctors in deprived regions promoted the consolidation of three main aspects, namely the health working process, primary health care and equity, making it possible to carry out a health working process focused on PHC. This implies performing a greater number of activities that are inherent to PHC, which were not carried out due to the absence of doctors. The More Doctors Program fulfills its role in the combat of inequalities, particularly regarding more vulnerable municipalities.

More Doctors Program: health work process and socioeconomic indicators

SUMMARY OBJECTIVE To analyze the working process of the professionals of the More Doctors Program and its relationship with socioeconomic indicators. It is a quantitative study, in which secondary data from supervision reports of PMM were used. The dependent variable was the quality of work processes in Primary Care facilities, and the independent ones were the type of municipality, education, Gini index, Primary Health Care investments, and health facilities coverage. Data were analyzed with multiple modeling based on Poisson regression with robust variance. RESULTS 16,000 doctors within 3816 municipalities were analyzed. Variables related to the working process the remained significant in the final model were the investments in Primary Health Care and the health facilities coverage. The results expressed the equity principle, as those municipalities with more vulnerable conditions and with higher coverage are prone to perform more activities in their working process. CONCLUSIONS The implementation of the More Doctors Program and hence the provision of doctors in deprived regions promoted the consolidation of three main aspects, namely the health working process, primary health care and equity, making it possible to carry out a health working process focused on PHC. This implies performing a greater number of activities that are inherent to PHC, which were not carried out due to the absence of doctors. The More Doctors Program fulfills its role in the combat of inequalities, particularly regarding more vulnerable municipalities.

RESUMO OBJETIVO Analisar a relação entre o processo de trabalho dos médicos do Programa Mais Médicos (PMM) no Brasil e alguns indicadores socioeconômicos no período de 2015. MÉTODO Trata-se de uma pesquisa quantitativa que utilizou dados secundários dos relatórios de supervisão do PMM. A variável dependente foi a qualidade do processo de trabalho e as variáveis independentes foram o tipo de município, expectativa de anos de estudo, índice de Gini, investimento em Atenção Primária à Saúde (APS) e cobertura de unidades de saúde. Na análise dos dados foi realizada a modelagem múltipla por regressão de Poisson com variância robusta. RESULTADOS Foram analisados dados de 3.816 municípios, abrangendo 1.537 profissionais. Destacam-se como variáveis socioeconômicas estratégicas e que explicam o modelo do processo de trabalho do PMM: o investimento e a cobertura da atenção básica. Tornou-se bastante evidente o princípio da equidade, pois os municípios mais vulneráveis e de maior cobertura realizam maior número de atividades em seu processo de trabalho. CONCLUSÕES Com a implantação do PMM e o provimento de médicos em regiões desassistidas ocorreu a consolidação do tripé processo de trabalho em saúde, atenção básica e equidade, tornando possível a efetivação de um processo de trabalho focado na APS. Isso implica a realização de maior número de atividades inerentes à APS, as quais não eram realizadas em função da ausência do profissional médico. Nesse sentido, o programa cumpre o seu papel de combater as desigualdades em municípios mais vulneráveis.

Health production: analysis of doctors health actions in the More Doctors program

SUMMARY OBJECTIVE Analyze the health actions carried out by the Cuban cooperated physicians and their relationship with socioeconomic characteristics of the municipalities, contained in the first supervision visit report, in 2015. METHODS This is a quantitative research that used secondary data from the reports of the 1st supervision visit of the "More Doctors Program". The dependent variables were the health actions, and the independent variables were the type of municipality, Human Development Index (HDI), Investment in Primary Health Care (PHC), health center coverage, rural population, and total population. Multiple correspondence analysis was used to identify the latent variable, related to the profile of the professional with respect to the actions/procedures carried out to which the characteristics of the municipalities were associated through frequency analysis. RESULTS Three profiles of professionals were obtained, who have their practices associated with the professional training, consolidating as a determining factor for carrying out actions compatible with the actual needs of the population. Such findings were associated with the socioeconomic variables, with emphasis on funding, health center infrastructure, and coverage. CONCLUSIONS From the observed results, we suggest strategies to expand the scope of the practices carried out in Primary Health Care, from the perspective of training and continuing education of health professionals, and the focus on the everyday life of the service being of paramount importance.

