More Doctors recruitment program: a new approach to overcome inequalities in human resources/Programa Mais Medicos: como avaliar o impacto de uma abordagem inovadora para superacao de iniquidades em recursos humanos/Programa Mas Medicos: como evaluar el impacto de un enfoque innovador para superar las inequidades en recursos humanos.(Artigo especial articulo en portugues)

Despite the 40 years elapsed since the Alma-Ata principles were first launched, a series of challenges still persists for the consolidation of primary health care (PHC) as the backbone of health care systems around the world. Among these challenges, especially noteworthy are the issues associated with the inequality in the allocation of human resources. The experience of the More Doctors Program (Programa Mais Medicos, PMM) in Brazil is an example of initiatives that tackle this inconclusive AlmaAta agenda. By changing key aspects of physician training, provision, and allocation, PMM was shown to be a feasible alternative to minimize the challenge of physician shortage. Assessments of PMM, even though preliminary, have produced positive evidence showing increase in access and improvement of PHC quality in Brazil, a middle income country. Nevertheless, the generation of more robust evidence regarding the impact of PMM on PHC performance indicators is urgent. The discussion proposed in the present article emphasizes the need to prioritize quasi-experimental studies to measure the impact of PMM on population health. The article thus introduces a set of guidelines that may become a useful model to approach challenges associated with the shortage of health care professionals in low and middle income countries. Keywords Human Resources; delivery of health care; physicians distribution; health care rationing. Apesar de decorridos 40 anos da divulgacao dos principios de Alma-Ata, ainda persistem desafios para a consolidacao da atencao primaria a saude (APS) como eixo norteador dos sistemas de saude ao redor do globo. Dentre os desafios ainda presentes, merecem destaque as questoes associadas a iniquidade na distribuicao de recursos humanos em saude. A experiencia do Programa Mais Medicos (PMM) no Brasil e um exemplo de proposta voltada para a abordagem dessa agenda inconclusa de Alma-Ata. Ao modificar aspectos centrais da formacao, provimento e alocacao de profissionais medicos, o PMM mostrou-se uma saida viavel para minimizar os desafios de escassez de profissionais. As avaliacoes do PMM, embora incipientes, produziram evidencias positivas quanto a ampliacao do acesso e melhoria da qualidade da APS no Brasil, um pais de medio desenvolvimento economico. Apesar disso, e premente a geracao de evidencias mais solidas a respeito do impacto do PMM sobre indicadores de desempenho da APS. O debate apresentado ao longo deste trabalho discute a necessidade de se viabilizar