Workforce dynamics in Brazilian primary health care: 2013-2023

Abstract

The dynamics of the health workforce is a complex challenge for the Unified Health System, given the significant regional differences in Brazil. Considering the need to produce information on the HWF for system management, the aim of this article was to analyse the growth and distribution of higher education professions in Health Centre/Basic Health Unit-type establishments in Brazil and its regions between 2013 and 2023. It is a descriptive study using the online database of the Department of Informatics of the Ministry of Health (DATASUS). Over a decade (2013-2023), there was a 53% increase in the number of professionals working in primary care units in Brazil, more significantly from 2019 to 2023. The total population ratio of professionals in Brazil and in each region increased in the three periods observed, with the Brazilian rate of higher education professionals in primary care being 170.16 per 100,000 inhabitants in 2023, compared to 117.58 in 2013. In all the periods evaluated, the S and SE regions had a higher population ratio than the CO, NE and especially N regions. The study shows that there was growth in the different occupations. However, density differences in the allocation of professionals remain a challenge in primary care.

Key words:
Health workforce; Health professionals; Primary care; Primary Health Care

Resumo

A dinâmica da força de trabalho em saúde (FTS) é um desafio complexo para o Sistema Único de Saúde, dada as significativas diferenças regionais no Brasil. Considerando a necessidade de produção de informações sobre a FTS para a gestão do sistema, o objetivo desse artigo foi analisar o crescimento e a distribuição das profissões de nível superior nos estabelecimentos tipo Centro de Saúde/Unidade Básica de Saúde no Brasil e suas regiões, entre 2013 e 2023. É um estudo descritivo utilizando o banco de dados online do Departamento de Informática do Ministério da Saúde (DATASUS). Em uma década (2013-2023), houve crescimento de 53% na ocupação por profissionais de nível superior nas unidades de atenção básica no Brasil, mais expressivamente de 2019 a 2023. A razão populacional total de profissionais no Brasil e em cada região aumenta nos três períodos observados, sendo a taxa brasileira de profissionais de nível superior na atenção básica de 170,16 para cada 100.000 habitantes em 2023, em comparação à taxa de 117,58 em 2013. Em todos os períodos avaliados, as regiões S e SE apresentaram razão populacional maior que as das regiões CO, NE e, especialmente N. O estudo demonstra que houve crescimento nas diferentes ocupações. No entanto, as diferenças de densidade na alocação de profissionais permanecem um desafio na AB.

Palavras-chave:
Força de trabalho; Profissionais de saúde; Atenção básica; Atenção Primária à Saúde

Resumen

La dinámica de la fuerza de trabajo en salud es un desafío complejo para el Sistema Único de Salud, dadas las significativas diferencias regionales en Brasil. Considerando la necesidad de producir información sobre la FTS para la gestión del sistema, el objetivo de este artículo fue analizar el crecimiento y la distribución de las profesiones de educación superior en los establecimientos del tipo Centro de Salud/Unidad Básica de Salud en Brasil y sus regiones entre 2013 y 2023. Se trata de un estudio descriptivo que utiliza la base de datos en línea del Departamento de Informática del Ministerio de Salud (DATASUS). En una década (2013-2023), hubo un aumento del 53% en el número de profesionales que trabajan en unidades de atención primaria en Brasil, más significativamente de 2019 a 2023. La proporción de profesionales en Brasil y en cada región aumentó en los tres períodos observados, siendo la tasa brasileña de profesionales de educación superior en atención primaria de 170,16 por 100.000 habitantes en 2023, frente a 117,58 en 2013. En todos los períodos evaluados, las regiones S y SE presentaron una tasa de población superior a las regiones CO, NE y, especialmente, N. El estudio muestra que hubo crecimiento en las diferentes ocupaciones. Sin embargo, las diferencias de densidad en la asignación de profesionales siguen siendo un reto en la atención primaria.

