Spatial distribution patterns of human resources allocation in maternal and child healthcare institutions in China from 2016 to 2021.

BACKGROUND: In China, economic, urbanization, and policy differences between the eastern and western regions lead to uneven healthcare resources. This disparity is more pronounced in the west due to fewer healthcare personnel per thousand individuals and imbalanced doctor-to-nurse ratios, which exacerbates healthcare challenges. This study examines the spatial distribution of human resources in maternal and child healthcare from 2016 to 2021, highlighting regional disparities and offering insights for future policy development. METHODS: The data were sourced from the "China Health and Family Planning Statistical Yearbook" (2017) and the "China Health and Health Statistics Yearbook" (2018-2022). This study utilized GeoDa 1.8.6 software to conduct both global and local spatial autocorrelation analyses, using China's administrative map as the base dataset. RESULTS: From 2016 to 2021, there was an upward trend in the number of health personnel and various types of health technical personnel in Chinese maternal and child healthcare institutions. The spatial distribution of these personnel from 2016 to 2021 revealed clusters characterized as high-high, low-low, high-low and low-high. Specifically, high-high clusters were identified in Guangxi, Hunan, Jiangxi, and Guangdong provinces; low-low in Xinjiang Uygur Autonomous Region and Inner Mongolia Autonomous Region; high-low in Sichuan province; and low-high in Fujian and Anhui provinces. CONCLUSIONS: From 2016 to 2021, there was evident spatial clustering of health personnel and various health technical personnel in Chinese maternal and child healthcare institutions, indicating regional imbalances.

Multiempleo en salud en provincia de Buenos Aires: estudio transversal de profesiones afectadas al cuidado de pacientes con COVID-19 / Multi-employment in health in the province of Buenos Aires: cross-sectional study of professions involved in COVID-19 patient care

RESUMEN INTRODUCCIÓN La pandemia de COVID-19 expuso el impacto del multiempleo en los servicios de salud. El objetivo de este estudio fue caracterizar el multiempleo en médicos y enfermeros que trabajaron en internación general y cuidados críticos durante la pandemia en la provincia de Buenos Aires. MÉTODOS Se realizó un estudio exploratorio, descriptivo y transversal. Los datos se recolectaron en el primer trimestre de 2021 con una encuesta estructurada anónima autoadministrada mediante muestreo no probabilístico en cadena. RESULTADOS El 96,3% de los médicos y el 68,1% de los enfermeros declararon estar multiempleados. La media de empleos fue 3,1 para médicos (entre 1 y 5) y 1,9 para enfermeros (entre 1 y 3). Los enfermeros declararon trabajos con mayor carga horaria, predominio del empleo público y contratación estable. Los médicos multiempleados manifestaron mayor diversidad en la forma de contratación. En ambas profesiones el multiempleo es motivado principalmente por razones de índole económica. DISCUSIÓN El multiempleo es difícil de medir mediante los registros oficiales. La proporción de multiempleo autorreportado en este estudio supera las cifras comunicadas por las estadísticas e informes oficiales. Aun así, las diferencias halladas entre médicos y enfermeros respecto al número de empleos son coincidentes con estudios previos. El problema del multiempleo requiere ser abordado desde la desprecarización del empleo, con mejoras en las condiciones económicas y de trabajo.

ABSTRACT INTRODUCTION The COVID-19 pandemic exposed the impact of multi-employment in health services. The objective of this study was to characterize multi-employment among physicians and nurses working in general hospitalization and critical care during the pandemic in the province of Buenos Aires. METHODS An exploratory, descriptive, cross-sectional study was conducted. Data were collected in the first quarter of 2021 with a structured anonymous self-administered survey using non-probabilistic chain sampling. RESULTS A total of 96.3% of physicians and 68.1% of nurses reported being multi-employed. The mean number of jobs was 3.1 for physicians (between 1 and 5) and 1.9 for nurses (between 1 and 3). Nurses reported having jobs with longer hours, mostly public and stable employment. Multi-employed physicians reported greater variety in the form of hiring. In both professions, multi-employment is mainly motivated by economic reasons. DISCUSSION Multi-employment is difficult to measure through official records. The proportion of self-reported multiemployment in this study exceeds the figures shown by official statistics and reports. The differences found between physicians and nurses regarding the number of jobs are still consistent with previous studies. The problem of multi-employment needs to be tackled by making employment less precarious, with improvements in economic and working conditions.

