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Review article
Medwave 2020;20(2):e7848 doi: 10.5867/medwave.2020.02.7848
Characteristics of compulsory service programs for medical professionals in the Andean states
Guido Bendezu-Quispe , Franco León, Joel Moreno, Fiorella Inga-Berrospi
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Key Words: rural health, rural health services, health physician personnel, physician

Abstract

Introduction
There are few studies on the impact of social service programs on health in the professional development of doctors in the Andean States (Argentina, Bolivia, Chile, Colombia, Ecuador, Peru, and Venezuela). The purpose of these programs is to increase the availability of human resources in health in rural and remote areas.

Objective
To describe the regulations of social service programs for medical professionals in the Andean countries.

Methods
We carried out a bibliographic review of normative documents concerning the social service for medical professionals using websites of governments of the Andean States as data sources. We sought to obtain information regarding service conditions, funding of these programs—including remunerations, and means of program allocation. Additionally, we used PubMed/MEDLINE to find complementary information on mandatory social services in these countries.

Results
Social service for medical professionals is established under a regulatory framework in all the Andean countries, except for Argentina, where this program does not exist. Participants receive remuneration (except in Bolivia, where students perform the service). The allocation systems used for these programs are heterogeneous, and in some Andean countries, the allocation is merit-based. Participation in social programs influences later professional opportunities (Ecuador, Colombia, and Venezuela) and the ability to specialize (Chile and Peru).

Conclusions
It is necessary to study the impact of these programs on the professional development of the participants to design and implement quality improvement strategies tailored to each context.


 

Only Spanish version is available.

Licencia Creative Commons Esta obra de Medwave está bajo una licencia Creative Commons Atribución-NoComercial 3.0 Unported. Esta licencia permite el uso, distribución y reproducción del artículo en cualquier medio, siempre y cuando se otorgue el crédito correspondiente al autor del artículo y al medio en que se publica, en este caso, Medwave.

 

Introducción
Se ha estudiado poco sobre el impacto de los programas de servicio social en salud en el desarrollo profesional de médicos de los Estados Andinos (Argentina, Bolivia, Chile, Colombia, Ecuador, Perú y Venezuela), programas cuya finalidad es incrementar los recursos humanos en salud en zonas rurales y remotas.

Objetivo
Describir la normativa de los programas de servicio social para profesionales médicos de los Estados Andinos.

Métodos
Se realizó una revisión bibliográfica de documentos normativos concernientes al servicio social para profesionales médicos en sitios web de gobiernos de los Estados Andinos, con la finalidad de obtener información la condición de servicio, financiamiento del programa/remuneraciones y modos de adjudicación. Adicionalmente, se empleó el motor de búsqueda PubMed para complementar la información sobre servicios sociales obligatorios en estos países.

Resultados
El servicio social para profesionales médicos está establecido bajo un marco normativo en todos los Estados Andinos, a excepción de Argentina, donde no existe este programa. Los participantes perciben una remuneración, salvo en Bolivia, donde el servicio es realizado por estudiantes. Los sistemas de adjudicación para estos programas son heterogéneos, siendo que en algunos Estados Andinos existe asignación de plazas según criterios meritocráticos. La participación en programas sociales en salud condiciona el ejercicio profesional (Ecuador, Colombia y Venezuela) y el poder realizar una especialización (Chile y Perú).

Conclusiones
Se requiere estudiar del impacto de estos programas en el desarrollo profesional del participante, con el objetivo de implementar estrategias de mejora adecuadas a sus contextos particulares.

Authors: Guido Bendezu-Quispe [1], Franco León[2], Joel Moreno[2], Fiorella Inga-Berrospi [3]

Affiliation:
[1] Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú
[2] Departamento Académico de Medicina Preventiva y Salud Pública, Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Perú
[3] Escuela de Medicina, Universidad Continental, Lima, Perú

E-mail: gbendezu@usil.edu.pe

Author address:
[1] Universidad San Ignacio de Loyola
Av. La Fontana 550, La Molina
Lima, Perú

Citation: Bendezu-Quispe G, León F, Moreno J, Inga-Berrospi F. Characteristics of compulsory service programs for medical professionals in the Andean states. Medwave 2020;20(2):e7848 doi: 10.5867/medwave.2020.02.7848

Submission date: 30/8/2019

Acceptance date: 14/2/2020

Publication date: 31/3/2020

Origin: Not commissioned

Type of review: Externally peer-reviewed by two reviewers, double-blind

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  40. Antonio CT, Guevarra JP, Medina PN, Avelino MD, Agbon AG, Sepe DC, et al. Components of compulsory service program for health professionals in low- and middle-income countries: a scoping review. Perspect Public Health. 2020 Jan;140(1):54-61. | CrossRef | PubMed |
  41. Reid SJ, Peacocke J, Kornik S, Wolvaardt G. Compulsory community service for doctors in South Africa: A 15-year review. S Afr Med J. 2018 Aug 30;108(9):741-747. | CrossRef | PubMed |
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Agudelo CA. Integración regional andina en salud. Cad. Saúde Pública. 2007;23:S267-72. | CrossRef |