Palabras clave:
Fuerza laboral en salud; Profesionales de la salud; Atención primaria; Atención Primaria de Salud

Introduction

The availability of an organized and adequately prepared health workforce to meet health needs is essential to ensure access to health services, reduce costs, and prevent morbidity and premature deaths¹. The health workforce (HWF) is a driver of social development and health security². Recent global experience with the COVID-19 pandemic underscored the well-known maxim that there is no health without a health workforce³. The response capacity of health systems was shaped by the ability of their workforce to promote prevention, detection, and appropriate responses to the situation. To achieve such capacity, health systems require a consistent workforce development plan⁴.

In Brazil, however, planning for HWF development and deployment has not been based on objective assessments, even though it should be grounded in the characteristics of professionals, their work processes (productivity, workload), the current health system’s characteristics (coverage and type of services offered), and the population’s health needs and specificities⁵. In the national context, we also see a lack of knowledge about present and future needs for health professionals⁶.

The implementation of the Unified Health System (SUS) as a state policy can be regarded as successful and as a global landmark in broad-reaching social policy⁷. Even so, management of labor and education in health is riddled with challenges of great magnitude because of the complexity involved: geographic and historical inequities, underfunding, widespread private-sector provision of professional education, precarious working conditions, informal employment ties, wage deterioration, the lack of public management models aimed at valuing and retaining workers, and intergovernmental relations⁸.

Since the period preceding the Eighth National Health Conference and the Constitutional Charter that created the SUS, limitations in the health workforce have remained among the obstacles to consolidating universal coverage and ensuring equity and care. Added to this picture, Brazil experienced a recent political past marked by authoritarianism that culminated in the discontinuity and interruption of important structuring initiatives and public policies for the SUS. The SUS workforce suffered from the lack of a federal policy coordinating actions oriented toward its governance, including for confronting the COVID-19 pandemic in Brazil⁹.

Although studies and health policies have focused more heavily on the presence of doctors in health services, we should recognize that, since the advent of the Family Health Strategy (ESF) and the reflection on the need to shift from a biologicist model toward one that includes comprehensive care, other Higher-Education health professions have grown in number of jobs in the sector, albeit in different proportions^10,11. The SUS organizes the Brazilian health system and is responsible for most health establishments and for employing about 80% of the sector’s workforce. According to the preparatory document for the Fourth National Conference on Labor Management and Health Education held in December 2024, Brazil has more than 3 million workers employed in the SUS, 75% of them women. Technical-level professionals predominate in all regions, particularly nursing technicians¹², configuring the historic doctor-assistant binomial (now technical professionals).

Considering the social and health context presented above, together with the need to produce information on the HWF for system management, this article aims to analyze the growth and regional distribution of Higher-Education professions registered in the CNES in establishments classified as “Health Center/PHC Unit” over the last ten years, identifying possible trends in the historical series analyzed and thereby contributing to the debate on workforce planning and sizing in the SUS.

Methods

This is a quantitative, descriptive, analytical, and retrospective study on the growth and distribution in Brazil and its regions, of Higher-Education health professions registered in establishments classified as Health Center/PHC Unit in the National Registry of Health Establishments (CNES). The data were extracted from the online database of the Department of Informatics of the Ministry of Health (DATASUS). The study follows previous research by the authors, which analyzed data from 2008 to 2013. Using the same perspective and methodology, the present research analyzes the 2013-2023 period, complementing and comparing the numbers and rates recorded in the two periods.

The fourteen Higher-Education professions analyzed were social worker, biologist, biomedical scientist, dentist (odontologist or dentist), physical education professional, nurse, pharmacist, physical therapist, speech therapist, doctor, veterinarian, nutritionist, psychologist, and occupational therapist. These categories were selected according to Resolution No. 287 of October 8, 1998, of the National Health Council (CNS)¹³.

Data collection was limited to information related to Health Centers/PHC Units (UBS), defined as units intended to provide primary care services to a population, whether scheduled or not, and which may offer medical, dental, and other Higher-Education professional care. These establishments are registered in the CNES and are considered the “gateway” to the SUS in all versions of the National Primary Care Policy (PNAB)¹⁴. The CNES is the largest secondary-source database in health, providing information on jobs (classified according to the Brazilian Classification of Occupations [CBO]), workers, and the number of employment ties for each worker. It includes all those linked to health establishments^15,16. Limitations of its use as a data source concern its scope; that is, support services for management are not included in its universe. This means that not all administrative support professionals, whether linked to the SUS or not, are included¹⁷.