Applications of lean in human resources management in healthcare.

Recent challenges brought by the coronavirus disease-2019 pandemic have underscored the importance of coping with pressures on the workforce in healthcare around the world and have emphasised the continuing need to improve quality and operation efficiency of healthcare services even in such dire circumstances. Over the years, lean thinking has gained recognition in the healthcare industry, where lean has been associated with benefits, such as improved healthcare delivery quality, reduced costs and increased effectiveness of the healthcare delivery processes. Lean thinking has also been analysed in human resources with benefits, such as increased job satisfaction and perceived job autonomy. The current narrative review was planned to analyse and discuss the application and implementation of lean strategies with a particular focus on human resource management in healthcare. The review is complemented by a case study in a private healthcare group in Turkey, aiming to demonstrate in practice the effect of lean strategies on the satisfaction of patients and relatives, the job satisfaction of the employees, and the level of turnover rates within healthcare enterprises.

Healthcare Human Resources: Trends and Demand in Saudi Arabia.

This paper estimates the impact of policies on the current status of Healthcare Human Resources (HHR) in Saudi Arabia and explores the initiatives that will be adopted to achieve Saudi Vision 2030. Retrospective time-series data from the Ministry of Health (MOH) and statistical yearbooks between 2003 and 2015 are analyzed to identify the impact of these policies on the health sector and the number of Saudi and non-Saudi physicians, nurses and allied health specialists employed by MOH, Other Government Hospitals (OGH) and Private Sector Hospitals (PSH). Moreover, multiple regressions are performed with respect to project data until 2030 and meaningful inferences are drawn. As a local supply of professional medical falls short of demand, either policy to foster an increase in supply are adopted or the Saudization policies must be relaxed. The discrepancies are identified in terms of a high rate of non-compliance of Saudization in the private sector and this is being countered with alternative measures which are discussed in this paper. The study also analyzed the drivers of HHR demand, supply and discussed the research implications on policy and society. The findings suggest that the 2011 national Saudization policy yielded the desired results mostly regarding allied health specialists and nurses. This study will enable decision-makers in the healthcare sector to measure the effectiveness of the new policies and, hence, whether to continue in implementing them or to revise them.

Avances en el desarrollo de los recursos humanos en salud en el Perú y su importancia en la calidad de atención / Progress in the development of healthcare human resources in Peru and their importance in the quality of care

RESUMEN Los Recursos Humanos en Salud (RHUS) son pilar clave en el éxito de todo sistema de salud, su desarrollo y desempeño son fundamental para garantizar una atención de calidad. A pesar de esta realidad, los RHUS suelen estar ausentes en procesos de reforma sanitaria. En el Perú, en los últimos 30 años, se han dado diversas reformas que han incluido en mayor o menor medida, mejoras en las políticas de RHUS con la finalidad de brindar una mejor calidad de atención a la población. Este artículo busca hacer un breve análisis de los avances en el campo de la gestión y desarrollo de los Recursos humanos en el Sector Salud en los últimos años, destacando su importancia en la calidad de atención. De hacer esfuerzos suficientes en este campo, lograríamos RHUS competentes, distribuidos de forma equitativa y comprometidos con entregar atención de calidad a todos los individuos.

ABSTRACT Healthcare Human Resources (HHR) are key for the success of any health system; its development and performance are fundamental to ensure quality care. Despite this reality, HHR are often absent from health reform processes. In Peru, in the last 30 years, there have been several reforms that have included, to a greater or lesser extent, improvements in HHR policies aimed at providing a better quality of care to the population. This article seeks to make a brief analysis of the advances in the field of management and development of human resources in the healthcare sector in recent years, highlighting their importance in the quality of care. Through considerable effort, we would achieve competent, equitably-distributed HHR committed to delivering quality care to all individuals.

The perceived organizational impact of the gender gap across a Canadian department of medicine and proposed strategies to combat it: a qualitative study.

