Understanding to care well: work related mental disorders in Brazil health sector and management implicationsAbstract
This article aims to analyze the occurrence of work-related mental disorders (WRMD) among healthcare workers, discussing their implications for health workforce management, with a focus on policy development, workforce recognition, and the assurance of adequate working conditions. This descriptive ecological study examined the occurrence and distribution of WRMD between 2015 and 2023, using data from the Notifiable Diseases Information System and the National Registry of Health Establishments. A total of 22,110 cases of work-related mental disorders were identified, of which 3,504 (15.8%) occurred among health workers, with a predominance of women (87.5%). The prevalence increased from 3.5 per 100,000 workers in 2015 to 13.3 in 2023, mainly in the Northeast and Midwest regions. The most affected categories were public health agents, nurses, community health workers and nursing assistants and technicians. The increase in cases demands workforce policies and actions aimed at professional appreciation, prevention, and comprehensive mental health care within the Unified Health System.
Key words:
Mental disorders; Health personnel; Occupational health; Health management
Resumo
O objetivo deste artigo é analisar a ocorrência de transtornos mentais relacionados ao trabalho (TMRT) entre trabalhadores(as) da saúde, discutindo suas implicações para a gestão do trabalho em saúde, com foco na formulação de políticas, na valorização do trabalho e na garantia de condições adequadas de trabalho. Estudo ecológico descritivo que examinou a ocorrência e distribuição dos TMRT entre 2015 e 2023, utilizando dados do Sistema de Informação de Agravos de Notificação e do Cadastro Nacional de Estabelecimentos de Saúde. No período analisado, foram registrados 22.110 casos de TMRT, sendo 3.504 (15,8%) em trabalhadores(as) da saúde, com predominância em mulheres (87,5%). A prevalência aumentou de 3,5 por 100.000 trabalhadores(as) em 2015 para 13,3 em 2023, com destaque para as regiões Nordeste e Centro-Oeste. As categorias mais afetadas foram agentes de saúde pública, enfermeiras, agentes comunitários de saúde e auxiliares e técnicos de enfermagem. O crescimento dos casos exige políticas e ações de Gestão do Trabalho voltadas à valorização profissional, prevenção e atenção integral à saúde mental no Sistema Único de Saúde.
Palavras-chave:
Transtornos mentais; Pessoal de saúde; Saúde do Trabalhador; Gestão em saúde
Resumen
El objetivo de este artículo es analizar la ocurrencia de trastornos mentales relacionados con el trabajo (TMRL) entre trabajadores de la salud, discutiendo sus implicaciones para la gestión del trabajo en salud, con énfasis en la formulación de políticas, la valoración del trabajo y la garantía de condiciones laborales adecuadas. Estudio ecológico descriptivo que examinó la ocurrencia y distribución de los TMRL entre 2015 y 2023, utilizando datos del Sistema de Información de Enfermedades de Declaración Obligatoria y del Registro Nacional de Establecimientos de Salud. Se registraron 22.110 casos de trastornos mentales relacionados con el trabajo, de los cuales 3.504 (15,8%) correspondieron a trabajadores de la salud, en su mayoría mujeres (87,5%). La prevalencia aumentó de 3,5 por 100.000 trabajadores en 2015 a 13,3 en 2023, principalmente en las regiones Nordeste y Centro-Oeste. Las categorías más afectadas fueron agentes de salud pública, enfermeras, agentes comunitarios de salud y auxiliares y técnicos de enfermería. El aumento de casos exige políticas y acciones de gestión orientadas a la valorización profesional, la prevención y la atención integral a la salud mental en el Sistema Único de Salud.
Palabras clave:
Trastornos mentales; Personal de salud; Salud laboral; Gestión en salud
Introduction
Work is a fundamental act in people’s lives because, at its core, it represents the possibility of fulfillment and of social and collective satisfaction. Despite the recent and growing expansion of isolated/individualized forms of work, work remains one of the main spaces for social integration1. By enabling the satisfaction of needs, work helps shape the way individuals perceive themselves, directly influencing their self-esteem and their position within the social fabric. Thus, work is essential to the construction of the identity of those who perform it2,3. Work is also a space in which the recognition and the derecognition of individuals and groups take shape, thereby creating relationships of power and domination on the one hand, and of recognition and belonging on the other.