We analyzed data referring to the December 2013-December 2023 period. Data were collected from December 2024 to January 2025 on the DATASUS portal, as shown in Figure 1. For temporal trend analysis, the period was subdivided into two intervals: 2013-2018 and 2018-2023. This division allows us to identify changes associated with different political, health, and economic contexts, including periods of investment retrenchment and the pandemic period.

Figure 1
Data access and extraction flow from the DATASUS portal.

The data were exported from DATASUS and organized in electronic spreadsheets in Microsoft Excel®. The following steps were conducted: 1) Consolidating employment ties by occupation and region; 2) Eliminating duplicates resulting from multiple ties; 3) Standardizing categories according to the CBO; and 4) Aggregating data by year, region, and occupation.

The analysis was conducted in three dimensions: 1) Growth in establishments and workforce, in which population growth rates, growth rates of CS/UBS, and growth rates of Higher-Education occupations were calculated; 2) Population ratio of professionals, used to assess the relative availability of the workforce, calculated as the number of professionals per 100,000 inhabitants. Population data were obtained from the 2022 Demographic Census of the Brazilian Institute of Geography and Statistics (IBGE); and 3) Regional and temporal comparative analysis, through which comparisons were made across Brazilian regions, between the two periods analyzed, among professional categories, and between workforce growth and the expanded service network. This strategy identified expansion trends, regional inequalities, and changes in the occupational profile.

Results

From 2013 to 2023, the Brazilian population increased from 201,062,789 to 212,583,750, representing an increment of 11,520,961 inhabitants and therefore a growth rate of 6% over 10 years^18,19. In turn, establishments classified as Health Center/PHC Unit (CS/UBS) registered in the CNES increased from 34,009 to 41,554 units, which means an increase of 7,545 new services and a growth of 8%.

In the 2013-2018 period, the North (N) and Midwest (MW) regions both showed population growth of 7%, the Northeast (NE) showed the lowest growth (only 2%), and the Southeast (SE) and South (S) grew by 4% and 3%, respectively. In turn, establishments classified as “CS/UBS” registered in the CNES showed a different dynamic in each region, with the highest rate observed in the North, at 23%, followed by the Midwest at 12%, somewhat tracking population growth. In contrast, in the Northeast, where the population growth rate was the lowest, establishments grew by 11%; in the remaining regions, Southeast and South, the rates were 7% and 5%, respectively. Regarding occupations, in the Northeast and Midwest regions, the rates were synchronized with the growth in establishments (23% and 23%; 12% and 12%). In the Northeast, the occupation rate was higher than the establishment rate (14% and 11%, respectively), as was also the case in the other regions, Southeast and South (10% and 7%; 10% and 5%, respectively) (Figure 2).

Figure 2
Growth rate of the Brazilian population, Health Centers/PHC Units, and higher-level occupations by region. Brazil, a) Dec/2013 to Dec/2018; b) Dec/2018 to Dec/2023.

In the same figure, when we analyze the 2018-2023 period, the picture changes. The population growth rate is highest in the Midwest (6%), followed by the South (5%), North (3%), and Northeast and Southeast with 1% each. The establishment rate remains highest in the North (20%), increases in the Northeast (13%), Southeast (10%), and South (8%), and is cut in half in the Midwest (6%). Growth rates for Higher-Education occupations show a considerable increase in all regions during this period, with the South showing the greatest growth (51%), followed by the North (42%), Midwest (38%), Southeast (34%), and Northeast (31%).

The total number of occupations in jobs increased from 236,419 in 2013 to 361,729 in 2023, an increase of 125,310 new occupations. Occupations held by Higher-Education professionals in PHC units in Brazil grew 53% over a decade (2013-2023) (Table 1).

Table 1
Gross growth rate (%) of Higher-Education occupations registered in Health Centers/PHC Units in the CNES by Brazilian region (Dec 2013-Dec 2018 and Dec 2018-Dec 2023).