BACKGROUND: Despite the gender parity existing in medical schools for over three decades, women remain underrepresented in academic medical centers, particularly in senior ranks and in leadership roles. This has consequences for patient care, education, research, and workplace culture within healthcare organizations. This study was undertaken to explore the perspectives of faculty members at a single department of medicine on the impact of the existing gender gap on organizational effectiveness and workplace culture, and to identify systems-based strategies to mitigate the gap. METHODS: The study took place at a large university department of medicine in Toronto, Canada, with six affiliated hospitals. In this qualitative study, semi-structured individual interviews were conducted between May and September 2016 with full-time faculty members who held clinical and university-based appointments. Transcripts of the interviews were analyzed using thematic analysis. Three authors independently reviewed the transcripts to determine a preliminary list of codes and establish a coding framework. A modified audit consensus coding approach was applied; a single analyst reviewed all the transcripts and a second analyst audited 20% of the transcripts in each round of coding. Following each round, inter-rater reliability was determined, discrepancies were resolved through discussion, and modifications were made as needed to the coding framework. The analysis revealed faculty members' perceptions of the gender gap, potential contributing factors, organizational impacts, and possible solutions to bridge the gap. RESULTS: Of the 43 full-time faculty members who participated in the survey (29 of whom self-identified as female), most participants were aware of the existing gender gap within academic medicine. Participants described social exclusion, reinforced stereotypes, and unprofessional behaviors as consequences of the gap on organizational effectiveness and culture. They suggested improvements in (1) the processes for recruitment, hiring, and promotion; (2) inclusiveness of the work environment; (3) structures for mentorship; and (4) ongoing monitoring of the gap. CONCLUSION: The existing gender gap in academic medicine may have negative consequences for organizational effectiveness and workplace culture but many systems-based strategies to mitigate the gap exist. Although these solutions warrant rigorous evaluation, they are feasible to institute within most healthcare organizations immediately.

Programa Mais Médicos e sua repercussão na mídia: o que informar e para quem? / Programa Mais Médicos and its repercussion in the media: what should be informed and for whom? / Programa Mais Médicos y su repercusión en los medios de comunicación: qué y para quién informar?

O Programa Mais Médicos (PMM) foi instituído no Brasil no ano de 2013. Desde então, vem sendo debatida pela sociedade a questão de sua viabilidade, seus resultados e sua continuidade. O objetivo deste artigo é identificar e analisar a produtividade discursiva midiática, no período de maio de 2013 a julho de 2014, sobre o PMM. Foi feito um estudo exploratório e documental em uma revista semanal de grande circulação no Brasil (IstoÉ), através da busca de reportagens no seu sítio virtual, com descritores relacionados ao Programa, em que foram selecionadas 34 reportagens em 31 edições a partir do mês anterior à publicação da medida provisória que instituiu o PMM. A revista destacou a chegada de profissionais estrangeiros, os atos xenofóbicos empreendidos pela classe médica e a proteção corporativista da categoria. O PMM contribui grandemente para a melhoria da saúde da população e o atendimento de suas necessidades, porém reproduz a centralidade médica, desconsiderando que outros profissionais de saúde também têm sua atuação dificultada em áreas negligenciadas pelo Estado.(AU)

The PMM ­ Programa Mais Médicos [More Doctors Program] was established in Brazil in 2013. Since it was announced, the question of its viability, results and continuity has been debated by the Brazilian society. The aim of this article is to identify and analyze the media discursive productivity in the first year (May 2013 to July 2014) of the PMM. An exploratory and documentary study of articles published in a weekly magazine of great circulation in Brazil (IstoÉ) was developed by means of a search for reports on its virtual site with descriptors related to the Program and 34 articles were selected in 31 editions from one month before the setting up of PMM by "medida provisória". The magazine noticed the arrival of foreign professionals, the xenophobic acts committed by Brazilian medical associations, and the category's corporative protection. The PMM contributes greatly to improve the health of the population and to satisfy its needs, but it reproduces the medical centrality, disregarding that the work of other health professionals have also been complicated in areas neglected by the State.(AU)

El PMM ­ Programa Mais Médicos [Programa Más Médicos] se estableció en Brasil en 2013. Desde su origen, su viabilidad, resultados y continuidad han sido objeto de debate por la sociedad brasileña. Este artículo tiene el objetivo de identificar y analizar la productividad discursiva mediática, en el primer año (mayo de 2013 a junio de 2014) del PMM. Un estudio exploratorio y documental en una revista semanal de gran circulación en Brasil (IstoÉ) fue llevado a cabo, a través de la búsqueda de reportajes en su sitio virtual, con descriptores relacionados al Programa y se seleccionaron 34 reportajes en 31 ediciones a partir del mes anterior a la publicación de la "medida provisória" que ha establecido el PMM. El periódico destaca la llegada de profesionales extranjeros, los actos de xenofobia practicados por entidades médicas, y la protección corporativista de la categoría. El PMM contribuye en gran medida a mejora de la salud de la población y a atención médica de sus necesidades, pero reproduce la centralidad médica, sin tener en cuenta otros profesionales de la salud que también tienen su desempeño obstaculizado en áreas desatendidas por el Estado.(AU)

