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National training program revamps the nursing profession in Brazil

Brazil’s national Program for Training Auxiliary Nurses (PROFAE) has been so successful that it almost resembles those "before" and "after" photos that often accompany ads for weight-loss programs and the like.

Before PROFAE, the country’s health workforce could be broken into three groups: medical doctors (one-third), other trained health professionals (one-third), and more than 200,000 uncertified, untrained “auxiliary nurses,” or attendants who had worked their way up from lower-level positions in the health care system.

Now, six years after PROFAE began, the first two components of the workforce are unchanged, but the third of the health workforce made up of auxiliary nurses is now fully trained and certified and their numbers have grown from 200,000 to more than 323,000, broadly distributed across every state in the country.

Dr. Francisco Eduardo de Campos, Director of Work and Education in Health in Brazil’s Ministry of Health and head of PROFAE, recently came to IDB headquarters in Washington, DC, to discuss his country’s experience with the program.

“This program [PROFAE] was part of a process Brazil was going through to formalize health services across the country. Our national health system aimed to provide every Brazilian with universal, equitable and holistic health services, but before we began the program, human resources in the health sector were a major constraint on achieving that goal,” Dr. de Campos said.

Before PROFAE began, Brazil had no shortage of university programs to train doctors and specialists, but it lacked technical schools to provide training for nurses, health technicians and attendants.

“Things were to the point that family health nurses and attendants were embarrassed to tell people what they did for a living because there was no official recognition of the profession and no formal education was required or even available,” Dr. de Campos explained. “On top of that, Brazil’s health system underwent a huge expansion in the 1980s; during that period the number of ‘informal’ health attendants operating in the country jumped from around 115,000 to over 200,000.”

The Brazilian government, using its own funds as well as resources from an IDB loan, started PROFAE, which cost some $370 million, in the year 2000. The program has since provided both classroom and on-the-job training to more than 323,000 health attendants and auxiliary nurses, enabling them to upgrade their job skills to become full-fledged professional nurses after 18 months, or more than 1,200 hours, of intensive training.

Brazil’s Ministry of Health is currently working to implement a national accreditation system incorporating the core competencies of nurses, as well as upgrade the more than 300 technical schools that have been created nationwide to carry out the training program, Dr. de Campos indicated. Of those technical schools, 37 are administered directly by Brazil’s national health system, and the rest were contracted to provide training for the program after successfully participating in a national bidding process.

“PROFAE has been so successful that my government has approached the IDB regarding a second program, which we call PROFAPS, to extend the original concept to other technical areas beyond nursing, such as radiology, dental technical skills, home health care, laboratory skills and health surveillance, for example. We’re also interested in inviting technical health personnel from other countries in the region to participate in PROFAE,” Dr. de Campos said.