Therefore, for work to be beneficial to those who perform it, it must be pleasurable, morally and socially acceptable, stimulating, and developed on the basis of respectful relationships; that is, it must be far removed from degrading, unsafe, or unprotected conditions. At the same time, it must meet both objective expectations (through adequate conditions, wages, and working hours) and symbolic expectations (through valuing, recognition, connection to positive bonds, and a sense of social relevance)1,4.
For positive subjectivity to be produced in everyday working life, working conditions should essentially allow workers to perform their activities with freedom, autonomy, mobilized capacities, creativity, and solidarity. In this context, the organization and management of the work process play a central role, since they determine whether work will be a source of fulfillment or, conversely, a factor of suffering and illness1,4.
World of work transformations have shown that the possibility of full realization in the workplace is increasingly distant, mainly because of the increased social precarization of labor, driven above all by the ultraliberal logic of economic production5. As a consequence of these overlapping processes, mental illness emerges or exacerbates among workers, associated with new/old configurations of working conditions, work processes, employment ties, and labor relations, marked by increasingly flexible and precarious recruitment forms, without social protection guarantees, with more intense and longer working hours, insufficient pay, and work management grounded in fear, insecurity, and oppression, especially among the most vulnerable groups6.
By expanding unsafe and violent work, the absence of prospects, the predominance of competition, and lack of solidarity within the working class, and social isolation, these processes compound psychological distress3,7,8. Impaired mental health thus exposes the harmfulness of these ongoing processes of exploitation and labor disenfranchisement6. In the Brazilian Health sector, all these precarious work features have spiraled since the 1990s.
A climate of insecurity predominates, given the different types of employment ties, wages, and differentiated access to labor rights. This situation also contributes to workplace violence and harassment-a problem that is growing sharply in the Health sector9. Several studies have identified situations of intense mental illness associated with factors within the context of health work precarization10-12.
In the Brazilian Unified Health System (SUS), Work-Related Mental Disorders (WRMDs) represent a major challenge for Health Workforce Management, because while actions and services must be fostered to provide care to the population, it is equally essential to care for the health workforce - the driving force behind the very purpose of the SUS. This requires strategies to confront both macro-level (outsourcing and different management models) and micro-level factors (management by fear in health services, harassment, violence, wage and workload disparities, and lack of labor-rights protection), which together may reverse the current situation observed.
To this end, identifying the characteristics and magnitude of the problem is a fundamental step toward an appropriate approach with the potential to guide a well-conducted intervention. Information on the mental health of workers provides the basis for implementing health-care programs to prevent and treat problems related to occupational stressors and mental health. This would allow us to create effective strategies to address the problem, while also providing support for the development of specific policies that tackle psychosocial risk factors and promote a healthier work environment.
We should also emphasize that the mental health and well-being of health workers are crucial determinants of the quality of the services they provide. Mentally healthy health teams deliver care and communicate more effectively and empathetically, and they show greater willingness to collaborate with peers, creating a more cohesive and productive work environment13. These factors not only increase the satisfaction of the populations served but also have a positive impact on clinical outcomes, including faster recovery and lower complication rates. Therefore, investing in the mental health of health workers is a strategic and necessary action to improve service quality and the overall well-being of the populations they serve.
Given the importance of workers’ mental health to sound health workforce management practices, this article aims to analyze the occurrence of work-related mental disorders (WRMDs) among health workers and to discuss their implications for health workforce management, focusing on policymaking, work recognition, and the guarantee of adequate working conditions.
Methods
This ecological, descriptive study focused on analyzing the occurrence and distribution of WRMDs from 2007 to 2023. WRMD cases were retrieved from the Notifiable Diseases Information System (SINAN), considering health workers identified through the National Classification of Economic Activities (CNAE). CNAE organizes economic activities into sections corresponding to large blocks or families of occupations, allowing for a standardized and systematic classification of the professionals included in the analysis.