Reforma en salud: complejidad y límites de la formación de recursos humanos especializados / Health sector reform: complexity and limits of specialized human resources development

El presente artículo examina el proceso de Reforma en Salud con un enfoque sistémico, desde la perspectiva de la formación de recursos humanos en salud. Consideramos que se tiene que visibilizar como un espacio necesario de formación de recursos humanos en salud, a los recursos para la generación e implementación de la reforma en salud. Se propone una relación entre los procesos de concepción, implementación y ejecución de las propuestas de reforma, los procesos de desarrollo de los recursos humanos necesarios para las propuestas, y la conformación de núcleos de desarrollo de las mismas. Esta relación se visualiza como una relación circular tripartita, en la cual los avances y frenos de cada uno de estos espacios, determina a su vez dinámicas codireccionales en los otros dos espacios, y por ende, la viabilidad y sentido de la Reforma que se propone, sólo será factible en las áreas en las cuales tiene recursos humanos disponibles.

We explore the Health Sector Reform process form a systemic viewpoint, in particular with a human resources perspective. We consider we have to make visible the human resources space as a key component of health sector reform, not only from a quantitative understanding, such as the need of medical specialists to provide health care, but also as the thinking block in the health system, so the quality, training, knowledge and expertise of these core resources, will be reflected in the quality of health sector reform proposals. Thus, we propose a dynamic flow among inception, implementation and deployment of health reform proposals, human resources development, and proposals development nuclei. This relationship is seen as a circular link, whereby balances and reinforcements in any of the three spaces determines changes in the other two;therefore, the proposed reform, there will be only feasible in áreas where there are available human resources.

[Factors associated with job satisfaction of human resources in healthcare].

INTRODUCTION: Healthcare employee satisfaction is an important criterion for the efficiency of human resource management and prognostic impact factor for high turnover of staff. Furthermore, job satisfaction positively affects patient satisfaction, which is an important indicator for quality of care. AIM: The goal of our study was to identify factors associated with job satisfaction in healthcare organizations in Ukraine. MATERIALS AND METHODS: We conducted sociological and psychological survey of 190 healthcare professionals (81% response rate) in Kherson City Hospital. Job satisfaction and organizational climate was assessed through developed questionnaire, "Test Motype" method of Gerchikov (motivational profile designing) and "Diagnosis Syndrome emotional burnout" method of Boyko. Spearman rank correlation was used for analysis. RESULTS: Job satisfaction positively correlated with personnel age and time record, career prospects, professional development, superior-subordinate, peer-to-peer and patient communications (p<0,01 for all), teamwork environment, among executives with achievement and affiliation motivations (р<0,001, accordingly). It negatively correlated with reward-oriented and lumpen-style motivational profile (р<0,001 and <0,01, accordingly). Job satisfaction did not correlate with responsibility of executives, factors for satisfaction of job description, working conditions and range of wages (all p> 0.05). CONCLUSIONS: Based on findings we developed dual job satisfaction-dissatisfaction approach specific for healthcare employee in Ukraine. This model includes internal factors such as work experience, career prospects, professional motivation; external factors such as leadership, governance, work environment, customer satisfaction and preventive factors such as staff role, job description, company policies, salary and benefits.

