Permanent Health Education - Canadian Public Health Association

Canadian Public Health Association
2011 Conference
Public Health in Canada: Innovative Partnership for Action
Education for Health Care Reform:
The Brazilian Case
Authors:
Fabiano Borges
Eduardo Siqueira
Cléa Garbin
Suzely Moimaz
Montreal Quebec - June 22nd, 2011
Education for Health Care Reform: The
Brazilian Case
Study made possible by a partnership of
UNESP
Sao
Montreal,
06/22/2011
Paulo State University
Araçatuba School of Dentistry
Dental Public Health Graduate Program
University of Massachusetts/ Lowell
School of Health and Environment
Community health and Sustainability
And by the support of CAPES Foundation,
Ministry of Education of Brazil
Grant 2343-10-0
Key Points
¾ Brazil’s Unified Health System (SUS) has its own assets for training
healthcare resources and conducting mass educational programs
for allied health personnel.
¾ An educational network was established, and embedded in four
domains of SUS: healthcare delivery, management, social
participation, and public policy.
¾ Beyond well-trained workers, the National Policy of Permanent
Health Education has become an important tool for the Brazilian
Healthcare Reform, as well as played a key role in developing
advocates of universal healthcare.
Objective
To develop critical analysis of the theoretical
framework – Permanent Health Education (PHE) – used to
guide the education of healthcare workers in the SUS
(Unified
Health
personnel training.
System),
focusing
on
allied
health
Methods
¾ Comprehensive literature review of peer-reviewed
journals, grey literature, government documents, and
books, from 1988 to 2010.
¾ The following databases were searched:
• PUBMED;
• SCIELO;
• BIREME;
• WEB OF SCIENCE;
• Brazilian Ministry of Health;
• Pan American Health Organization Library.
Study Question
What is the role of educational
programs
for
allied
health
personnel in engaging human
resources to support universal
healthcare systems?
Figure 1- Educational Meetings for
allied health personnel in Brazil’s
countryside
Unified Health System (SUS)
¾ Intense social participation has been a cornerstone of the SUS since the
grassroots movements that resulted in Brazilian healthcare system
reform in the 1970s and 1980s.
¾ The implementation of a universal healthcare system in Brazil began in
an unfavorable political and economic climate, which promoted a
neoliberal, private delivery of care rather than an universal approach.
¾ Brazil has profited from a strong and committed healthcare system
reform movement, including not only academics, policy makers, and
managers, but also health workers from all levels (allied health
personnel, support staff, nurses, and doctors), trade unionists, and
citizens.
Permanent Health Education (PHE)
¾ The PHE policy was formulated by the Pan American
Health Organization (PAHO) in the early 1990’s in Latin
America.
¾ The aim of this policy was to support healthcare reforms
in Latin America, providing tools to improve the quality
of healthcare delivery by increasing the skills of
healthcare workers.
¾ PHE started by assuming the incapability of traditional
educational models to shift older healthcare practices
toward universal healthcare in the Americas.
Permanent Health Education (PHE)
PHE consists of on-the-job learning, where learning and
teaching embrace the day-to-day activities of healthcare
facilities, building knowledge from the grassroots up.
How???
¾No Pedagogical Recipes.
¾Workers learn from and teach each other.
¾Workers take ownership of seeking changes in
healthcare delivery.
Permanent Health Education (PHE)
¾ PHE becomes reality by reflecting the day-to-day
practices inside the healthcare workplace, aiming at their
transformation and respecting the “library” of knowledge
that each and every worker has.
¾ PHE does not just focus on medical education, but also
on broader education programs for all majors in
healthcare professions, as well as all levels of training.
¾ The key principle of PHE lies in the educational network
embracing the entire healthcare system.