The SINAN database is publicly available and provided by the Department of Informatics of the Unified Health System (DATASUS) at: https://datasus.saude.gov.br/transferencia-de-arquivos/. The following strategy was adopted to build the database,: (a) Converting files from .DBC to .CSV format; (b) Selecting cases, separating from the generated database the cases with National Registry of Health Establishments (CNES) in families 86, 87.1, and 87.2-which refer to human healthcare activities, including hospital and outpatient services; (c) from the database generated by selecting the CNES of interest, selecting cases belonging to health workers based on occupation codes (CBO); and (d) finally, checking again the data case by case to verify the adequacy of the selection to the occupations associated with the categories described above. CNES data were made available by the Ministry of Health.
We identified and organized 478 occupations/specialties linked to the health sector in this study into 13 major categories: doctors; nurses; dentists; other higher-level health occupations; nursing aides and technicians; community health workers; public health and sanitation workers, including endemic disease workers; other technical- and auxiliary-level health occupations; administration (managers); other administrative occupations; cleaning and maintenance services; security; and other elementary-level health occupations. These categories are the same as those used in CNES and were grouped in this way to estimate the prevalence of WRMDs. Thus, the denominators for the estimates were obtained from CNES.
We selected the following variables to describe WRMDs: year of notification, federation unit (state) and municipality of residence, age, gender, ethnicity/skin color, schooling, occupation (CBO), employment status, sector of economic activity (CNAE), employment relationship (outsourced or not), specific diagnosis (according to the International Classification of Diseases, ICD-10), measures taken, whether there were other workers with the same problem in the same workplace, issuance of a Work Accident Report (CAT), and case outcome.
For data analysis, we estimated annual prevalence rates from 2015 to 2023 - a period chosen because it showed greater completeness and data quality, thereby avoiding biases arising from underreporting in earlier years. Estimates were stratified by Brazilian region and federation unit. We analyzed aggregated data for the entire period to develop a descriptive analysis of the distribution of occurrences by sociodemographic and occupational variables. The 2015 population estimate (midpoint of the period) was used as the denominator for calculating prevalence by occupational category. Frequencies of missing and ignored cases were recorded to gauge notification problems (reported in table and graph notes). Data were tabulated and analyzed using spreadsheet software and accessed in June 2024.
Results
In Brazil, from 2007 to 2023, 3,504 WRMD cases were recorded among Health Workers (HWs), of which 3,067 occurred in women (87.5%) and 437 in men (12.5%), corresponding to a ratio of seven records among women for every one record among men. The Southeast accounted for the highest percentage of records, totaling 41% of cases, and the state of Minas Gerais accounted for 22.8% of all notifications in the country. The Northeast accounted for 24.6% of records, followed by the South (20.0%) (Graph 1). Although the total number of cases differed across regions, all showed an increase in the number of WRMD cases during the period analyzed, especially from 2020 onward.
Number of registered cases of work-related musculoskeletal disorders (WRMSDs) among health workers, by Brazilian regions, from 2007 to 2023.
From 2015 to 2023, the prevalence of WRMDs among HWs rose from 3.5 to 13.3 per 100,000 HW. In 2023, prevalence in the North was 19.9/100,000 HW, with the highest values in the states of Roraima (45.7/100,000) and Pará (30.5/100,000). In the Northeast, the mean prevalence was 13.6/100,000, with Rio Grande do Norte (50.8/100,000) and Paraíba (35.2/100,000) standing out. In the Southeast, overall prevalence was 10/100,000, but reached 21.1/100,000 in Minas Gerais. In the South, prevalence was 15.1/100,000, with Rio Grande do Sul showing the highest prevalence (26.4/100,000). In the Midwest, prevalence was 21.9/100,000, with Mato Grosso do Sul showing the highest prevalence (98.9/100,000). Notably, Mato Grosso do Sul was the state with the highest prevalence of WRMDs in the country (Table 1).
Analysis of the socio-occupational profile of reported cases (Table 2) showed that notifications predominated among women (87.5%), in the 30-49 age group (69.7%), and among self-reported White individuals (56.8%). Regarding schooling, percentages were similar between workers with secondary education (45.8%) and higher education (43.0%). Most records occurred among public servants (61.0%), and in 45.1% of cases, the adopted measure was removal from the workplace, the most frequent response observed. Reports of other people with WRMDs in the same workplace were found in 59.2% of cases. Temporary disability predominated in case outcomes, accounting for 73.0% of records. Two cases resulted in death; CAT was issued in 35.2% of cases. Missing information was observed for many variables, which affects the accurate sizing of the real situation.