RESUMO OBJETIVO Analisar as ações em saúde realizadas pelos médicos cooperados cubanos e sua relação com características socioeconômicas dos municípios, contidas no primeiro relatório de visita de supervisão, em 2015. MÉTODOS Pesquisa quantitativa que utilizou dados secundários dos relatórios da primeira visita de supervisão do Programa Mais Médicos. A variável dependente foram as ações em saúde e as variáveis independentes foram o tipo de município e infraestrutura. Utilizou-se a análise de correspondência múltipla para a identificação da variável latente, relativa ao perfil do profissional com relação às ações realizadas, a qual foi associada às características dos municípios por intermédio de análise de frequência. RESULTADOS Foram obtidos três perfis de profissionais, que possuem suas práticas associadas à formação profissional, consolidando-se como um fator determinante para efetivação de ações condizentes com as reais necessidades da população. Tais achados estiveram associados às variáveis socioeconômicas, tendo como destaques a infraestrutura das unidades e o tipo de município. CONCLUSÕES A partir dos resultados observados, sugerem-se estratégias para ampliar o escopo das práticas desenvolvidas na APS, na perspectiva de formação e educação permanente de profissionais de saúde, sendo fundamental a ênfase no cotidiano do serviço.

A pessoa idosa domiciliada sob distanciamento social: possibilidades de enfrentamento à covid-19 / Older adults living under social distancing: possibilities for tackling Covid-19

Reflete sobre a contribuição da Atenção Primária à Saúde na concretização da estratégia de proteção dos idosos em isolamento social no contexto do seu domicílio e na vigilância e monitoramento das ILPI (Instituição de Longa Permanência para Idosos), neste momento da pandemia do novo coronavirus . Recomenda ações para os cuidados em saúde na atenção primária no Brasil numa perspectiva de um trabalho articulado e integrado que garanta a proteção às pessoas idosas em todos os locais de moradia, inclusive para aquelas em situação de maior vulnerabilidade, como os residentes em instituições de longa permanência, comunidades, os de baixa renda, moradores de rua, refugiados e nômades. Sugere a implementação de política pública emergencial, que reduza os internamentos, necessidade de terapia intensiva e, principalmente, os óbitos. Propõe uma ferramenta de monitoramento dos cuidados essenciais domiciliares à saúde das pessoas idosas que possibilite mapeamento das fortalezas e fragilidades na gestão do cuidado do idoso e será um guia para as ações da APS.

It reflects on the contribution of Primary Health Care to the implementation of the strategy to protect the elderly under social distancing in the context of their homes and in the surveillance and monitoring of the LTCFs (Long-Term Care Facility for the Elderly), at this time of the new coronavirus pandemic. Recommends actions for health care in primary care in Brazil from the perspective of articulated and integrated work that guarantees the protection of elderly people in all places of residence, including those in situations of greater vulnerability, such as residents of long-term care institutions. permanence, communities, the low-income, homeless, refugees and nomads. Suggests the implementation of emergency public policy, which reduces hospitalizations, the need for intensive care and, especially, deaths. It proposes a tool for monitoring essential home care for the health of the elderly that enables mapping of strengths and weaknesses in the management of elderly care and will be a guide for PHC actions.

