Processes and experiences of Portugal's international recruitment scheme of Colombian physicians: Did it work?

The Portuguese Ministry of Health performed five international recruitment rounds of Latin American physicians due to the need for physicians in certain geographic areas of the country and in some specialties, as a temporary solution to shortages. Among these recruitments is that of Colombian physicians in 2011 that was the largest of the five groups. This paper presents an evaluation of the international recruitment procedure of Colombian physicians based on the criteria of procedural outcomes and health system outcomes. The methodology used is qualitative, based on semi-structured interviews with key informants and Colombian physicians recruited in Portugal and also on documentary analysis of secondary sources. International recruitment of Colombian physicians coincided with a period of political change and severe economic crisis in Portugal that caused some problems in the course of this recruitment, mainly family reunification in the later group of Colombian physicians and non-compliance of the salary originally agreed upon. Furthermore, due to the continuous resignations of Colombian physicians throughout the 3-year contract, procedural outcomes and health system outcomes of this international recruitment were not fulfilled and therefore the expected results to meet the temporary needs for medical personnel in some areas of the country were not accomplished.

Características dos concursos para contratação de cirurgiões-dentistas na Estratégia Saúde da Família / Characteristics of exams for hiring dentists for the Family Health Strategy

O objetivo do presente estudo foi avaliar as características dos concursos públicos para contratação de cirurgiões-dentistas para a Estratégia Saúde da Família em municípios Brasileiros. Foi realizada análise documental de editais de concursos públicos ocorridos entre 2006 e 2014 no Brasil, com base nos seguintes critérios: macrorregião, conteúdo programático, salário, número de vagas e regime de contratação. De um total 765 editais de concursos, 42% eram para a região Sudeste, 24% Nordeste, 22% Sul, 7% Centro-Oeste e 5% Norte. A média de vagas ofertadas foi de 4,2 e de salário foi de R$ 2.458,01. Os conteúdos foram distribuídos em conhecimento específico (81%), língua portuguesa (71%), conhecimentos gerais (30%), saúde coletiva (14%) e outros (33%). Com relação às formas de contratação, 21% estavam relacionadas a regime de trabalho estatutário, 16% celetista, 4% processo seletivo de caráter temporário, 1% contrato temporário na ausência de processo seletivo público e 57% não especificaram. Os concursos públicos no período avaliado mostraram editais imprecisos, com ausência de informações importantes para a decisão segura em participar do processo seletivo. A maioria dos concursos foi realizada na região Sudeste, estado de Minas Gerais, com a exigência de conhecimentos específicos da área de atuação e língua portuguesa. Conteúdos de Saúde Coletiva e titulação foram exigidos apenas pela minoria. Faz-se necessário o direcionamento, principalmente em relação aos conhecimentos exigidos nas provas, para que seja contemplado o profissional com perfil e conhecimentos adequados para o trabalho na Estratégia de Saúde da Família (AU).

The aim of the present study was to evaluate the characteristics of public exams for hiring dental surgeons for the Family Health Strategy in Brazilian municipalities. Documentation of public tenders issued in Brazil between 2006 and 2014 was analyzed, based on the following criteria: macro region, programmatic content, salary, number of vacancies, and hiring system. Of a total number if 765 tenders for applications to do the exam, 42% were for the Southeastern region; 24% for the Northeastern; 22% for the Southern; 7% for the Midwestern, and 5% for the Northern region. The mean number of vacancies offered was 4.2, and the mean salary was R$ 2.458,01 (Brazilian Reais). The contents of the exams were distributed into the categories of specific knowledge (81%), Portuguese language (71%), general knowledge (30%), collective health (14%) and others (33%). Relative to the forms of hiring, 21% were related to the statutory work regime, 16% were contracted under the laws for employees which govern the private sector (consolidated labor law), 4% selection process of a temporary nature, 1% temporary hiring in the absence of the public selection process and 57% did not specify the type of contract. The public exams in the period evaluated showed imprecise tender documents, with the absence of important information for making a secure decision to participate in the selection process. The majority of the exams were held in the Southeastern region, and state of Minas Gerais, with the demand for specific knowledge of the area of work and Portuguese language. Contents relative to Collective Health and public titles were demanded only by the minority of tenders. It is necessary for tenders to be more specific, particularly with regard to the knowledge demanded in the exams, so that the professional with the adequate profile and knowledge will be hired to work in the Family Health Strategy (AU).