CBO 2002 Occupations	2013-2018						2018-2023
	N	NE	MW	SE	S	BR	N	NE	MW	SE	S	BR
Social Worker	40%	39%	8%	14%	12%	21%	26%	12%	21%	23%	28%	21%
Biologist	-22%	-54%	-45%	-18%	6%	-25%	-57%	-56%	0%	-24%	-18%	-30%
Biomedical Scientist	128%	36%	-21%	41%	36%	39%	64%	30%	26%	67%	100%	52%
Dentist	16%	11%	11%	3%	2%	7%	32%	24%	17%	14%	17%	19%
Nurse	25%	18%	16%	17%	18%	18%	42%	28%	48%	37%	58%	39%
Pharmacist	106%	51%	34%	36%	53%	44%	55%	33%	74%	27%	51%	38%
Physiotherapist	54%	38%	41%	16%	26%	27%	30%	37%	38%	39%	61%	41%
Speech Therapist	56%	40%	41%	14%	10%	22%	4%	21%	7%	6%	44%	14%
Doctor	7%	-3%	-2%	2%	1%	1%	45%	31%	36%	42%	62%	43%
Veterinarian	100%	17%	-9%	30%	-9%	19%	109%	81%	190%	44%	106%	75%
Nutritionist	50%	50%	39%	27%	31%	35%	56%	43%	35%	41%	50%	44%
Physical Education Professional	138%	70%	96%	98%	110%	91%	140%	133%	90%	51%	63%	86%
Psychologist	71%	46%	39%	18%	26%	28%	55%	55%	59%	40%	56%	48%
Occupational Therapist	140%	52%	8%	6%	71%	24%	4%	-4%	21%	-4%	47%	2%
Total	23%	14%	12%	10%	10%	12%	42%	31%	38%	34%	51%	37%

CBO 2002 Occupations	2013-2023
	N	NE	MW	SE	S	BR
Social Worker	77%	55%	30%	41%	44%	47%
Biologist	-67%	-79%	-45%	-38%	-13%	-48%
Biomedical Scientist	274%	77%	0%	135%	171%	110%
Dentist	53%	38%	30%	18%	19%	27%
Nurse	78%	51%	72%	61%	86%	64%
Pharmacist	219%	100%	134%	73%	130%	100%
Physiotherapist	101%	89%	94%	61%	102%	79%
Speech Therapist	63%	69%	51%	21%	58%	39%
Doctor	54%	27%	34%	45%	63%	44%
Veterinarian	318%	112%	164%	87%	88%	108%
Nutritionist	133%	115%	87%	79%	97%	95%
Physical Education Professional	472%	296%	272%	200%	242%	257%
Psychologist	165%	126%	121%	66%	97%	89%
Occupational Therapist	149%	46%	31%	2%	152%	26%
Total	75%	49%	54%	47%	67%	53%

• Notes: N = North; NE = Northeast; MW = Midwest; SE = Southeast; S = South.
• Source: Ministry of Health - DATASUS (2025).

Among the professional categories registered in Health Center/PHC Unit establishments in the CNES, in the 2013-2018 period, the Physical Education Professional showed the highest growth rate (91%), followed by Pharmacists (44%). In the subsequent period (2018-2023), we observed a greater percentage growth in most professional categories: physical education professionals (86%), followed by veterinarians (75%), biomedical scientists (52%), psychologists (48%), nutritionists (44%), and doctors (43%) (Table 1).

There was an important percentage increase for the doctor category, which in the 2013-2018 period showed negative variation in the Northeast and Midwest and national growth of only 1%, whereas it grew by more than 30% in all regions in the 2018-2023 period. In contrast, the lowest rates included dentists, with the lowest rate in the 2013-2018 period (7%), and occupational therapists, with a rate of only 2% in the 2018-2023 period (Table 1).

Negative variation is observed for biologists in all regions and periods; growth in biomedicine, especially in the North, Southeast, and South, particularly in the second period; growth in veterinarians in all regions, especially in the second period studied; the highest growth rates for physical education professionals in both periods and in all regions; and, finally, the large variation in occupational therapy rates in the first period, with a sharp decrease in the second (Table 1).

