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Planeamento e gestão de recursos humanos de saúde na província de Cabinda/Angola: mecanismos de atracção e retenção dos profissionais de saúde em áreas rurais e remotas
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A cobertura universal dos serviços de saúde constitui um importante desafio para os políticos e gestores do sector da saúde. O alcance desta meta requer um sistema de saúde sólido, apoiado por recursos humanos (RH) motivados e equitativamente distribuídos. Mui-tos países, principalmente os de média e baixa renda estão confrontados com graves carên-cias de recursos humanos de saúde (RHS), que impedem a consecução de seus objetivos em saúde. Angola é um destes países com uma crise substancial dos RHS e Cabinda, uma das suas províncias, vive este problema com escassez e desequilíbrio desses recursos. Foi pro-posto este trabalho com o objectivo de estudar os RHS desta província, de modo a compre-ender o contexto que afecta a distribuição geográfica dos mesmos, bem como os factores de atracção e retenção de profissionais de saúde (PS) em áreas rurais e remotas, buscando evi-dências para informar a tomada de decisão, com vista ao desenvolvimento de estratégias capazes de assegurar uma melhor oferta de RH nas localidades mais desfavorecidas do inte-rior. A abordagem metodológica articulou quatro estudos: 1) estado de arte, utiliza o fra-mework de acção em RHS, sugerido pela OMS para os países lidarem com a escassez de RH, abordando o estado de conhecimentos produzidos em cada uma das suas dimensões; 2) análise do contexto dos RHS, análisa as políticas e práticas de gestão dos RH igualmente em cada dimensão do framework referido, com abordagesns mistas, dados recolhidos atra-vés de questionário, entrevista e análise documental, numa população composta por unida-des sanitárias (US), instituições de saúde e de formação, públicas e privadas representadas por informantes-chaves; 3) análise dos factores de atracção e retenção dos PS do sector público em áreas rurais/remotas, buscando os factores push/pull e job embeddedness, com impacto nas decisões destes profissionais para permanecerem, ou não nas localidades do interior, integrando igualmente abordagens mistas, dados recolhidos através de um questio-nário que incluiu questões em escalas de medidas e questões abertas. Participaram deste estudo PS das principais categorias (médicos, enfermeiros e técnicos de diagnóstico e tera-pêutica); 4) tradução dos resultados da pesquisa em lições para informar a tomada de deci-são, com a condução de um Policy dialogue (diálogo de políticas). Os principais resultados mostraram escassez e desequilíbrios dos RHS influenciados por um conjunto de factores, por um lado os factores contextuais: dificuldades de ingresso dos PS nos serviços públicos, migração, falta de retenção dos mesmos nas localidades do interior e a insatisfação e des-motivação que os levam a adopção de estratégias de enfrentamento, financiamento insufici-ente das US, e preparação inadequada dos gestores de RH; por outro lado, os factores de atracção e retenção: ambiente local e condições de trabalho desfavoráveis, necessidades de progressão na carreira e de qualificação profissional, preocupações com a família e com o tempo de trabalho indefinido no interior, salário insuficiente e não diferenciado consoante a localização geográfica do emprego, e falta de estímulos não-financeiros. O Policy dialogue produziu recomendações que possam contribuir para as estratégias capazes de tornar as áreas rurais/remotas mais atractivas para os RHS. A complexidade dos factores identifica-dos, requer intervenções multifacetadas, coordenando esforços com outros sectores e en-volvendo todas as partes interessadas.