Coerência entre editais de concurso público para professores e Diretrizes Curriculares dos cursos de Odontologia / Consistency between public position announcements for teachers and Curricular Guidelines for Dentistry courses

O presente estudo tem como objetivo traçar o perfil dos editais para seleção de professores de cursos de Odontologia em instituições públicas e analisar a coerência entre esses processos seletivos com as Diretrizes Curriculares Nacionais (DCN). A pesquisa foi desenvolvida utilizando os editais de concurso de universidades públicas no período de 2009 a 2014, com conceito 5 no Exame Nacional de Desempenho dos Estudantes (ENADE). Os resultados demonstram que a maioria dos processos seletivos é desenvolvida em quatro etapas: prova escrita, prova didática, defesa de memorial e análise de currículo. O perfil do processo seletivo encontrado remete à repetição de modelos tradicionais de ensino, com excessiva valorização da especialidade e fragmentação dos conhecimentos em disciplinas, não demonstrando coerência entre o que se recomenda nas DCN e os editais analisados nesse estudo. Para que o perfil dos egressos esteja em consonância com o preconizado pelas DCN, um desafio a ser enfrentado é pensar maneiras de reformular o processo seletivo para professores de Odontologia, assim como investir em processos de desenvolvimento docente permanente (AU).

The present study aims to draw the profile of position announcements for selecting Dental School teachers in federal public institutions and to analyze the consistency between these selective processes and Brazilian National Curriculum Guidelines (DCN). The research was conducted using data from schools that reached grade 5 in National Exam of Student Performance (ENADE) in the 2009-2014 assessment. The results showed that most selection processes are developed in four stages: written test, teaching test, memorial and curriculum analysis. The profile of the selective process found repeats the traditional teaching models, with excessive fragmentation of knowledge and specialization into disciplines. The position announcements are not consistent with the DCN's recommendations. A challenge to be faced in order to reach the graduates profile in line with DCN is to reshape the selection process for dental teachers, as well as invest in permanent teacher development processes (AU).

Assessment of human resources for health programme implementation in 15 Latin American and Caribbean countries

Background: The health systems in the Americas region are characterized by fragmentation and segmentation, which constitute an important barrier to expanding coverage, achieving integrated primary health care, and reducing inefficiency and discontinuity of care. An assessment of the human resources for health (HRH) programmes that have been implemented at the country level was developed as part of the measurement of the 20 HRH regional goals for 2007­2015, adopted in 2007 by the Pan American Sanitary Conference (CSPA). Methods: The exercise was a combination of academic research and the development/application of an advocacy tool involving policy makers and stakeholders to influence the decision-making in the development, implementation, or change of HRH programmes while building evidence through a structured approach based on qualitative and quantitative information and the exchange and dissemination of best practices. Results: This paper covers the methodological challenges, as well as a summary of the main findings of the study, which included 15 countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama in the Central America, Dominican Republic in the Caribbean, Chile, Colombia, Ecuador and Peru in the Andean sub region, and Argentina, Paraguay, and Uruguay in the South Cone. Despite the different contexts, the results showed that the programmes evaluated faced common challenges, such as lack of political support and financial unsustainability. Conclusions: The evaluation process allowed the exchange and dissemination of practices, interventions, and programmes currently running in the region. A shared lesson was the importance of careful planning of the implementation of programmes and interventions. The similarities in the problems and challenges of HRH among the participating countries highlighted the need for a cooperation programme on the evaluation and assessment of implementation strategies in the Americas region.(AU)

Enfermeiros de um hospital universitário: evidências do processo de seleção / Nurses at a university hospital: evidence from the selection process / Enfermeros de un hospital universitario: evidencias del proceso de selección

O objetivo do estudo foi comparar as características dos enfermeiros de um hospital universitário, selecionados antes e depois do ano de 2004. Estudo descritivo, exploratório, realizado em um hospital universitário da região centro-oeste, com 81 enfermeiros que responderam a um questionário autoaplicável entre fevereiro e agosto de 2008. Evidenciou-se que a mudança do processo seletivo centralizado para o descentralizado não interferiu na qualidade do pessoal selecionado, destacando a qualificação profissional como um dos principais itens para se trabalhar em hospital universitário. O estudo propiciou o feedback para outros momentos de seleção no processo de gestão de pessoas em enfermagem e saúde.

The study compared the characteristics of nurses selected before and after 2004 at a university hospital. In this descriptive, exploratory study, conducted at a university hospital in Brazil’s Midwest region, 81 nurses answered a self-administered questionnaire between February and August 2008. It was found that the change from a centralized to a decentralized selection process did not affect the quality of the personnel selected, noting that professional qualification is one of the main requirements to work in a university hospital. The study fostered feedback for other selection process instances for people management in nursing and health care.

