Continuing Education in the Indigenous Health Care Subsystem in Brazil: A Documental Analysis
1
National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A1084
ABSTRACT
BACKGROUND:
Despite more than two decades since the establishment of the Indigenous Health Care Subsystem (SASI) in Brazil, a consolidated strategy for continuing education has yet to be achieved. Previous studies highlight the limited availability of initial training and continuing education initiatives, which contributes to the devaluation of Indigenous health workers, high professional turnover, management challenges, and compromised quality of health care delivery and surveillance.
METHODS:
This documentary study analyzed 34 District Indigenous Health Plans (Planos Distritais de Saúde Indígena – PDSI) covering the 2024–2027 period, as well as five reports from the Indigenous Health Seminars “A SasiSUS for Good Living”, conducted between 2024 and 2025.
RESULTS:
The analysis revealed considerable heterogeneity in both the content and depth of continuing education approaches across the documents. The Indigenous Health Seminars identified key challenges, including structural racism, fragile infrastructure, professional turnover, inadequate training, and the invisibility of Indigenous knowledge. The 34 PDSIs generally included brief sections on “Education Management,” predominantly presented as tables listing annual activities in absolute numbers. Proposed topics for 2024–2027 ranged from broad thematic areas to specific techniques, procedures, or health conditions, employing diverse methodological strategies. Recurring challenges included low professional adherence, limited internet access, and the scarcity of tailored training opportunities. Conversely, successful experiences were identified, such as institutional partnerships, distance learning initiatives, and Indigenous participation in educational activities. Final Considerations The findings indicate a lack of coherent theoretical and methodological frameworks for continuing education, likely reflecting the absence of a specific public policy from the Indigenous Health Secretariat to guide such actions. Strengthening Indigenous participation in training processes—particularly in teaching roles—and actively confronting institutional racism are essential to advancing continuing education within the SASI.
Despite more than two decades since the establishment of the Indigenous Health Care Subsystem (SASI) in Brazil, a consolidated strategy for continuing education has yet to be achieved. Previous studies highlight the limited availability of initial training and continuing education initiatives, which contributes to the devaluation of Indigenous health workers, high professional turnover, management challenges, and compromised quality of health care delivery and surveillance.
METHODS:
This documentary study analyzed 34 District Indigenous Health Plans (Planos Distritais de Saúde Indígena – PDSI) covering the 2024–2027 period, as well as five reports from the Indigenous Health Seminars “A SasiSUS for Good Living”, conducted between 2024 and 2025.
RESULTS:
The analysis revealed considerable heterogeneity in both the content and depth of continuing education approaches across the documents. The Indigenous Health Seminars identified key challenges, including structural racism, fragile infrastructure, professional turnover, inadequate training, and the invisibility of Indigenous knowledge. The 34 PDSIs generally included brief sections on “Education Management,” predominantly presented as tables listing annual activities in absolute numbers. Proposed topics for 2024–2027 ranged from broad thematic areas to specific techniques, procedures, or health conditions, employing diverse methodological strategies. Recurring challenges included low professional adherence, limited internet access, and the scarcity of tailored training opportunities. Conversely, successful experiences were identified, such as institutional partnerships, distance learning initiatives, and Indigenous participation in educational activities. Final Considerations The findings indicate a lack of coherent theoretical and methodological frameworks for continuing education, likely reflecting the absence of a specific public policy from the Indigenous Health Secretariat to guide such actions. Strengthening Indigenous participation in training processes—particularly in teaching roles—and actively confronting institutional racism are essential to advancing continuing education within the SASI.
| eISSN: | 2654-1459 |
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