Flores-Anaya L, León-Lozada C, Mayta-Tristán P. Servicio social en medicina en Latinoamérica: cobertura sin retención. Salud Publica Mex. 2016 Jan-Feb;58(1):2-3. | PubMed |

Acuña MC. Exclusión, protección social y el derecho a la salud. OPS/OMS; 2005.

Van Wieren A, Palazuelos L, Elliott PF, Arrieta J, Flores H, Palazuelos D. Service, training, mentorship: first report of an innovative education-support program to revitalize primary care social service in Chiapas, Mexico. Glob Health Action. 2014 Nov 3;7:25139. | CrossRef | PubMed |

Cavender A, Albán M. Compulsory medical service in Ecuador: the physician's perspective. Soc Sci Med. 1998 Dec;47(12):1937-46. | PubMed |

Palma AE, Gutiérrez AM, Morejon PG, Castro A. La medicina rural, un imperativo en los países en vías de desarrollo. Enferm Inv (Ambato). 2018;3(Sup 1):48-52. [On line]. | Link |

Hongoro C, McPake B. How to bridge the gap in human resources for health. Lancet. 2004 Oct 16-22;364(9443):1451-6. | PubMed |

Mayta-Tristán P, Poterico JA, Galán-Rodas E, Raa-Ortiz D. [Mandatory requirement of social health service in Peru: discriminatory and unconstitutional]. Rev Peru Med Exp Salud Publica. 2014 Oct-Dec;31(4):781-7. | PubMed |

World Health Organization. Increasing access to health workers in remote and rural areas through improved retention. 2010. [On line]. | Link |

Ley 17.132. Reglas para el ejercicio de la medicina, odontología y actividad de colaboración de las mismas. Buenos Aires: Ministerio de Justicia y Derechos Humanos; 1967. [On line]. | Link |

Decreto Supremo N° 26217. Reglamento del Servicio Social de Salud Rural Obligatorio. La Paz; 2001. [On line]. | Link |

Ley 19664. Establece normas especiales para profesionales funcionarios que indica de los servicios de salud y modifica la ley nº 15.076. Santiago: Ministerio de Salud; 2000. [On line]. | Link |

Resolución N° 1058. Reglamento del Servicio Social Obligatorio para los egresados de los programas de educación superior del área de la salud. Bogotá: Ministerio de la Protección Social; 2010. [On line]. | Link |

Acuerdo Ministerial N° 5307. Expedir la norma para el cumplimiento del Año de Salud Rural del Servicio Social en la Red Pública Integral de Salud. Quito: Ministerio de Salud Pública; 2015. [On line]. | Link |

Espinosa V, de la Torre D, Acuña C, Cadena C. [Human resources for health in Ecuador's new model of care]. Rev Panam Salud Publica. 2017 Jun 8;41:e52. | PubMed |

Ley N° 23330. Ley del Servicio Rural y Urbano Marginal de Salud. Lima: Ministerio de Salud; 2018. [On line]. | Link |

Asamblea Nacional de la República Bolivariana de Venezuela. Ley N° 38.272. Ley del Servicio Comunitario del Estudiante de Educación Superior. Caracas; 2005. [On line]. | Link |

Asamblea Nacional de la República Bolivariana. Ley N° 30.823. Ley del Ejercicio de la Medicina. 2011. [On line]. | Link |

Guillou M, Carabantes C J, Bustos F V. [Availability of physicians and specialists in Chile]. Rev Med Chil. 2011 May;139(5):559-70. | CrossRef | PubMed |

Biblioteca del Congreso Nacional de Chile. Ley N° 15076. Fija el texto refundido del estatuto para los Médicos- cirujanos, Farmacéuticos o Químico-farmacéuticos, Bioquímicos y Cirujanos dentistas. Santiago; 1962. [On line]. | Link |

Ministerio de Salud y Protección social. Resolución Ministerial N° 2358. Procedimiento para la asignación de las plazas del Servicio Social Obligatorio - SSO-, de las profesiones de medicina, odontología, enfermería y bacteriología, en la modalidad de prestación de servicios de salud. Bogotá; 2014. [On line]. | Link |

Ministerio de Salud de Chile. Evaluación de programa “Política de Formación de Especialistas en Chile”. 2013. [On line]. | Link |

