Living Labor in Action: Workforce Planning and Sizing in Primary Health Care in Espírito Santo, Brazil
1
1 Capixaba Institute for Education, Research and Innovation in Health, Espírito Santo State Department of Health, Vitória, Brazil
2
2 Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitória, Brazil
3
3 Espírito Santo State Department of Health (SESA), Brazil, Vitória, Brazil
4
4 Department of Health Workforce Management and Education, Ministry of Health, Brazil, Distrito Federal, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A1856
ABSTRACT
INTRODUCTION:
Workforce planning in Primary Health Care (PHC) is strategic for strengthening health systems and ensuring equitable access to care. Beyond quantitative staffing requirements, it must consider territorial specificities, social vulnerabilities, and work processes. Grounded in the Brazilian public health concept of living labor in action (trabalho vivo em ato), understood as a relational, ethical, and political practice shaped by everyday care encounters, workforce sizing is conceived as an ethical-political device and an analytical tool to reflect on care production, integrality, and equity within territories.¹˒²
METHODS:
This study reports an experience of PHC workforce planning in the São Pedro Health Region, Vitória, Espírito Santo, conducted between December 2024 and April 2025 within a national training program. A descriptive-analytical approach included territorial characterization and analysis of four vulnerability indicators: beneficiaries of cash transfer programs, children under five, older adults, and infant mortality. Territories were stratified by vulnerability to define population-to-team ratios. Workforce sizing considered weekly workloads adjusted for absenteeism and statutory leave, following national methodological guidelines.³˒⁴
RESULTS:
The analysis revealed significant mismatches between calculated workforce needs and the actual composition of Family Health teams. Physicians and nursing technicians showed productivity above recommended parameters, indicating systemic strain, while nurses and community health workers presented lower-than-expected productivity in several units. These discrepancies highlight tensions between standardized productivity models and the complexity of care in socially vulnerable territories, reinforcing workforce sizing as an analytical device for understanding work organization.¹˒²
CONCLUSIONS:
PHC workforce sizing should not be reduced to a merely technocratic task. When grounded in the concept of living labor in action, it functions as an ethical-political device capable of revealing tensions in work processes, supporting care reorganization, and promoting equity. Incorporating territorial singularities and relational dimensions of care is essential for sustainable workforce management and for strengthening PHC within universal public health systems.¹˒⁵
Workforce planning in Primary Health Care (PHC) is strategic for strengthening health systems and ensuring equitable access to care. Beyond quantitative staffing requirements, it must consider territorial specificities, social vulnerabilities, and work processes. Grounded in the Brazilian public health concept of living labor in action (trabalho vivo em ato), understood as a relational, ethical, and political practice shaped by everyday care encounters, workforce sizing is conceived as an ethical-political device and an analytical tool to reflect on care production, integrality, and equity within territories.¹˒²
METHODS:
This study reports an experience of PHC workforce planning in the São Pedro Health Region, Vitória, Espírito Santo, conducted between December 2024 and April 2025 within a national training program. A descriptive-analytical approach included territorial characterization and analysis of four vulnerability indicators: beneficiaries of cash transfer programs, children under five, older adults, and infant mortality. Territories were stratified by vulnerability to define population-to-team ratios. Workforce sizing considered weekly workloads adjusted for absenteeism and statutory leave, following national methodological guidelines.³˒⁴
RESULTS:
The analysis revealed significant mismatches between calculated workforce needs and the actual composition of Family Health teams. Physicians and nursing technicians showed productivity above recommended parameters, indicating systemic strain, while nurses and community health workers presented lower-than-expected productivity in several units. These discrepancies highlight tensions between standardized productivity models and the complexity of care in socially vulnerable territories, reinforcing workforce sizing as an analytical device for understanding work organization.¹˒²
CONCLUSIONS:
PHC workforce sizing should not be reduced to a merely technocratic task. When grounded in the concept of living labor in action, it functions as an ethical-political device capable of revealing tensions in work processes, supporting care reorganization, and promoting equity. Incorporating territorial singularities and relational dimensions of care is essential for sustainable workforce management and for strengthening PHC within universal public health systems.¹˒⁵
| eISSN: | 2654-1459 |
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