A Percepção do Supervisor do Provab sobre a Fixação do Médico na Atenção Primária à Saúde / The Perception of the Provab Supervisor on the Retention of Doctors in Primary Health Care

RESUMO Atrair profissionais médicos para o trabalho na Atenção Primária em Saúde (APS) tem sido um desafio permanente para o Sistema Único de Saúde. A impossibilidade de educação continuada e permanente configura-se como um dos principais fatores impeditivos do provimento e da fixação de médicos na APS. O Programa de Valorização do profissional da Atenção Básica (PROVAB) trouxe como pressuposto o incentivo à Educação Permanente em Saúde (EPS) com ênfase na interação ensino-serviço-comunidade (IESC), contando com a presença de uma supervisão pedagógica composta por médicos capacitados para tal fim. O objetivo do presente estudo foi analisar os motivos que levaram um grupo de médicos de Natal, Rio Grande do Norte, participantes do Programa de Valorização do Profissional da Atenção Básica (PROVAB), a permanecerem na Atenção Primária em Saúde por meio da precedência ao Programa Mais Médicos (PMM), a partir da percepção de seus supervisores. Para tanto, foi realizado estudo qualitativo por meio da técnica de grupo focal com sete supervisores médicos do PROVAB e do PMM. A análise de conteúdo identificou cinco categorias de análises temáticas: Contexto político do início dos programas; Perfil do supervisor pedagógico; Perfil do médico que fez precedência do PROVAB para o Programa Mais Médicos; Motivos de fixação do provabiano à APS; e Porque não escolher a APS para a vida? Evidenciou-se que o PROVAB funcionou como uma estratégia inicial de enfrentamento aos desafios de se fixar médicos à APS em consonância à remodelação da formação médica. Apesar do contexto político desfavorável nos anos que se seguiram à implementação do PROVAB, houve uma sinergia entre a supervisão e os médicos que se empoderaram para desenvolverem suas atividades proporcionando condições para enfrentamento das condições desfavoráveis. A aproximação com o contexto do território e as competências adquiridas no programa acerca da Atenção Primária em Saúde com desenvolvimento de vínculo com a comunidade funcionaram como fatores de estímulo para a permanência do médico na Atenção Primária em Saúde traduzindo-se na mudança do perfil do profissional que assimilou e adquiriu o componente social de trabalhar em áreas de grande vulnerabilidade. Esse movimento deve favorecer as mudanças previstas nos cursos de graduação em Medicina, evitando um retrocesso que tange aos vazios assistenciais, animando a luta que se constitui na busca por um Brasil em que o acesso universal à saúde e a um profissional médico não seja um privilégio de poucos, mas o direito garantido de todos.

ABSTRACT Attracting medical professionals to work in Primary Health Care (PHC) has been an ongoing challenge for Brazil's Unified Health System (SUS). The impossibility of a continuous and ongoing education is one of the main factors hindering the provision and retention of doctors in PHC. One of the basic premises of the Program to Value Primary Healthcare Professionals (PROVAB) was to encourage Continuous Education in Health (EPS), emphasizing the interactions between teaching, service and the local community (IESC), with the presence of pedagogical supervision by doctors trained for this purpose. The goal of this study was to analyze, based on the perceptions of their supervisors, the factors that led a group of doctors from Natal, in the State of Rio Grande do Norte, participants in the PROVAB, to stay in Primary Health care (PHC), giving it precedence over the More Doctors Program (PMM). A qualitative study was carried out, using the focal group technique with seven medical supervisors of the PROVAB and PMM. The content analysis identified five thematic categories: The political context at the start of the programs; the profile of the pedagogical supervisors; the profile of the doctors who prioritized PROVAB over the More Doctors Program (PMM); the reasons that led to the retention of PROVAB doctors in the PHC; and why not choose PHC for life? It was demonstrated that the PROVAB worked as an initial strategy to face the challenges of retraining doctors in PHC, in line with the reforms in Medical Education. Despite the difficult political environment in the years that followed the implementation of the PROVAB, there was a synergy between supervision and doctors, who were empowered to carry out their activities, providing conditions to combat unfavorable situations. Strengthening ties with the territorial context, and the skills acquired during the program, related to Primary Health Care (PHC), through the development of links with the local community, acted as factors of stimulus for the retention of doctors in PHC. This led to a change in doctors' profiles, as they assimilated and acquired the social aspect to work of working in vulnerable areas. This movement should favor the changes predicted in Medical Schools, preventing a regression when it comes to gaps in the health care system. It also encourages the fight for a better country, in which universal access to health and to a medical professional may be not only a privilege of a few, but a guaranteed right for all.

