Implementation of the More Doctors Program in Espírito Santo State, Brazil: Logic model and proposed indicators

Abstract

The study aimed to assess the implementation of the More Doctors Program (PMM in Portuguese) based on a case study of the Espírito Santo State, Brazil. The first stage involved analyzing the documents that launched the PMM, allowing the creation of a logic model. In the second stage, data on the PMM in Espírito Santo State were analyzed (2013-2016) based on population brackets, creating indicators for the proportion of physicians before and after the Program with the following parameters: unacceptable (0 to 0.99 physicians/1,000 inhabitants); acceptable (1 to 1.99); and desirable (2.0 or more). Data were analyzed with the Wilcoxon and Kruskal-Wallis non-parametric tests. The model included the size, inputs, activities, outputs, results, and impact of the PMM, orienting analysis of the Program’s implementation. Of all the physicians in the emergency supply to Espírito Santo State (432), the majority (63.8%) were cooperative exchange physicians (Cubans), while 31.2% were regional board-accredited Brazilians. The Brazilian and individual exchange physicians were allocated mainly in medium and large municipalities, while the Cubans were distributed more heterogeneously in municipalities of all population sizes and were thus more common in areas with greater social vulnerability and lower social capital. There was a significant increase in the number of physicians in Espírito Santo State, but the supply to the extremely poor population did not reach the desired level, presenting an unacceptable mean rate in municipalities with up to 10,000 inhabitants and an acceptable rate in municipalities in the other population brackets.