Table 2 shows the ratio of Higher-Education occupations per 100,000 inhabitants in 2013, 2018, and 2023. The overall ratio of professionals in Brazil and in each region increases across the three periods observed, with the Brazilian rate of Higher-Education professionals in primary care reaching 170.16 per 100,000 inhabitants in 2023, compared with 117.58 in 2013. In all periods evaluated, the South and Southeast had higher overall rates than the Midwest, Northeast, and especially the North.

Table 2
Population ratio (per 100,000 inhabitants) of Higher-Education occupations registered in Health Centers/PHC Units in the CNES by Brazilian region (Dec 2013-Dec 2018 and Dec 2018-Dec 2023).

CBO 2002 Occupations	2013						2018
	N	NE	MW	SE	S	BR	N	NE	MW	SE	S	BR
Social Worker	3.0	3.0	3.2	3.7	3.6	3.4	3.9	4.0	3.2	4.1	3.9	4.0
Biologist	0.1	0.1	0.1	0.1	0.1	0.1	0.1	0.0	0.0	0.1	0.1	0.1
Biomedical Scientist	0.2	0.1	0.4	0.1	0.0	0.1	0.5	0.2	0.3	0.1	0.1	0.2
Dentist	15.6	22.6	21.2	20.6	24.7	21.4	16.9	24.7	22.0	20.5	24.4	22.0
Nurse	24.8	29.8	27.8	26.0	29.7	27.6	29.1	34.7	30.0	29.4	33.8	31.5
Pharmacist	1.3	1.2	2.8	3.1	3.3	2.4	2.6	1.8	3.5	4.0	4.8	3.4
Physiotherapist	2.7	4.7	4.0	5.1	4.9	4.7	3.9	6.3	5.2	5.7	6.0	5.7
Speech Therapist	0.7	1.2	1.2	2.3	1.8	1.7	1.0	1.6	1.5	2.6	1.9	2.0
Doctor	28.8	36.5	39.1	55.2	55.9	46.7	28.8	34.7	35.9	54.3	54.7	45.4
Veterinarian	0.1	0.2	0.1	0.1	0.2	0.1	0.1	0.2	0.1	0.2	0.2	0.2
Nutritionist	1.9	2.8	2.7	3.1	4.2	3.0	2.6	4.1	3.4	3.8	5.3	4.0
Physical Education Professional	0.6	1.3	0.7	1.0	0.9	1.0	1.3	2.1	1.3	1.8	1.8	1.8
Psychologist	2.1	3.0	3.6	6.0	6.4	4.7	3.4	4.3	4.7	6.8	7.8	5.8
Occupational Therapist	0.2	0.5	0.4	1.0	0.3	0.6	0.5	0.7	0.4	1.0	0.4	0.7
Total	82.2	106.9	107.2	127.4	135.9	117.6	94.7	119.5	111.6	134.3	145.2	126.6

CBO 2002 Occupations	2023
	N	NE	MW	SE	S	BR
Social Worker	4.9	4.5	3.7	5.0	4.8	4.7
Biologist	0.0	0.0	0.0	0.1	0.0	0.0
Biomedical Scientist	0.8	0.2	0.3	0.2	0.1	0.3
Dentist	21.8	30.5	24.3	23.1	27.3	25.7
Nurse	40.3	44.0	41.9	39.9	51.2	42.8
Pharmacist	3.9	2.4	5.7	5.1	7.0	4.6
Physiotherapist	4.9	8.6	6.8	7.8	9.3	7.9
Speech Therapist	1.0	2.0	1.5	2.7	2.6	2.2
Doctor	40.6	45.3	46.1	76.3	84.5	63.6
Veterinarian	0.2	0.3	0.2	0.2	0.3	0.3
Nutritionist	3.9	5.8	4.4	5.3	7.7	5.6
Physical Education Professional	3.0	4.9	2.4	2.7	2.8	3.3
Psychologist	5.1	6.6	7.1	9.4	11.6	8.4
Occupational Therapist	0.5	0.7	0.5	0.9	0.6	0.7
Total	130.9	155.8	144.8	178.7	209.7	170.2

• Notes: N = North; NE = Northeast; MW = Midwest; SE = Southeast; S = South.
• Source: Ministry of Health - DATASUS (2025).

