title: Implementation research: towards universal health coverage with more doctors in Brazil.
abstract: OBJECTIVE
  To evaluate the implementation of a programme to provide primary care physicians for remote and deprived populations in Brazil.
  
  
  METHODS
  TheMais Médicos(More Doctors) programme was launched in July 2013 with public calls to recruit physicians for priority areas. Other strategies were to increase primary care infrastructure investments and to provide more places at medical schools. We conducted a quasi-experimental, before-and-after evaluation of the implementation of the programme in 1708 municipalities with populations living in extreme poverty and in remote border areas. We compared physician density, primary care coverage and avoidable hospitalizations in municipalities enrolled (n= 1450) and not enrolled (n= 258) in the programme. Data extracted from health information systems and Ministry of Health publications were analysed.
  
  
  RESULTS
  By September 2015, 4917 physicians had been added to the 16 524 physicians already in place in municipalities with remote and deprived populations. The number of municipalities with ≥ 1.0 physician per 1000 inhabitants doubled from 163 in 2013 to 348 in 2015. Primary care coverage in enrolled municipalities (based on 3000 inhabitants per primary care team) increased from 77.9% in 2012 to 86.3% in 2015. Avoidable hospitalizations in enrolled municipalities decreased from 44.9% in 2012 to 41.2% in 2015, but remained unchanged in control municipalities. We also documented higher infrastructure investments in enrolled municipalities and an increase in the number of medical school places over the study period.
  
  
  CONCLUSIONS
  Other countries having shortages of physicians could benefit from the lessons of Brazil's programme towards achieving universal right to health.
authors.affiliation: Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Saúde Coletiva, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900 Brasília, Brazil .
authors.forename: Leonor Maria Pacheco
authors.initials: LM
authors.lastname: Santos
authors.affiliation: Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Saúde Coletiva, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900 Brasília, Brazil .
authors.forename: Aimê
authors.initials: A
authors.lastname: Oliveira
authors.affiliation: Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Saúde Coletiva, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900 Brasília, Brazil .
authors.forename: Josélia Souza
authors.initials: JS
authors.lastname: Trindade
authors.affiliation: Fundação Osvaldo Cruz - Ceará, Torre Saúde, Fortaleza, Brazil .
authors.forename: Ivana Chc
authors.initials: IC
authors.lastname: Barreto
authors.affiliation: Universidade Federal de Campina Grande, Centro de Educação e Saúde, Cidade Universitária, Cuité, Brazil .
authors.forename: Poliana Araújo
authors.initials: PA
authors.lastname: Palmeira
authors.affiliation: Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Saúde Coletiva, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900 Brasília, Brazil .
authors.forename: Yamila
authors.initials: Y
authors.lastname: Comes
authors.affiliation: Fundação Osvaldo Cruz - Brasília, Campus Universitário Darcy Ribeiro, Brasília, Brazil .
authors.forename: Felipe Os
authors.initials: FO
authors.lastname: Santos
authors.affiliation: Secretaria de Estado de Saúde do Distrito Federal, Diretoria Regional de Atenção Primária - DIRAPS, Brasília, Brazil .
authors.forename: Wallace
authors.initials: W
authors.lastname: Santos
authors.affiliation: Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Saúde Coletiva, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900 Brasília, Brazil .
authors.forename: João Paulo Alves
authors.initials: JP
authors.lastname: Oliveira
authors.affiliation: Fundação Osvaldo Cruz - Ceará, Torre Saúde, Fortaleza, Brazil .
authors.forename: Vanira Matos
authors.initials: VM
authors.lastname: Pessoa
authors.affiliation: Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Saúde Coletiva, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900 Brasília, Brazil .
authors.forename: Helena Eri
authors.initials: HE
authors.lastname: Shimizu
mesh_terms: D001938:Brazil; D003906:Developing Countries; D006297:Health Services Accessibility / Q000458:organization & administration*; D006302:Health Services Research; D006280:Health Workforce / Q000458:organization & administration*; D006801:Humans; D008507:Medically Underserved Area; D009313:National Health Programs / Q000458:organization & administration*; D058007:Physicians, Primary Care / Q000600:supply & distribution*; D015397:Program Evaluation