ROUND TABLE DISCUSSION

Strategic training for health in Brazil

Antônio Ivo de Carvalho¹

National School of Public Health (ENSP), Oswaldo Cruz Foundation, Brazil

Brazil's Unified Health System (Sistema Unificado de Saude - SUS) is probably the largest public health system in the world today.

In 1988, the Sergio Arouca National School of Public Health of the Oswaldo Cruz Foundation (Fundação Oswaldo Cruz - FIOCRUZ) set up the School of Health Governance (Escola de Governo em Saúde), and embarked on a substantial "reorientation of its teaching and research programmes with a view to helping expand health governance capability and quality in Brazil". This new school has had a history of health achievements and social results including health improvements for citizens in large and previously often marginalized portions of the population. It is now imperative to managerial capability and quality, and to make health care effective, humane and comprehensive. In future, the challenge will be to consolidate the school as a centre for intersectoral policies and foster a new leading role for society and citizenry in the social production of health and well-being.

The school provides ongoing training and is directed to the production and large-scale dissemination of new professional and institutional competences to meet the challenges of the SUS. It gives special priority to the 100 000 managers at different spheres and levels of the SUS.

The school has expanded, and now involves some 40 000 practitioner-students in new teaching programmes as well as around 50 institutional partnerships in Brazil. The new model sees training as a component of the work process, directly oriented to the health system environment.

The school works within an agenda agreed with the SUS management, and developed from a shared perception of the deficits in managerial competence and resultant training needs.

The school proposes an educational path that fosters competence in mobilizing scientific knowledge for management practice. In view of the regional inequalities in existing training capacity in Brazil, the School of Governance model is being set up progressively as a single training system for the SUS. It is organized as a network of government schools, and the extensive use of new information, communication and distance-education technology allows these institutions to combine efforts and share resources in an appropriate time frame and at a tolerable cost. For FIOCRUZ, it has been stimulating to develop and coordinate, using this School of Governance model, Brazil's network of Schools of Public Health (about 30), SUS Technical Schools (about 50) and the Public Health Virtual Campus (in cooperation with the Pan American Health Organization).

More recently, in a joint venture with the Ministry of Health and universities, the Federal Nucleus of the School of Government was set-up. Under the coordination of the National School of Public Health (ENSP), it will develop advanced courses directed to the upper echelons of government, with a view to enabling various sectors to take a stronger role in the social construction of health.

1 Correspondence to Antônio Ivo de Carvalho (e-mail: aivo@ensp.fiocruz.br).