Challenges in the training of mid-level workers for the Unified Health System in the state of Maranhão, Brazil

Abstract Historically, the training of mid-level health workers has been provided sporadically, with a focus on know-how. Within the context of the Brazilian Sanitary Reform, initiatives such as the ‘Large-Scale Training Project’ boosted the transition to an understanding of the critical-reflective technical work, and required a new model of training for basic- and mid-level workers. The Mid-Level Professional Training Program is the most recent large-scope initiative to qualify the work in the Unified Health System. We analyzed the profile, the work placement and the perception regarding the training process of this Training Program in the state of Maranhão, Brazil, of 404 graduates from the Technical School of the Unified Health System in Maranhão. We identified that: the socioeconomic profile of the graduates seems to mirror social inequalities; the teaching-learning process was in line with the guidelines of the Unified Health System, with pedagogical contradictions to be considered; and that there is a difficulty in retaining the trained professionals, which is expressed by the loss of ties, and the migration to private health services and to other fields not related to health. The qualification of professionals is complex, requiring actions in the field of political-pedagogical projects and work management projects, which go beyond the extension of the offer of enrollment spots in professionalization courses.

摘要 长期以来，中级卫生人员的培训多零星开展，且核心聚焦于实操技能的传授。在巴西卫生改革（Brazilian Sanitary Reform）的背景下，“大规模培训项目（Large-Scale Training Project）”等举措推动卫生工作理念向批判性反思型技术工作转型，同时也要求构建适配基层与中级卫生从业人员的全新培训模式。本次研究涉及的中级专业培训项目（Mid-Level Professional Training Program），是巴西统一卫生系统（Unified Health System）当前规模最大的专业人才资质提升举措之一。本研究以巴西马拉尼昂州统一卫生系统技术学院（Technical School of the Unified Health System in Maranhão）的404名毕业生为研究样本，对该培训项目的学员画像、就业安置情况以及学员对培训流程的认知展开分析。研究结果表明：一是毕业生的社会经济特征映射出当前存在的社会不平等问题；二是教学流程虽契合统一卫生系统的指导方针，但仍存在亟待重视的教学矛盾；三是培训后的专业人才留存面临显著困境，具体表现为人才与公立系统的职业纽带断裂、流向私立卫生服务机构，乃至转行至与卫生领域无关的其他行业。专业人才的资质提升是一项复杂的系统性工程，不仅需要扩充职业技能培训的招生名额，更需在政治-教学项目与工作管理项目层面开展多维度建设行动。