Interprofessional work and education in the National Brazilian Health System: evaluating and monitoring for improvement

Background: Since its inception in the 1980s, the National Brazilian Health System (SUS) was based on teamwork and the integration of promotion, prevention, and care actions in defined territories and population, along a vast and diverse country. Comprehensive health care requires interprofessional work and education. This approach has been adopted, especially in Primary Health Care in the SUS, particularly with the implementation of the Family Health Strategy, but it is still fragile in specialized care.

The implementation of the SUS is also based on the premise of interdependence between work and continued education, integrated with changes in health training incorporating interprofessional education since the mid-2000s. This study analyzed monitoring and evaluation of interprofessional work and education, in order to describe a theoretical-logical model conducive to the development of a matrix with dimensions, criteria, and indicators of interprofessionality. The study and proposals were requested by the Ministry of Health, aiming to apply indicators of interprofessional teamwork and education countrywide.

 

Approach: Evaluative study developed in three phases: scope review and document analysis; development of the theoretical-logical model and the matrix of indicators of interprofessionality in the SUS; and workshops in the five regions of the country, with representatives of potential users of the indicators: managers, health professionals, teachers, students and patients.

 

Results: The theoretical-logical model has two levels: political-institutional and interprofessional health and education practices. The political-institutional level has two dimensions: Work and health education management policies, and Institutionalization of interprofessional activities. The level of health practices and interprofessional education has four dimensions: Interprofessional communication, centrality of the health needs of users and the population, Interprofessional collaboration, and power relations and participatory management.

 

In the resulting indicator matrix, each dimension unfolds into criteria, indicators, sources, and granularity. This process lead to 29 indicators of interprofessional work and education, related to: 1. Existence of a policy; 2. Institutionalization at the federal, state, and municipal levels in health practices and educational institutions; 3. Number of educational programs/plans with interprofessional components; 4. Number of programs/plans with shared decision-making between professionals and users; 5. Number of educational programs/plans about the scope of practice of various health and social work professions, number of health services that receive students for interprofessional activities, and percentage of interprofessional activities in partnership with sectors other than health; 6. Collective management committees in health services and educational institutions; 7. Interprofessional activities carried out with the participation of SUS patients, 8. Events and institutional initiatives analyzing interprofessionality with the participation of professional bodies, and 9. Joint Academia-Health Services actions on participatory management and collaborative leadership.

 

Implications: The logical model and matrix of indicators for interprofessional work and education in the SUS is suitable to be adopted by the system, health services, and educational institutions. They are also suitable to be extended to other countries scenarios with national health systems using comprehensive health care approach and interprofessional practice. The model and matrix of indicators constitutes instruments for strengthening interprofessional practice and education and the integration of promotion, prevention, and care actions.