Considering occupational groups, nursing aides and technicians were the categories with the highest number of records (35.2%), followed by community health workers (19.4%) and nurses (17.7%). In terms of prevalence, the most affected categories were Public Health workers (489.8), nurses (246.9), community health workers (228.8), and nursing aides and technicians (163.9) (Table 3).
A total of 146 specific diagnoses, based on ICD-10, were reported. For both men and women, neurotic, stress-related, somatoform, and post-traumatic stress disorders were the most frequent. Mood disorders were the third most prevalent diagnosis among women (12.2%). The third most prevalent diagnosis among men was adjustment disorder (11.4%) (Graph 2).
Specific diagnoses of Work-Related Mental Disorders (WRMD) in healthcare workers, by gender, in Brazil, 2007 to 2023.
Discussion
The results show high and rising prevalence rates of WRMDs among HWs. Variability was observed in the spatial distribution of the condition, and the Southeast accounted for nearly half of the records. Differences related to gender and occupation were also evident, highlighting persistent gender inequality in health work and showing that different occupational exposures contribute in distinct ways to mental illness. Attention is also drawn to the measures adopted once cases were identified, with a predominance of individual-centered strategies.
The unequal distribution of the condition across genders and occupational categories deserves attention, given the predominance of notifications among women and among occupations mainly performed by women. Despite this alarming outlook, individual-centered measures (removal from the workplace, removal from the situation of mental strain, adoption of individual protection) prevailed over collective-based strategies, such as changes in work organization and adoption of collective protection measures.
Our findings are consistent with the literature. Evidence of high prevalence rates of psychological distress and mental disorders among HWs has been reported in national and international studies, indicating that mental illness is a serious Public Health problem among HWs14-16. These conditions are distributed unequally across social class, gender, ethnicity, and occupational groups. Such disorders are not merely reflections of individual conditions; they are also influenced by structural factors such as economic, social, political, and cultural aspects17.
Sociodemographic characteristics such as gender, age, race, schooling, and income are associated with mental disorders, and work conditions and characteristics also stand out in the literature18. In this study, the distribution of WRMDs according to sociodemographic aspects showed a predominance of women over men. Studies indicate that features of the sexual division of labor, which assign women roles related to care, contribute to this inequality, with women taking on tasks involving greater emotional and physical burden, which may increase their vulnerability to illness and stress in the workplace. These responsibilities, associated with the lower recognition of women’s work, generate overload, stress, and, consequently, affect workers’ health11.
The 30-39 and 40-49 age groups had the highest percentages of cases-a troubling finding because it affects a relatively young group and supports the hypothesis of intense precarization of working conditions, especially among younger groups. This has an important impact on health and social security costs, representing a factor that increases potential years of life lost, time away from work, and early abandonment of the profession19.
Our results showed similar proportions of WRMDs among workers with higher education and secondary schooling levels. The literature, however, highlights a higher prevalence of mental illness among workers in occupations with lower schooling levels13,20.
Regarding the most affected occupational groups, nursing technicians and aides, community health workers, Public Health workers, and nurses stood out. Inadequate working conditions, failures to recognize these professional categories, low wages, and long and intense working hours have been associated with greater vulnerability in these groups11,13,16. Added to these aspects is the domestic overload resulting from gender inequalities, which may subject these workers to long working days. Considering the predominance of women in these occupational groups, a second work shift is likely a reality for most female health workers. In this way, domestic activities add to labor and psychosocial burdens and contribute to intensifying mental strain among female workers11.
Socially protected workers (such as public servants, formally registered employees, and public employees under labor-law contracts) accounted for a higher proportion of reported WRMD cases than workers in informal situations (such as self-employed workers and cooperative workers). Notably, social protection does not reach all workers, and the most vulnerable workers with flexible ties may not have their illnesses properly reported. Fear of unemployment may generate presenteeism, and these workers may hide their illness, given the lack of job guarantees. In addition, protected ties do not mean the lack of other forms of precarization, such as low wages and lack of professional and social recognition, factors that also contribute to mental illness. Thus, stable employment alone is not sufficient to ensure good health conditions21-23.