The retention of physicians to primary health care in Brazil: motivation and limitations from a qualitative perspective.

BACKGROUND: This study analyzed the reasons why physicians migrated from the Program to Value Primary Healthcare Professionals (PROVAB) to the Mais Médicos (More doctors) Program in 2015, opting to become physicians of the Primary Health Care. METHODS: The focal group techniques were used consisting of six doctors that made the option to remain in the PHC, being the results analyzed through content monitoring as well as the respective categories, which were identified as theme analysis. RESULTS: It was evidenced that the physician's retention on primary care has a strong relationship with the acquisition of knowledge that is consistent with the context and the health needs of the population. Thus, appropriate competencies for the management of the different biopsychosocial characteristics of the territories, in consonance with abilities that use the communication centered on the patient as well as on the interdisciplinarity, producing health projects that include the uniqueness of the people, essential factor for the daily confrontation of the work of these physicians, strengthened by the training component of the program. Personal factors related to the empathetic profile with this level of care and the possibility of continuous improvement, besides the factors related to the adequate infrastructure and organizational climate with guaranteed salary in keeping with the complexity of Primary Care, positively influenced the permanence of these professionals and were drivers of changes in healthcare and management in the health units they were related to. The bond created with the team and patients was a great satisfaction factor for the professional, being identified by them as a possibility to make a difference in the treatment process of patients, strengthening the promotion of a healthier life through health education. CONCLUSIONS: PROVAB had an unparalleled contribution to the qualification of care in Primary Health Care, contributing to the birth of a new logic of medical training in Brazil. Its effective cooperation with the consolidation of the Mais Médicos Program, still in progress, is a great movement of resistance to the disarticulation and deconstruction of Unified Health System (SUS) which is in charge of public health in Brazil.

Fixação do médico na atenção primária à saúde: uma perspectiva a partir do Programa de Valorização do Profissional da Atenção Básica / Physician retention in primary health care: a perspective from the Primary Care Professional Appreciation Program

