Social Medicine (www.socialmedicine.info) Volume 3 Number 4, November 2008- 221 -
VENEZUELAN HEALTH REFORMS
National Training Program for ComprehensiveCommunity Physicians, Venezuela
Eugenio Radamés Borroto Cruz& Ramón Syr Salas Perea
Note from the Editors: This article by Drs. Borroto Cruz and Salas Perea was published inthe Fall 2008 edition of MEDICC Review. Wewill be publishing a Spanish translation thismonth in Medicina Social. We present here theabstract of the article. We encourage readers toread the English original which is available at:www.medicc.org/mediccreview/ . The issue isentitled:
Teaching for Health Equity: Changing Paradigms of Medical Education.
National Training Program for ComprehensiveCommunity Physicians, VenezuelaIntroduction:
Through the 1990s, widedisparities in health status were recorded inVenezuela, a mirror of poor social conditions,decreasing investment in the public health sectorand a health workforce distribution unable to meetpopulation health needs or to staff effective,accessible public health services. Venezuelans’health status deteriorated as a result. In 2003-2004, the Venezuelan government launchedBarrio Adentro, a new national public healthmodel aimed at assuring primary health carecoverage for the entire population of an estimated26 million. Cuban physicians staff Barrio Adentroclinics, mainly in poor neighborhoods, untilenough Venezuelan physicians can be trained tofill the posts.
Intervention:
Cuban experience with community-oriented medical education and global healthcooperation was drawn upon to developcurriculum and provide faculty for the newNational Training Program for ComprehensiveCommunity Physicians, begun in 2005 incooperation with six Venezuelan universities. Theprogram differs from previous Venezuelanmedical education models by adopting a statedgoal of training physicians for public service,recruiting students who had no previousopportunity for university-level education, andconcentrating the weight of their training on aservice- and community-based model of education, relying on practicing physician-tutors.
Results:
Over 20,000 students have been enrolledin three years. The six-year program has beenextended to all 24 Venezuelan states, relyingmainly on Cuban faculty who are practicingBarrio Adentro doctors and who receivepostgraduate training in medical education. This“university without walls” has accredited 5,131Barrio Adentro clinics as teaching institutions; itsinfrastructure includes other health care deliveryfacilities plus 855 multipurpose classroomsthroughout the country. For the 2006-2007academic year, the pass rate was 82% for first-year students and 94% for second-year students.Some difficulties persist in student selection, pre-medical preparation, and achieving optimum useof existing resources. Academic, institutional, andexternal evaluations are ongoing.
Conclusion:
This is the most ambitious exampleof scaling up of physician training in a singlecountry. The program has been made possible byconsiderable political will from the Venezuelanand Cuban governments; by the experienceacquired through development of the Cuban healthsystem and medical education programs; by theindividual commitment of Cuban curriculumdevelopers and physician-tutors; and by ever-
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