El estudio objetivó comparar las características de los enfermeros de un hospital universitario, seleccionados antes y después del año 2004. Estudio descriptivo, exploratorio, realizado en un hospital universitario, en la región del Medio-Oeste-Brasil, con 81 enfermeros que respondieron a un cuestionario autoaplicable entre febrero y agosto de 2008. Se señaló que el cambio del proceso de selección centralizada para una descentralizada no afectó la calidad del personal seleccionado, destacando la calificación como uno de los temas principales para trabajarse en un hospital universitario. El estudio proporcionó el feedback para otros momentos de selección en el proceso de gestión de personas en enfermería y salud.

[Incentives to attract and retain the health workforce in rural areas of Peru: a qualitative study]. / Incentivos para atraer y retener personal de salud de zonas rurales del Perú: un estudio cualitativo.

The study aimed to identify the main incentives for attracting and retaining health workers in rural and remote health facilities in Ayacucho, Peru. In-depth interviews were performed with 80 physicians, obstetricians, nurses, and nurse technicians in the poorest areas (20 per group), plus 11 health managers. Ayacucho lacks systematic policies for attracting and retaining human resources. The main incentives, in order of relevance, were higher wages, opportunities for further training, longer/permanent contracts, better infrastructure and medical equipment, and more staff. Interviewees also mentioned improved housing conditions and food, the opportunity to be closer to family, and recognition by the health system. Health workers and policymakers share perceptions on key incentives to encourage work in rural areas. However, there are also singularities to be considered when designing specific strategies. Public initiatives thus need to be monitored and evaluated closely in order to ensure the intended impact.

Incentivos para atraer y retener personal de salud de zonas rurales del Perú: un estudio cualitativo / Incentives to attract and retain the health workforce in rural areas of Peru: a qualitative study

El objetivo fue identificar incentivos de atracción y retención en zonas rurales y distantes de Ayacucho, Perú. Fueron realizadas entrevistas en profundidad con 80 médicos, enfermeras, obstetras y técnicos (20 por grupo) de las zonas más pobres y con 11 funcionarios. No existen políticas sistemáticas de atracción y retención de personal de salud en Ayacucho. Los principales incentivos, en orden de importancia, fueron mejoras salariales, oportunidades de formación y capacitación, estabilidad laboral y nombramiento, mejoras en infraestructura y equipos, e incremento del personal. Se mencionaron también mejoras en la vivienda y alimentación, mayor cercanía con la familia y reconocimiento por el sistema de salud. Existen coincidencias y singularidades entre los distintos grupos sobre los incentivos clave para estimular el trabajo rural, que deben considerarse al diseñar políticas públicas. Las iniciativas del Estado deben comprender procesos rigurosos de monitoreo y evaluación, para asegurar que las mismas tengan el impacto deseado.

The study aimed to identify the main incentives for attracting and retaining health workers in rural and remote health facilities in Ayacucho, Peru. In-depth interviews were performed with 80 physicians, obstetricians, nurses, and nurse technicians in the poorest areas (20 per group), plus 11 health managers. Ayacucho lacks systematic policies for attracting and retaining human resources. The main incentives, in order of relevance, were higher wages, opportunities for further training, longer/permanent contracts, better infrastructure and medical equipment, and more staff. Interviewees also mentioned improved housing conditions and food, the opportunity to be closer to family, and recognition by the health system. Health workers and policymakers share perceptions on key incentives to encourage work in rural areas. However, there are also singularities to be considered when designing specific strategies. Public initiatives thus need to be monitored and evaluated closely in order to ensure the intended impact.

Parâmetros para seleção de pessoal através de concurso público: o caso INCA / Parameters for personnel selection through open competition: the case INCA

Na administração pública brasileira a regulamentação em vigor para a realização do processo de ingresso de pessoal no serviço público prioriza os níveis de conhecimentos e habilidades dos candidatos, tradicionalmente avaliados através de provas escritas e prova de títulos, reforçando a dimensão acadêmica e cognitiva do processo.A avaliação dos aspectos relacionados às atitudes, a conduta pessoal e interpessoal dos futuros servidores não são considerados neste processo, que se baseia no modelo clássico weberiano, privilegiando os princípios da impessoalidade e da competência técnica. Especialmente, na perspectiva da gestão do trabalho na área de saúde, o resultado destes processos seletivos tende agregar a instituição, profissionais com dificuldades de adaptação às rotinas laborativas, produtividade aquém do desejado e com elevados índices de doenças profissionais que acabam por comprometer a qualidade da atenção prestada ao paciente. O objetivo deste trabalho foi, a partir da análise dos processos de seleção utilizados pelo INCA e instituições congêneres, identificar, procedimentos que pudessem contribuir para o aperfeiçoamento e para a melhoria da qualidade da seleção dos profissionais que ingressam nas instituições públicas de saúde, particularmente, nas de alta complexidade, através da incorporação no processo avaliativo de procedimentos que permitirão a análise de outras competências além das competências técnicas e de formação acadêmica...