The doctor category is the one with the highest number of records in the CNES in all periods and regions, followed by nurses and dentists. However, this category shows greater concentration in the South and Southeast in all periods and, moreover, a higher growth rate in the South compared with the others in 2023. Psychologists and pharmacists also figure among the categories, and in the South and Southeast, they present higher population ratios than in the other regions. Nutritionists and physical education professionals, in turn, show greater concentration in the Northeast, especially from 2018 to 2023.

Discussion

In its three decades of existence, the SUS has been affected by changes in the national political, economic, social, and the health contexts. Discontinued public policies, aggravated by the COVID-19 pandemic and post-pandemic period, led to exacerbated transformations in the configuration of health teams and in the profile of care practices. The landscape is emerging as a challenge for labor management in the health sector^20,21.

The results presented here portray the last ten years of this situation. The growth in the number of establishments classified as Health Center/PHC Unit above population growth in all regions indicates an upward movement in primary care, resulting from investments linked to municipalities. Kashiwakura et al.²¹ showed a positive relationship between municipal primary care expenditure and the infrastructure of health units, revealing major regional disparities in which, in the North and Northeast, the proportion of structures classified as lower quality stands out. The increase in per capita municipal health expenditure is also recognized²², indicating that, even under national economic recession and fiscal austerity policies, municipalities maintained (albeit with important differences among them) the policy of expanding primary care.

The growth of the primary care workforce is constant over the decade, albeit more pronounced in the latter period. Although the North showed higher growth rates than the others until 2018, the 2018-2023 period’s rates of growth were higher in all regions. In turn, the profile of Higher-Education occupations changes, with an expressive increase in most professions in the 2019-2023 period, except for biologists and occupational therapists. The increase in primary care coverage through expansion in the number of health teams is also evident, since in 2019, more than half of Brazilian municipalities had 100% coverage. Certainly, the increased density of workers from several categories is directly related to the capacity to expand primary care coverage.

The 2013-2018 period was marked by policies of investment retrenchment and recession. The contingent of workers in this period experienced only modest growth, which may characterize maintenance, in contrast with the period previously studied (2008 and 2013), which was marked by the expansion of the Family Health Strategy and the implementation of NASF^10,11. In the same period, the proportion of chronically ill people in the population rose from 15.04% to 31.48%^23,24, which should have been an indicator for increasing the primary care workforce. Evidence supporting policy decisions to expand the workforce is well known, as shown by the study by Costa et al.²⁵, which showed that primary care coverage from 2008 to 2018 was associated with a lower likelihood of death among older adults from primary care-sensitive conditions. Likewise, in 2018, a study by Dilelio et al.²⁶ showed that the proportion of primary care teams with an adequate work process and the proportion of UBS with adequate structure were associated with a lower infant mortality rate.

In this same period (2013-2018), growth of only 1% in the doctor category stands out, with negative growth in the Northeast and Midwest. For dentists, growth was only 7%. Girardi et al.²⁷ argue that, although in those years, policies to expand health services in Brazil targeted the most vulnerable regions and reduced inequalities, guaranteeing human resources for care to the population was a barrier.

The following period recorded a 43% increase in the employment of doctors, and the ratio of doctors per 100,000 inhabitants was 46.71 (2013), 45.38 (2018), and 63.60 (2023). The factors that led to these findings include how foreign doctors from the More Doctors Program (PMM) were registered in the CNES. In the first years, the PMM was created using a special professional category, since these doctors received a Unique PMM Registration issued by the Ministry of Health, and several studies showed that there was an increase in the number of doctors in primary care in the 2013-2015 period²⁷. Subsequently, there was a reduction of more than 8,000 doctors due to the breakdown of international relations between Brazil and Cuba. The resumption of the PMM (then called the More Doctors for Brazil Program) brought back growth in the number of doctors, including both Brazilian doctors trained in Brazil and abroad and foreign doctors²⁷.