Potencialidades da Residência Multiprofissional em Saúde da Família: o olhar do trabalhador de saúde / Potential of multiprofessional residency for family healthcare: the view of healthcare workers / Potencialidades de la Residencia Multi-profesional en Salud de la Familia: la mirada del trabajador de la salud

Para a consolidação da proposta da Residência Multiprofissional em Saúde da Família (RMSF), torna-se imprescindível a participação do profissional de saúde atuante no serviço. Assim, o objetivo deste estudo foi revelar a percepção do trabalhador de saúde sobre as potencialidades da inserção da RMSF nas Unidades de Saúde da Família (USF). Trata-se de um estudo qualitativo, realizado com 25 trabalhadores das USF contempladas com a RMSF. Os discursos revelaram que a atuação dos residentes nas USF foi potente para induzir mudanças no processo de trabalho destas e para a formação de profissionais capacitados para atuar na Estratégia Saúde da Família (ESF). Deste modo, a residência contribui para que a ESF se torne um dispositivo de mudança do modelo de assistência à saúde e constitui uma forma de operar o proposto na Política de Educação Permanente em Saúde (EPS)...

To consolidate the proposal of multiprofessional residency for family healthcare (MRFH), participation by healthcare professionals working in this service becomes essential. Thus, the objective of this study was to reveal healthcare workers’ perceptions about the potential for inserting MRFH in family healthcare units (FHUs). This was a qualitative study, conducted among 25 workers at FHUs covered by MRFH. The discourse revealed that the actions of residents at FHUs had the power to induce changes in the work process at FHUs and to train professionals who would be qualified to act within the family health strategy (FHS). Thus, residency contributes towards making the FHS a tool for changing the healthcare model and constitutes a way of operating the proposals of the continuing health education policy...

Para la consolidación de la propuesta de la Residencia Multi-profesional en Salud de la Familia (RMSF) resulta imprescindible la participación del profesional de la salud que actúa en el servicio. De tal forma, el objetivo de este estudio fue el de revelar la percepción del trabajador de la salud sobre las potencialidades de la inserción de la RMSF en las Unidades de Salud de la Familia (USF). Se trata de un estudio cualitativo, realizado con 25 trabajadores de las USF que cuentan con la RMSF. Los discursos revelaron que la actuación de los residentes en las USF tuvo gran fuerza para inducir cambios en el proceso de trabajo de las mismas y para la formación de profesionales capacitados a actuar en la Estrategia Salud de la Familia (ESF). Siendo así, la residencia contribuye para que la ESF pase a ser un dispositivo de cambio del modelo de asistencia a la salud y constituye una forma de operar lo propuesto en la Política de Educación Permanente en Salud (EPS)...

Atuação profissional no âmbito da segurança alimentar e nutricional na perspectiva de coordenadores de cursos de graduação em Nutrição / Professional practice relating to food and nutritional security from the perspective of coordinators of undergraduate nutrition courses / Las actividades profesionales en el ámbito de la seguridad alimentaria y nutricional en la perspectiva de los coordinadores de cursos de graduación en Nutrición

Identificaram-se fatores facilitadores e barreiras para a atuação do nutricionista em segurança alimentar e nutricional (SAN) na perspectiva de coordenadores de cursos de graduação em Nutrição do município de São Paulo, Brasil. Em estudo qualitativo, com uso do Discurso do Sujeito Coletivo, questionaram-se os coordenadores sobre aspectos favoráveis e limitadores da prática profissional em SAN. As políticas públicas e a formação foram apontadas positiva e negativamente. Como facilitadoras, verificaram-se as ideias centrais "existência de políticas e programas públicos" e "formação adequada"; como barreiras, a "insuficiência ou não-aplicação dessas políticas", "pouca possibilidade de atuação do nutricionista no setor público" e "formação insuficiente ou inadequada". Concluiu-se que coordenadores valorizam a existência de políticas públicas, porém é nítida a limitação de ações. A formação, considerada adequada por alguns, foi criticada quanto à tecnicidade, fragmentação e desarticulação entre teoria e prática.

Facilitating factors for and barriers against nutritionists' practices relating to food and nutritional security were identified, from the perspective of coordinators of undergraduate nutrition courses in the municipality of São Paulo, Brazil. In this qualitative study, using collective subject discourse, coordinators were asked about factors favoring and limiting professional practice relating to food and nutritional security. Public policies and training were identified positively and negatively. The following central ideas were considered to be facilitators: "existence of public policies and programs" and "adequate training". The barriers identified were "insufficiency or non-application of these policies", "little possibility for nutritionists to act within the public sector" and "insufficient or inadequate training". It was concluded that coordinators placed value on the existence of policies, but the limitations of actions were clear. Although the training was considered adequate by some coordinators, it was criticized regarding its technical nature, fragmentation and disconnection between theory and practice.