Universal coverage of health services is a major challenge for health sector policy makers and managers. Achieving of this goal requires a hard health system supported by motivated and equitably distributed human resources (HR). Many countries, especially middle and low-income countries, are facing serious shortages of human resources for he-alth (HRH), which prevent them from achieving their health goals. Angola is one of these countries with a substantial HRH crisis and Cabinda, one of its provinces, is experiencing this problem with scarcity and imbalance of these resources. This work was proposed with the objective of studying the HRH of this province, in order to understand the context that affects their geographical distribution, as well as the factors of attraction and retention of health professionals (HP) in rural and remote areas, seeking evidence to inform decision-making with a view to developing strategies to ensure a better supply of HR in the poorest locations in the interior. The methodological approach articulated four studies: 1) state of the art, it uses the HRH action framework suggested by World Health Organization (WHO) for countries to deal with HR scarcity, addressing the state of knowledge produced in each of its dimensions; 2) HRH context analysis, HR management policies and practices also analyzed in each dimension of the referred framework, with mixed approaches, data collec-ted through questionnaire, interview and document analysis, in a population composed of health units (US), public and private health and training institutions represented by key in-formants; 3) analysis of the attractiveness and retention factors of public sector Health Pro-fessionals in rural/remote areas, seeking the push/pull and job embeddedness factors, with an impact on the decisions of these professionals to remain, or not in the localities, also integrating mixed approaches, data collected through a questionnaire that included questi-ons on measurement scales and open questions. Participated in this study HP of the main categories (doctors, nurses and diagnostic and therapeutic technicians); 4) translation of research findings into lessons for informing decision making by conducting a Policy dialo-gue. The main results showed shortages and imbalances of HRH influenced by a set of fac-tors, on the one hand, the contextual factors: difficulties of entry of the HP in public servi-ces, migration, lack of retention of these in the interior locations and dissatisfaction, and demotivation leading them to adopt coping strategies, insufficient US funding, and inade-quate preparation of HR managers; On the other hand, the factors of attraction and retenti-on: local environment and unfavorable working conditions, career advancement and profes-sional qualification needs, concerns about family and indefinite working time, insufficient salary and differentiated according to the geographical location of employment, and lack of non-financial stimuli. Policy dialogue has produced recommendations that can contribute to strategies that can make rural/remote areas more attractive to HRH. The complexity of the factors identified requires multifaceted interventions, coordinating efforts with other sectors and involving all stakeholders.
Universal coverage of health services is a major challenge for health sector policy makers and managers. Achieving of this goal requires a hard health system supported by motivated and equitably distributed human resources (HR). Many countries, especially middle and low-income countries, are facing serious shortages of human resources for he-alth (HRH), which prevent them from achieving their health goals. Angola is one of these countries with a substantial HRH crisis and Cabinda, one of its provinces, is experiencing this problem with scarcity and imbalance of these resources. This work was proposed with the objective of studying the HRH of this province, in order to understand the context that affects their geographical distribution, as well as the factors of attraction and retention of health professionals (HP) in rural and remote areas, seeking evidence to inform decision-making with a view to developing strategies to ensure a better supply of HR in the poorest locations in the interior. The methodological approach articulated four studies: 1) state of the art, it uses the HRH action framework suggested by World Health Organization (WHO) for countries to deal with HR scarcity, addressing the state of knowledge produced in each of its dimensions; 2) HRH context analysis, HR management policies and practices also analyzed in each dimension of the referred framework, with mixed approaches, data collec-ted through questionnaire, interview and document analysis, in a population composed of health units (US), public and private health and training institutions represented by key in-formants; 3) analysis of the attractiveness and retention factors of public sector Health Pro-fessionals in rural/remote areas, seeking the push/pull and job embeddedness factors, with an impact on the decisions of these professionals to remain, or not in the localities, also integrating mixed approaches, data collected through a questionnaire that included questi-ons on measurement scales and open questions. Participated in this study HP of the main categories (doctors, nurses and diagnostic and therapeutic technicians); 4) translation of research findings into lessons for informing decision making by conducting a Policy dialo-gue. The main results showed shortages and imbalances of HRH influenced by a set of fac-tors, on the one hand, the contextual factors: difficulties of entry of the HP in public servi-ces, migration, lack of retention of these in the interior locations and dissatisfaction, and demotivation leading them to adopt coping strategies, insufficient US funding, and inade-quate preparation of HR managers; On the other hand, the factors of attraction and retenti-on: local environment and unfavorable working conditions, career advancement and profes-sional qualification needs, concerns about family and indefinite working time, insufficient salary and differentiated according to the geographical location of employment, and lack of non-financial stimuli. Policy dialogue has produced recommendations that can contribute to strategies that can make rural/remote areas more attractive to HRH. The complexity of the factors identified requires multifaceted interventions, coordinating efforts with other sectors and involving all stakeholders.
Descrição
Palavras-chave
Saúde pública Recursos humanos em saúde Sistemas de saúde Gestão Atracção e retenção Áreas rurais e remotas Cabinda Angola
Contexto Educativo
Citação
Editora
Instituto de Higiene e Medicina Tropical