An organized, comprehensive, and security-enabled strategic response to the Haiti earthquake: a description of pre-deployment readiness preparation and preliminary experience from an academic anesthesiology department with no preexisting international disaster response program.

BACKGROUND: On Tuesday, January 12, 2010 at 16:53 local time, a magnitude 7.0 M(w) earthquake struck Haiti. The global humanitarian attempt to respond was swift, but poor infrastructure and emergency preparedness limited many efforts. Rapid, successful deployment of emergency medical care teams was accomplished by organizations with experience in mass disaster casualty response. Well-intentioned, but unprepared, medical teams also responded. In this report, we describe the preparation and planning process used at an academic university department of anesthesiology with no preexisting international disaster response program, after a call from an American-based nongovernmental organization operating in Haiti requested medical support. The focus of this article is the pre-deployment readiness process, and is not a post-deployment report describing the medical care provided in Haiti. METHODS: A real-time qualitative assessment and systematic review of the Hospital of the University of Pennsylvania's communications and actions relevant to the Haiti earthquake were performed. Team meetings, conference calls, and electronic mail communication pertaining to planning, decision support, equipment procurement, and actions and steps up to the day of deployment were reviewed and abstracted. Timing of key events was compiled and a response timeline for this process was developed. Interviews with returning anesthesiology members were conducted. RESULTS: Four days after the Haiti earthquake, Partners in Health, a nonprofit, nongovernmental organization based in Boston, Massachusetts, with >20 years of experience providing medical care in Haiti contacted the University of Pennsylvania Health System to request medical team support. The departments of anesthesiology, surgery, orthopedics, and nursing responded to this request with a volunteer selection process, vaccination program, and systematic development of equipment lists. World Health Organization and Centers for Disease Control guidelines, the American Society of Anesthesiology Committee on Trauma and Emergency Preparedness, published articles, and in-country contacts were used to guide the preparatory process. CONCLUSION: An organized strategic response to medical needs after an international natural disaster emergency can be accomplished safely and effectively within 6 to 12 days by an academic anesthesiology department, with medical system support, in a center with no previously established response system. The value and timeliness of this response will be determined with further study. Institutions with limited experience in putting an emergency medical team into the field may be able to quickly do so when such efforts are executed in a systematic manner in coordination with a health care organization that already has support infrastructure at the site of the disaster.

Cuba answers the call for doctors.

Havana's Latin American Medical School takes passionate young people from developing countries and sends them home as doctors. It's all about driving health equity, writes Gail Reed. Now the challenge is to get medical societies to accept them.

Profesionalización de auxiliares de enfermería en América Latina / Professionalization of nursing auxiliaries in Latin America

La escasez de profesionales de enfermería tiene rasgos cuali-cuantativos que la definen como un problema prioritario a resolver dentro del campo de los recursos humanos en salud, siendo numerosos los estudios que evidencian que la falta de una dotación adecuada de enfermeras tiene importantes consecuencias para la salud de las poblaciones. Al histórico déficit de enfermeras y a su inapropiada distribución geográfica y en los servicios, se agrega actualmente la falta de incentivos para ingresar y permanecer en la profesión ocasionada por el deterioro de las condiciones laborales(AU)

[Revealing the nurses participation in the Brazilian Nurses Association-Cascavel region]. / Revelando a participação dos (as) enfermeiros (as) na Associação Brasileira de Enfermagem-regional Cascavel.

The objective of the present research is to identify the reasons for the scarce participation of nursing professionals in the Brazilian Association of Nursing (ABEn) and other professional associations. The data was collected from nurses in the city of Cascavel-Paraná and was analysed according to qualitative and quantitative methods. Results show that a small number of professionals take part in the events promoted by ABEn-Cascavel and that there is little interest in joining any professional association. 36.6%, of nurses interviewed showed interest in becoming members of ABEn. Thus, for these professionals ABEn should define strategies of inclusion. The data collected in this research, regarding the reasons for the participation of nurses in the association, has provided ABEN-Cascavel with information that can support its performance in the city, as well as help on the planning of new activities and policies such as the promotion of events and changes on the price of the tuition, which was pointed out as one of the main reasons for the scarce participation of nurses in the association.