Frehywot S, Mullan F, Payne PW, Ross H. Compulsory service programmes for recruiting health workers in remote and rural areas: do they work? Bull World Health Organ. 2010 May;88(5):364-70. | CrossRef | PubMed |

Yuksekdag Y. The right to exit and skilled labour emigration: Ethical considerations for compulsory health service programmes. Dev World Bioeth. 2019 Sep;19(3):169-179. | CrossRef | PubMed |

Wiwanitkit V. Mandatory rural service for health care workers in Thailand. Rural Remote Health. 2011;11(1):1583. | PubMed |

Liaw ST, McGrath B, Jones G, Russell U, Bourke L, Hsu-Hage B. A compulsory experiential and inter-professional rural health subject for undergraduate students. Rural Remote Health. 2005 Oct-Dec;5(4):460. | PubMed |

Ferrinho P, Van Lerberghe W. Providing health care under adverse conditions: health personnel performance & individual coping strategies. SHSOP. 2000;16. [On line]. | Link |

Mollahaliloglu S, Aydogan U, Kosdak M, Oncul HG, Dilmen U. The views of new graduate physicians about compulsory service in Turkey. Med J Islamic World Acad Sci. 2012;20(4):140-145. [On line]. | Link |

Capstick S, Beresford R, Gray A. Rural pharmacy in New Zealand: effects of a compulsory externship on student perspectives and implications for workforce shortage. Aust J Rural Health. 2008 Jun;16(3):150-5. | CrossRef | PubMed |

Liu X, Dou L, Zhang H, Sun Y, Yuan B. Analysis of context factors in compulsory and incentive strategies for improving attraction and retention of health workers in rural and remote areas: a systematic review. Hum Resour Health. 2015 Jul 21;13:61. | CrossRef | PubMed |

Lehmann U, Dieleman M, Martineau T. Staffing remote rural areas in middle- and low-income countries: a literature review of attraction and retention. BMC Health Serv Res. 2008 Jan 23;8:19. | CrossRef | PubMed |

Johnson JC, Nakua E, Dzodzomenyo M, Agyei-Baffour P, Gyakobo M, Asabir K, et al. For money or service?: a cross-sectional survey of preference for financial versus non-financial rural practice characteristics among Ghanaian medical students. BMC Health Serv Res. 2011 Nov 3;11:300. | CrossRef | PubMed |

Sánchez Del Hierro G, Remmen R, Verhoeven V, Van Royen P, Hendrickx K. Are recent graduates enough prepared to perform obstetric skills in their rural and compulsory year? A study from Ecuador. BMJ Open. 2014 Jul 31;4(7):e005759. | CrossRef | PubMed |

Lertrattananon D, Limsawart W, Dellow A, Pugsley H. Does medical training in Thailand prepare doctors for work in community hospitals? An analysis of critical incidents. Hum Resour Health. 2019 Jul 29;17(1):62. Lertrattananon D, Limsawart W, Dellow A, Pugsley H. Does medical training in Thailand prepare doctors for work in community hospitals? An analysis of critical incidents. Hum Resour Health. 2019 Jul 29;17(1):62. | CrossRef | PubMed |

Ortiz-Acosta R, Beltrán-Jiménez BE. Habilidades clínicas, inteligencia emocional percibida y desgaste laboral en médicos pasantes de servicio social. Inv Ed Med. 2019;8(29):76-84. | CrossRef |

Muñoz Cano JM, Córdova Hernández JA. Percepción de pasantes de medicina en servicio social sobre su plan de estudios. Perspectivas Docentes. 2018;28(63). | CrossRef |

Ugalde HS, Roldán SM. Perspectivas del Servicio Médico Social en Costa Rica. Acta Méd Costarric. 2000 Jun;42(2):71-75. [On line]. | Link |

Grobler L, Marais BJ, Mabunda S. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database Syst Rev. 2015 Jun 30;(6):CD005314. | CrossRef | PubMed |

Dolea C, Stormont L, Braichet JM. Evaluated strategies to increase attraction and retention of health workers in remote and rural areas. Bull World Health Organ. 2010 May;88(5):379-85. | CrossRef | PubMed |

Antonio CT, Guevarra JP, Medina PN, Avelino MD, Agbon AG, Sepe DC, et al. Components of compulsory service program for health professionals in low- and middle-income countries: a scoping review. Perspect Public Health. 2020 Jan;140(1):54-61. | CrossRef | PubMed |

Reid SJ, Peacocke J, Kornik S, Wolvaardt G. Compulsory community service for doctors in South Africa: A 15-year review. S Afr Med J. 2018 Aug 30;108(9):741-747. | CrossRef | PubMed |

World Health Organization. Global strategy on human resources for health: Workforce 2030. Geneva, Switzerland. 2016. [On line]. | Link |