Physician Provision Programmes and Health Workforce Governance in Primary Health Care: Evidence from Espírito Santo, Brazil
1
Federal University of Espírito Santo, Vitória/ES, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A3524
ABSTRACT
ABSTRACT:
Physician shortages and insufficient training for Primary Health Care (PHC) have driven the implementation of physician provision programmes at federal and subnational levels in Brazil.1,2 In the state of Espírito Santo, three initiatives coexist: two federally managed programmes (the More Doctors Programme and Doctors for Brazil) and a state-led programme (Qualifica-APS).3 These programmes reflect distinct approaches to public health workforce governance and have expanded physician availability in PHC. This study analyses their contribution to the composition of the PHC medical workforce in Espírito Santo. This cross-sectional study included all 78 municipalities in Espírito Santo. Data were collected in May 2024 from the Ministry of Health’s PHC Coverage History system, the National Monitoring Panel of Physician Provision Programmes, and administrative records from the State Health Secretariat of Espírito Santo. The outcome was the proportion of PHC teams staffed by programme physicians, calculated as the ratio between programme-based physicians and total PHC teams per municipality, expressed as a percentage. Descriptive analyses were conducted overall and stratified by municipal typology. In Espírito Santo, 90.5% of PHC teams included physicians from provision programmes. Qualifica-APS accounted for 48.8% of teams, the More Doctors Programme for 38.1%, and Doctors for Brazil for 13.1%. Urban municipalities showed higher coverage (92.7%) than rural (90.3%) and intermediate municipalities (81.7%). In 36 municipalities, coverage reached or exceeded 100.0%, indicating more than one physician per team. The programmes totalled 1,100 physicians, with coverage ranging from 0.0% to 150.0% across municipalities. These findings demonstrate the central role of physician provision programs in guaranteeing access to PHC and reveal varied governmental capacities to steer the health workforce. Qualifica-APS illustrates how state governments actively shape policy beyond federal initiatives. Strengthening such multilevel governance is essential for transitioning from emergency staffing solutions toward a stable, sustainable, and long-term public workforce strategy.
Physician shortages and insufficient training for Primary Health Care (PHC) have driven the implementation of physician provision programmes at federal and subnational levels in Brazil.1,2 In the state of Espírito Santo, three initiatives coexist: two federally managed programmes (the More Doctors Programme and Doctors for Brazil) and a state-led programme (Qualifica-APS).3 These programmes reflect distinct approaches to public health workforce governance and have expanded physician availability in PHC. This study analyses their contribution to the composition of the PHC medical workforce in Espírito Santo. This cross-sectional study included all 78 municipalities in Espírito Santo. Data were collected in May 2024 from the Ministry of Health’s PHC Coverage History system, the National Monitoring Panel of Physician Provision Programmes, and administrative records from the State Health Secretariat of Espírito Santo. The outcome was the proportion of PHC teams staffed by programme physicians, calculated as the ratio between programme-based physicians and total PHC teams per municipality, expressed as a percentage. Descriptive analyses were conducted overall and stratified by municipal typology. In Espírito Santo, 90.5% of PHC teams included physicians from provision programmes. Qualifica-APS accounted for 48.8% of teams, the More Doctors Programme for 38.1%, and Doctors for Brazil for 13.1%. Urban municipalities showed higher coverage (92.7%) than rural (90.3%) and intermediate municipalities (81.7%). In 36 municipalities, coverage reached or exceeded 100.0%, indicating more than one physician per team. The programmes totalled 1,100 physicians, with coverage ranging from 0.0% to 150.0% across municipalities. These findings demonstrate the central role of physician provision programs in guaranteeing access to PHC and reveal varied governmental capacities to steer the health workforce. Qualifica-APS illustrates how state governments actively shape policy beyond federal initiatives. Strengthening such multilevel governance is essential for transitioning from emergency staffing solutions toward a stable, sustainable, and long-term public workforce strategy.
| eISSN: | 2654-1459 |
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