A presente pesquisa analisou fatores que levaram médicos a migrarem do Programa de Valorização do Profissional da Atenção Básica (PROVAB) para o Programa Mais Médicos para o Brasil (PMM), optando por continuar como médico da Atenção Primária à Saúde (APS), assim como objetivou analisar a inserção do Médico na Atenção Primária à Saúde a partir do PROVAB e da visão dos usuários, gestores, supervisores acadêmicos e do próprio médico. Utilizou uma metodologia que contemplou aspectos qualitativos e quantitativos de forma a potencializar o diagnóstico e se aproximar do fenômeno pesquisado. Foram utilizados dados secundários provenientes do Relatório de Primeiras Impressões (RPI), preenchidos pelos médicos ao chegar ao PROVAB, sendo utilizado para a análise desses dados o software Iramuteq. Para análise dos dados qualitativos coletados a partir de seis grupos focais, foi utilizada a técnica de análise de conteúdo, identificando-se as respectivas categorias de análises temáticas. Ao chegar ao PROVAB o médico identificou que o acesso do usuário era dificultado por uma organização de agenda que priorizava a livre demanda e atendimentos por tipo de doença e ciclos de vida, com prejuízo na identificação, escuta e acolhimento das necessidades de saúde dos usuários. Havia dificuldades relacionadas à falta de material, a condições inadequadas de infraestrutura e a uma rotina de sobrecarga dos trabalhadores de saúde. Na formação desse médico constatou-se uma lacuna na graduação relacionada à APS, tendo o ano de formação do PROVAB se configurado como um agregador dessas competências, oportunizando vivência profissional com autonomia, capacidade de trabalhar em equipe e de atuar na educação permanente nos seus territórios qualificando o cuidado na APS. Foi identificada nos médicos uma postura diferenciada com relação à escuta e ao acompanhamento dos usuários com forte vínculo e comprometimento com o cuidado no território. Foi constatado que o acesso às ações e serviços de saúde sofre influência da presença do médico e do modelo de atenção com ênfase nas necessidades de saúde dos usuários e na promoção e educação em saúde a partir do acolhimento e acesso humanizado, ampliando a capacidade de resolutividade e a integralidade do cuidado. A gestão das Unidades Básicas de Saúde (Diretores de Unidade) foram considerados facilitadores desse processo de qualificação desencadeado pelo programa, na medida em que foram observados aspectos como sensibilidade, flexibilidade e busca pela qualificação permanente, as quais permitiram a promoção de um trabalho vivo em ato, produzido pela tessitura de saberes e fazeres dos atores sociais envolvidos na equipe de trabalho da Atenção Primária a Saúde. Verifica-se por fim, que apesar de todos os desafios enfrentados pelo PROVAB em todo o seu percurso, o mesmo teve uma contribuição ímpar para a qualificação do cuidado na APS, contribuindo para o nascimento de uma nova lógica de formação médica no Brasil. Sua efetiva contribuição com a consolidação do PMM, este ainda em construção, configura-se como um grande movimento de resistência à desarticulação e desconstrução do SUS que acontece diariamente no nosso país (AU).

The present study not only analyzed factors that led physicians to migrate from the Program to Value Primary Healthcare Professionals (PROVAB) to the More Physicians for Brazil Project (PMM), opting to continue as Primary Health Care (APS), but also aimed to analyze the insertion of the Doctor in Primary Health Care from PROVAB and the vision of users, managers, academic supervisors and the doctor himself.. It used a mixed methodology when contemplating qualitative and quantitative aspects in order to potentialize the diagnosis and to approach the researched phenomenon. Secondary data from the First Impressions Report (RPI) were used by physicians when they arrived at PROVAB. The Iramuteq software was used to analyze these data. To analyze the qualitative data collected from six focus groups, the content analysis technique was used, identifying the respective categories of thematic analyzes. Upon arriving at PROVAB, the doctor identified that the access of the user was hampered by an agenda organization that prioritized free demand and care by type of illness and life cycles, with a loss in the identification, listening and reception of the users' health needs. There were difficulties related to lack of material, inadequate infrastructure conditions and a routine of overloading health workers. In the training of these doctors there was a gap in the graduation course related to the APS, and the year of formation at PROVAB was configured as an aggregator of these competences, providing professional experience with autonomy, ability to work as a team and to work in permanent education in their territories qualifying care in APS. The physicians identified a differentiated posture regarding the listening and follow-up of users with a strong bond and commitment to care in the territory. It was verified that the access to health services and actions is influenced by the presence of the physician and the model of attention with emphasis on the health needs of the users and in the health promotion and education from the reception and humanized access, increasing the resolving capacity and the completeness of care. The management was a facilitator of this qualification process triggered by the program, and aspects such as sensitivity, flexibility and search for permanent qualification were observed, which allowed the promotion of a live work in an act, produced by the knowledge and know-how social workers involved in the Primary Health Care workforce. Finally, despite all the challenges faced by PROVAB throughout its course, it has had a unique contribution to the qualification of APS, contributing to the birth of a new logic of medical education in Brazil. Its effective contribution to the consolidation of the PMM, which is still under construction, is a major movement of resistance to the disarticulation and deconstruction of the SUS that happens daily in our country (AU).