Se identifican los facilitadores y las barreras para el trabajo del nutricionista relacionados a la seguridad alimentaria y nutricional en la perspectiva de los coordinadores de cursos de Nutrición en São Paulo, Brasil, en un estudio cualitativo por medio de Discurso del Sujeto Colectivo. La política pública y la capacitación fueron mencionados tanto positiva como negativamente. Como facilitadores, fueran identificadas las ideas "existencia de políticas y programas públicos" y "formación adecuada" y como barrera, "la insuficiencia o no aplicación de tales políticas", "pocas posibilidades de acción de nutricionista en el sector público" y "formación insuficiente o inadecuada". Los coordinadores indican las políticas como importantes pero las acciones públicas son restrictas. La formación, aunque considerada adecuada por algunos, se ha criticado en cuanto a la complejidad técnica, la fragmentación y la desconexión entre la teoría y la práctica.

Educação no trabalho na atenção primária à saúde: interfaces entre a educação permanente em saúde e o agir comunicativo / Work education in primary health care: interfaces between permanent education in health and the communicative action

O trabalho em saúde e a educação no trabalho constituem-se com uma dupla dimensão - ação instrumental e intersubjetividade. OBJETIVO: Analisar as concepções de educação que fundamentam as atividades educativas de trabalhadores da saúde na atenção primária. MÉTODO: Estudo de abordagem qualitativa realizado em duas unidades básicas de saúde do município de São Paulo, por meio de entrevista semiestruturada gravada com 36 informantes-chave, representativos de cada categoria profissional dos serviços, incluindo o segmento gerencial e o de trabalhadores da saúde. Os dados foram analisados com a técnica de análise de conteúdo temática com base no quadro teórico: processo de trabalho em saúde, teoria do agir comunicativo, educação continuada (EC), educação permanente em saúde (EPS) e integralidade, os quais permitiram a construção das categorias empíricas: educação instrumental/tradicional e educação comunicativa/emancipatória. Resultados: Os resultados mostram o predomínio da concepção de educação no trabalho como construção coletiva do saber a partir da realidade de trabalho, pertinentes à EPS que se pretende instituir para a mudança das práticas e do modelo assistencial biomédico. Contudo, alguns depoentes expressam uma concepção de educação instrumental com ênfase em ações técnicas e de atualização do saber, que se aproxima da EC. CONCLUSÃO: Os resultados evidenciam a convivência das duas concepções de educação de trabalhadores - instrumental e comunicativa com o predomínio da segunda, que mostra a capilaridade da política de EPS entre os trabalhadores de saúde das UBS e a necessidade de aprofundar o debate para consolidar a prática educativa no cotidiano de trabalho.

Atividades educativas de trabalhadores na atenção primária: concepções de educação permanente e de educação continuada em saúde presentes no cotidiano de Unidades Básicas de Saúde em São Paulo / Actividades educativas de trabajadores en la atención primaria: concepciones de educación permanente y de educación continuada en salud presentes en el quehacer cotidiano de Unidades Básicas de Salud en Sao Paulo, Brasil / Educational activities for primary healthcare workers: permanent education and inservice healthcare education concepts in the daily life of primary healthcare units in São Paulo

Esta pesquisa tem o objetivo de analisar a prática de atividades educativas de trabalhadores da saúde em Unidade Básica de Saúde (UBS) segundo as concepções de educação permanente em saúde (EPS) e de educação continuada (EC), processo de trabalho em saúde e enfermagem, trabalho em equipe e integralidade. Estudo do tipo transversal, realizado em dez UBS do Município de São Paulo, por meio de entrevista dirigida com 110 informantes-chave, representantes de todas as categorias profissionais e equipes das UBS, sobre as atividades educativas desenvolvidas em 2005. As informações foram classificadas segundo categorias operacionais para cada variável de estudo, com base no referencial teórico. Os trabalhadores relataram 396 atividades educativas, que revelam a complementaridade das concepções de EPS e EC. De acordo com a perspectiva do Sistema Único de Saúde (SUS) e da transformação das práticas de saúde, coloca-se a necessidade de ampliação do debate em torno da EPS como política pública.

