There was an increase in the health worker density at the subnational level in rehabilitation in PHC in Brazil from 2007 to 2020, brought about by the essential contribution of public health policies for rehabilitation. These results generate information that could subsidize evidence-based policies for the need for rehabilitation in PHC in the country and may guide the scale of academic education of physiotherapists, audiologists, psychologists, and occupational therapists to attend to the health needs of people with disabilities.
One of the central public policies that can explain the expansion of the health worker density in rehabilitation in PHC in Brazil is the NASF, which was created to expand the scope of primary care actions with the insertion of different professional categories at this level of care, including physiotherapists, speech therapists, psychologists and occupational therapists . From 2008 to 2016, there was significant support from the federal government, including financial support, for implementing these teams, positively impacting the life and health conditions of people with disabilities, considering the increase in the workforce in rehabilitation in PHC in Brazil.
Thus, the results observed after the implementation of the NASF may have subsidized the creation of the RCPD, an important inductive policy for the expansion and qualification of health care for people with disabilities in Brazil. It was observed that the growth of the workforce was higher around 2012, the year of publication of this policy. Thus, both the NASF and the RCPD are shown to be fundamental for strengthening comprehensive care for the population with disabilities in PHC, with multi-professional rehabilitation actions.
However, in 2017, the reformulation of the National Primary Care Policy had a considerable impact on the work process of the NASF teams, considering that the teams started to assist the health of a greater number of people, regardless of the minimum population coverage . Although the changes in the NASF did not happen in a structural way, there was an increase in the responsibility of the PHC teams , financing has changed, and this can lead to the loss of the increase in the workforce that has been identified, allowing for a shift in the workforce from rehabilitation in PHC to health care for people with disabilities.
Public policy actions can ensure that more resources are made available to develop the rehabilitation workforce, and workers’ practices may vary according to the specific needs of the country . However, for the health care of people with disabilities, it is harmful to have a public policy that expands the scope of health actions and after some time disqualifies them, such as the Previne Brasil Program in 2019, which established a reduction in PHC funding, limiting to the registered population, threatening the universality of health care in Brazil .
Learning about the PHC rehabilitation workforce is one of the actions to meet the “Six Rehab-Workforce Challenges” and provides adequate assistance to current and future rehabilitation health needs . Thus, this study was relevant to understand the availability of physiotherapists, audiologists, psychologists, and occupational therapists in PHC in Brazil.
It is not easy to compare the workforce in rehabilitation in PHC in Brazil with that of other countries, as studies from other countries point to the network’s workforce in general. Although there is a recommendation that the rehabilitation workforce not be focused on professional singularities , international scientific knowledge is divided by professional categories, mainly focused on doctors and nurses . It can be said that analyzing the rehabilitation workforce in PHC is one of the strengths of this article.
In 2020, Brazil reached 500,000 doctors, with a ratio of 2.38 per 1000 inhabitants; of this total, 20.4% reported a relationship with the PHC. There has also been an increase of 180,000 doctors in the last decade, which may have arisen due to the Law “Mais Médicos”, instituted in 2013 . Although there was a significant increase in the numbers of doctors and nurses in the whole country between 1991 and 2005, the southern and southeastern regions demonstrate more accentuated growth in the densities of these professionals .
In Canada, the average number of physiotherapists per 10,000 people is 2.32 , while in the United States, this number is 6.5 . For occupational therapists, the average for every 10,000; in Portugal, it is 1.9 and 3.6 in the United States . These rates, however, are calculated considering all professionals in the country, and there is no estimate of the distribution of these workers according to the level of attention.
Some limitations must be considered in this study, primarily that it was focused on rehabilitation, including the four main professions, as the inclusion of other professionals could help in discussions that PHC public policies require teamwork in health promotion and disease prevention, as well as in health care and continuing education. The CNES is the official registry of all health establishments in Brazil, with the advantage of faster and less expensive data retrieval and a larger population, temporal, and geographical scope. However, there are issues with coverage, particularly in the private sector, and overall insufficiency or duplication of data regarding human resources for health [28, 29]. The population used in the analysis was the estimated population due to the absence of an annual census. It was not possible to calculate the workforce specifically in rehabilitation for people with disabilities because there is only a record of the population with disabilities in Brazil according to the Census conducted in 2010. Therefore we consider the general population since rehabilitation is understood as “a set of measures that help people with disabilities or about to develop disabilities to have and maintain an ideal functionality in the interaction with their environment” , and everyone can benefit from it at some point in life.
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