Análise Espacial da Gravidez na Adolescência no Rio Grande do Norte / Spatial Analysis of Teenage Pregnancy in Rio Grande do Norte

A gravidez na adolescência está comumente associada a condições de vida desfavoráveis, em que múltiplos fatores podem estar envolvidos com o seu acontecimento. Desta forma entende-se que para se propor estratégias efetivas de enfrentamento desta problemática no estado do Rio Grande do Norte (RN), necessário se faz, a incorporação do espaço e dos fatores demográficos, sociais e econômicos como determinantes deste processo. Neste sentido, realizou-se um estudo ecológico, com o objetivo de analisar a distribuição espacial da gravidez na adolescência e sua correlação com esses fatores no período de 2001 a 2010. Para tanto, utilizou-se o Sistema de Informações sobre Nascidos Vivos (SINASC) como fonte de dados, em relação aos nascimentos cujas mães eram adolescentes neste período e adotou-se como unidades de análise os municípios do estado. Para o estudo foi considerada como variável desfecho a proporção de nascidos vivos de mães adolescentes e como variáveis independentes contextuais aquelas relacionadas com fatores sócio-demográficos, econômicas, de mercado de trabalho, educacionais e relacionadas ao acesso ao serviço e à assistência social. Foi feita a análise exploratória da variável dependente e das variáveis independentes e construídos mapas temáticos utilizando o SIG terraview 4.1.0. Também foi calculada a autocorrelação espacial para todas as variáveis e com o programa estatístico GeoDA, as variáveis foram submetidas a uma análise bivariada. Como resultados mais importantes foi encontrado uma dependência espacial entre a gravidez na adolescência principalmente na faixa etária de 15 a 19 anos, nas regiões que abrangem municípios da 8ª e 3ª regiões de saúde do RN, regiões estas historicamente produtoras de petróleo, gás e sal marinho, que pela marca cartográfica que se repetiu na análise bivariada, foi chamada pelas autoras de "Região do Caranguejo da Gravidez na adolescência". Pelas análises realizadas concluiu-se que apesar desta região abranger alguns dos municípios de maior PIB per capita do estado, estas riquezas não são redistribuídas com a coletividade em geral, visto a gravidez na adolescência ter sido fortemente explicada pela pobreza, pela baixa qualidade de ensino e pelo acesso aos componentes da Estratégia Saúde da Família. (AU)

Teenage pregnancy is commonly linked to unfavorable living conditions, which multiple factors may involve and contribute to its existence. In that matter it is known that in order to propose effective strategies, aiming to face this problem in the state of Rio Grande do Norte (RN), the association of demographic and regional factors ­ as social and economic determinants of this process ­ becomes necessary. Thus an ecological study was done, aiming to analyze the spatial distribution of teenage pregnancy and its correlation with these factors in the period from 2001 to 2010. For this matter we used the Information System on Live Births (SINASC) as a source of data regarding not only the births whose mothers were teenagers during the pregnancy period but also it was adopted as a tool for analyzing the cities of the State. For the study the proportion of live births of teenage mothers' babies was considered the outcome variable and, as independent variable, those related to socio-demographic , economic , labor market , education and access related to services and social assistance. Exploratory analysis were made regarding both the independent and dependent variables and thematic maps were bulti using SIG terraView 4.1.0. The spatial autocorrelation for all variables and the statistical program GeoDa was also calculated; the variables were subjected to bivariate analysis. The most important results found were a spatial dependence among teenage pregnancy especially in the age group from 15 to 19 years old in the regions covering the municipalities of the 8th and 3rd regions of the State Infant Health, locals that historically produce oil, gas and sea salt ­which was cartographically branded as "Crab Region of Teen Pregnancy ". Through the analyzes it was concluded that, although this region covers some of the municipalities with the highest GDP per capita in the state, these riches are not redistributed to the community in general, as teenage pregnancy is strongly explained by poverty, low quality education and access to the components of the Family Health Strategy. (AU)