Permanent Health Education (PHE)
Pedagogical Strategy
Work‐Education Integration
Multi‐Professional Teaching and Learning
Reflexive Pedagogical Practices
Work as Methodological Principle
Learning goals based on jobs Learning based on non‐
traditional educational methods
Figure 2 Work -Education Integration Strategy
Permanent Health Education (PHE)
Table 1- Elements of the Work-Education Integration Strategy
Elements
Description
Students
Poorly trained healthcare workers who advocated for education and
training that allowed them to contribute to the development of the
healthcare system
Core Curricula
The curricula must be understood as a structure related to day-to-day
experiences, and their logic may not lose either the micro or macro
contexts of practice. The core curricula of education in healthcare
services should be equally comprehensive in political, technical, and
managerial features
Instructors
Instructors are healthcare professionals with college degrees who
work directly with patients, arrange and supervise the fieldwork, and
take charge of the training. They are mediators in the process of
building student knowledge
Figure 3- PHE training: workers train workers wherever they are
Permanent Health Education in
Brazil
¾ Emerged initially as Educational Projects-Programs in the 1980’s and
1990’s.
¾ Came about via the struggle of undertrained Allied Personnel (mainly
nursing assistants) who were already employed in healthcare services.
¾ Became a national public policy for human resources training in the
healthcare system through Decree 198 /2004.
¾ Updated through Decree 1996/2007, which empowered the SUS’s
Bipartite and Tripartite Management Committees.
¾ Set training programs for all levels of education in human resources in
healthcare.
Permanent Health Education in
Brazil
Table 2 – Features of Permanent Health Education in Brazil
Features of Brazilian National Policy of Permanent
Health Education
Grassroots-based planning Development of networks
and decision-making
Broad scale programs
Strong peer support
Reflexive educational
Peer training
practices
Collective esprit de corps
Organized within the SUS
among all healthcare
workers
Table 3- Programs Developed by PHE in Brazil for allied healthcare personnel
Programs
Description
Number of Workers Graduated/duration of program Allied Health Personnel Allied Personnel who 96,000 in 19 years (1981‐
Broad Scale Training attended the program 1989)
Program (LARGA ESCALA)
fulfilled broad tasks in the healthcare field, from management to health care team support
Nursing Staff Professional The program aimed at 319,518 in 09 years (2000 Training Project (PROFAE) qualifying nursing assis ‐ ‐2009)
tants who were required to have minimal education standards for employment in healthcare
Community Health Workers Training for Family Health Teams (PACS)
The training was designed 153,435 in 07 years for Community Health (2004‐now)
Workers so as to make them Community Health Technicians
Discussion
PHE Origins
¾PHE originated in the Latin American Social Medicine – known in
Brazil as Collective Health – Movement, and advocated for universal
health care in the Americas.
¾The Collective Health’s political and ideological views regarded health
not as an exclusively biological issue to be resolved by medical
services, but as a social and political issue to be addressed by the
state.
¾Latin American movements relied on the potential of healthcare
workers to become leaders of transformations in health care systems.
¾It was based on the ability of education to transform unfair healthcare
systems into affordable ones in the Americas.
Discussion
The state of the SUS today
¾Implementation of the SUS has been complicated by
state support for the private sector, the concentration of
healthcare services in more developed regions, and
chronic underfunding of the public healthcare infrastructure.
¾Despite these limitations, the SUS has managed to vastly
improve access to primary and emergency care, reach
universal coverage of vaccination and prenatal care, and
invest heavily in the expansion of human resources and
technology, including major efforts to produce the country’s
essential drugs.
Permanent Health Education
Student/ Worker
Instructor /Worker
Significant Changes
Collaborative practices, strengthening of healthcare services
Development of advocates who support healthcare system reforms
Universal Health Care System Domains
Health Care Delivery Social Participation
Health Policy
Management
Education for Health Care Reform
Figure 5- Education for Health Care Reform Framework
Conclusion
¾ The Permanent Heath Education Framework has
surpassed the role of a mere educational strategy and
become an important political tool for the SUS in the
ongoing Brazilian healthcare reform.
¾ Mass educational programs for allied healthcare
personnel can strengthen the grassroots human
resources of the healthcare system. Healthcare workers
may become advocates who stand for universal
healthcare in their communities.
Finally….
This speculative approach must be validated by
the
academic
community,
using
qualitative
research to assess the influence of mass
educational
programs
for
allied
healthcare
personnel in creating pro healthcare reform
advocates.
Thanks!
Contact: fabianotonaco@yahoo.com.br
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