Poor medical training becomes obstacle to the closer care to the population

“There is a doctor who forwards a patient to the endocrinologist just to prescribe insulin,” criticized Junqueira. This means more cost to the system, more wear for the patient, who needs to miss work again and wait longer for an appointment with an expert.

The structural problem is aggravated by the lack of places in residency programs and the low financial attractiveness of the scholarships. “The system does not encourage continuous training. The professional leaves straightened college, wants to make money fast, and UBS becomes the first job, but he is not prepared for it,” he said.

For Tânia Mara Coelho, President of Conass (National Council of Health Secretaries) and Secretary of Health of Ceará, the root of the problem is even deeper. “Health does not change without education. This is the basic pillar to transform care in Brazil,” he said. It also defends the empowerment of the population as part of the process: “People need to know what to charge and how to charge.”

Decentralization of care proposes that care occurs in the most appropriate place to the complexity of the case, preferably near the patient’s house. Basic units, outpatient clinics and even home are preferable to hospitals, which should only attend the most serious cases. The proposal improves access, unburden emergency services and promotes more humanized and efficient care. But without professionals trained to work with autonomy in primary care, this logic disassembles.

“Without people prepared to take care, it is no use reorganizing the network. Decentralization needs to go hand in hand with the formation and appreciation of teamwork,” said José Gomes Temporão, former Minister of Health and Researcher at Fiocruz. For him, decentralizing care is also “a cultural response to the contemporary transformations of collective health, such as population aging and increased chronic diseases.”