Unfilled jobs in primary care still persist in Brazil, and gaps in medical education remain: the supply of places in very high-cost private medical schools continues, with major geographic and social disparities in access to medical training. The North and Northeast offer the country’s lowest per capita rates of vacancies in undergraduate medical programs.

The 2019-2023 period begins with a retrenchment of investments in public policies, followed by the COVID-19 pandemic, and ends with the beginning of a new political administration that resumes valuing primary care and implements incentive programs for hiring, such as the return of the PMM and the creation of incentives for e-Multi teams. Late 2023 witnessed a significant positive growth balance in most categories and in population ratios of primary care professionals in all regions.

Notably, however, although the North showed expressive growth rates in recent years for many professional categories, with growth above the national average, the population ratio for all categories remained, in late 2023, lower than in the other regions and the national average. Therefore, although programs have targeted vulnerabilities historically presented in the region, inequity remains a reality to be addressed with strong public policies.

In 2023 alone, 2,198 Family Health teams (ESF) were implemented in the country, representing an increase of 52%. As a result, the Ministry of Health reports a 16% increase in medical visits and a 29% increase in medical procedures compared with 2022²⁸. To achieve 80% primary care coverage by 2026^28,29, the Ministry of Health aims to implement 2,360 more ESFs, 3,030 Oral Health teams, and 1,000 Multiprofessional teams. Such measures must consider, however, regional and intraregional inequities and the organizational and economic capacity of Brazilian municipalities.

Final considerations

The changes in the political and health context experienced by the country have certainly influenced the configuration of and forms of investment in and organization of health services, reflected in the several adjustments to the National Primary Care Policy (PNAB) since its first version in 2006. However, the present study shows that, although specific to each region of the country, there was growth in the different occupations. Therefore, the many Higher-Education professional categories in Primary Care grew in the periods studied, except for biologists, whose category remained stagnant.

Some factors may be relevant to explain this situation. One is the ESF, which brought a new way of organizing services through teams and defined micro-areas, corroborated by the strategy of implementing NASF, which introduced new ways of delivering health care, broadening the doctor-nurse-dentist triad by bringing new forms of knowledge into teams and new approaches to care for the population. It would be worthwhile to delve deeper into the impact of NASF teams and perhaps of multiprofessional residency training in primary care, as well as of the recently created e-Multi teams, given the heterogeneity in the dynamics of HWF composition in primary care over the periods analyzed.

A second factor may be attributed to the change in institutional vision introduced in the context of primary care, fulfilling the role of expanding procedures and care practices from the perspective of an expanded concept of health. In any case, these are factors that deserve more in-depth investigation and were not the object of this study.

The data analyzed here, however, do not provide information on the working conditions to which these professionals are subjected, and this is a limitation of the study, indicating the need for deeper investigation. The precarization of working conditions, unprotected contractual relations, and fragility in guaranteeing workers’ rights are recognized as growing elements in public administration, along with their effects on service quality and workers’ quality of life.

Finally, considering the scope and importance of the SUS in the national and international context, and also given that the SUS has collegiate institutional spaces for management, it would be important to prioritize efforts to analyze and construct adjustments in the instruments that qualify management so that they effectively reveal the landscape of workforce needs in all care levels, especially in PHC, thus enabling workforce planning. Overcoming this critical bottleneck will reveal to us the reality of HWF dynamics in the SUS and in the Health sector, estimating trends for better sizing of needs and future challenges. The CNES, as a management tool, is a commitment of all SUS managers, especially municipal managers. It is the main management tool that will make it possible to better understand the dynamics of the HWF in the SUS.

References

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• Data availability statement
  The data sources adopted in the research are indicated in the article’s body.

• Chief editors:
  Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva, Vania de Matos Fonseca

Data availability

The data sources adopted in the research are indicated in the article’s body.

Publication Dates

• Publication in this collection
  27 July 2026
• Date of issue
  June 2026

History

• Received
  31 Jan 2025
• Accepted
  19 Mar 2026
• Published
  21 Mar 2026