The objective of this study was to analyze the educational activity practices among healthcare workers in primary healthcare units (PHUs) according to the concepts of permanent healthcare education (EPS) and continuing education (CE), healthcare and nursing work processes, teamwork and comprehensiveness. This was a cross-sectional study conducted in 10 PHUs in the municipality of São Paulo, through structured interviews with 110 key informants who represented all professional categories and teams at the PHUs. The interviews covered educational activities developed in 2005. The information was classified according to operational categories for each study variable, based on the theoretical framework. The workers reported 396 educational activities that demonstrated the complementary nature of the concepts of CFHE and CE. In accordance with the perspectives of the Brazilian Unified Health System (SUS) and the transformation of healthcare practices, there is a need to expand the debate relating to CFHE as public policy.

Investigación con el objeto de analizar la práctica de actividades educativas de trabajadores de salud en Unidad Básica de Salud (UBS) según las concepciones de educación permanente en salud (EPS) y de educación continuada (EC), proceso de trabajo en salud y enfermería, trabajo en equipo e atención integral. Estudio del tipo transversal realizado en diez UBS del municipio de São Paulo, por medio de entrevista dirigida con 110 informantes clave representantes de todas las categorías profesionales y equipos de las UBS, sobre las actividades educativas desarrolladas en 2005. Las informaciones se clasificaron según categorías operacionales para cada variable de estudio con base en el referencial teórico. Los trabajadores relataron 396 actividades educativas que revelan la complementariedad de las concepciones de EPS y EC. De acuerdo con la perspectiva del Sistema Unico de Salud (SUS) y de la transformación de las prácticas de salud se plantea la necesidad de ampliación en el debate en torno de la EPS como política pública.

Complexidade em Saúde da Família e formação do futuro profissional de saúde / Complejidad en la Salud de la Familia y formación del futuro profesional de la salud / Complexity in Family Healthcare and the training of future healthcare professionals

As características do Sistema Único de Saúde (SUS) e da Estratégia de Saúde da Família (ESF) os aproximam do pensamento complexo, termo que não se refere à adjetivação de fenômeno de aspectos múltiplos, e sim ao marco teórico e epistemológico. Indícios de inadequação da formação dos profissionais de saúde para a atuação em Saúde da Família levaram a proposta de levantar a formação desses profissionais para a abordagem ampliada de saúde implicada no SUS/ESF. Foram realizados grupos focais com acadêmicos de Enfermagem, Medicina e Odontologia da Universidade Federal do Amazonas, analisado sob a perspectiva hermenêutica dialética. Os dados apontaram para a formação reducionista/biomédica nas três profissões assim como o foco no trabalho individual, e não em equipe multiprofissional, quadro inadequado ao SUS/ESF, que preconiza atuação profissional focada na complexidade do entorno sócioeconômico e antropológico dos usuários do sistema.

The characteristics of the Unified Health System (SUS) and the Family Healthcare Strategy (ESF) bring them close to complex thought, a term that refers to the theoretical and epistemological framework rather than to an adjective describing phenomena with multiple features. Indications of inadequacy in the training of healthcare professionals, for them to work within family healthcare, led to a proposal to survey the training of these professionals for the expanded approach to healthcare implicated in SUS/ESF. Focus groups among undergraduate nursing, medical and dental students at the Federal University of Amazonas were conducted, with analysis from a hermeneutic-dialectic perspective. The data indicated that the training for these three professions was reductionist and biomedical, focusing on individual work rather than on multi-professional teamwork. This is an inadequate framework for SUS/ESF, for which professional action focusing on the complexity of the socioeconomic and anthropological context of the system's users is recommended.

Las características del Sistema Único de Salud (SUS) y de la Estrategia de Salud de la Familia (ESF) aproximan al pensamiento complejo, término que no se refiere a la adjetivación de fenómeno de aspectos múltiplos y si al marco teórico-epistemológico. Dados los indicios de la formación inadecuada de profesionales de la salud para la actuación en ESF, se apuntó a elevar la formación de estos profesionales con el abordaje ampliado de salud implicado en el SUS/ESF, utilizándose grupos focales con académicos de Enfermería, Medicina y Odontología de la Universidad Federal de Amazonas, tratados por una perspectiva hermenéutica dialéctica. Los datos apuntaron a una formación reduccionista/biomédica en las tres profesiones así como foco en el trabajo individual y no en equipo multiprofesional, cuadro inadecuado al SUS/ESF, que preconiza la actuación profesional enfocada en la complejidad del entorno socioeconómico de los usuarios.