Although the literature indicates that stable employment ties constitute more protected situations for workers, recent years have shown changes in the configuration of employment relationships in the Health sector that alter-and make more complex-this expected situation. Thus, we need to reflect on the characteristics of employment in the Health sector in current contexts, where temporary contracts have increasingly become the main form of hiring for health workers with higher schooling/qualification and higher wages (as in the case of doctors, dentists, and nurses). There is, therefore, a dissociation between job stability and access to labor rights, on the one hand, and qualification/better pay in health work, on the other. This operating logic also affects the perspective of collectivity among HWs, since it fragments and separates the interests of groups within the workforce23.
Working in an environment filled with psychological burdens, as is the case in health work, can generate stress and distress, thereby exacerbating mental health problems. Persistent symptoms such as anxiety, depression, irritability, difficulty concentrating, forgetfulness, and fatigue compromises workers’ quality of life, contributes to higher absenteeism, increases demand on health services, adversely affects the quality of care, and can entail significant economic impacts24.
Removal from work and withdrawal from situations of work-related strain are the main actions adopted to mitigate WRMDs, highlighting a tendency to treat illness in an individualized way rather than considering the relationship between work and health. We should emphasize that isolated measures focused on the ill individual are insufficient to create healthy work environments and are ineffective in preventing other workers from continuing to become ill25. The low implementation of organizational measures reveals a lack of prioritization of collective protection strategies, exposing the lack of adequate prevention and support policies in the work environment3. Thus, it is urgent to rethink models of workforce management in the SUS in order to recover other aspects also related to health work, such as satisfaction, pleasure, and fulfillment, thereby promoting strategies for health promotion/preservation and prevention of mental illness at work.
Regarding the outcomes of WRMD cases among workers after diagnosis and treatment, temporary disability stands out in this study. This landscape is aggravated by the fact that mental disorders in Brazil are among the main causes of disability. The impact of this disability in the workplace is evident, generating high socioeconomic costs, mainly due to work leave, which affects the active workforce. In addition, removal from work may further aggravate workers’ health, especially in the lack of adequate support and rehabilitation programs26.
Implications of WRMDs for Health Workforce Management
The analyzed data show a marked increase in the number of reported cases in recent years. Although this growth may be partly associated with improved records and the strengthening of worker health surveillance actions, the results point to a persistent and growing trend of illness. Notably, however, the available data still capture the magnitude of the problem only partially, given the persistent underreporting as a structural limitation of health information systems. This setting poses a major challenge both for SUS health services and for management, given the high prevalence of cases, their progressive increase, and their direct impacts on the quality of care provided and on the living conditions of health professionals.
We should underscore that Health Workforce Management is a constitutional and legal responsibility assigned to SUS managers. There is consensus in the literature that such management should encompass not only workers themselves, but also the characteristics and conditions of the work performed. This implies recognizing work and workers through adequate regulation of labor relations, the guarantee of decent conditions, the overcoming of precarization, and the strengthening of employment ties. Workforce Management involves the entire cycle of a worker’s functional life, covering work processes, employment relationships, qualifications, working conditions, and participation in policy formulation, all of which contribute to autonomy, recognition, and reduced alienation27.
The role of Workforce Management in reducing WRMDs among SUS workers requires the formulation and implementation of policies, programs, and actions aimed at health promotion and protection, the monitoring and control of risks associated with working conditions, the prevention of illness and injury, and the guarantee of care and rehabilitation in order to preserve health and improve quality of life at work28.
Creating mechanisms for the proper identification, surveillance, and follow-up of mental illness among health teams, coordinated with the development of permanent actions for the protection and promotion of mental health in work environments, could be appropriately structured through a Workforce Management Policy focused on workers’ safety and health.
Such a policy and the actions associated with it may serve as a strategy for organizing how work is structured. It involves reviewing work planning, execution stages, communication, and interaction among people within a team, and interaction across teams. Mental illness is known to be linked to exposure to psychosocial factors at work, which are determined by work organization and the work process-areas under the responsibility of workforce management. This implies redesigning aspects that have been identified as major risk factors for psychological distress, such as overload, underload, lack of control over work, distance between management and workers, social isolation in the workplace, role-related conflicts, difficulties in interpersonal interactions, and lack of social support29.
We should underscore work precarization as an increasingly striking feature of the health sector. This reality manifests itself through several indicators and dimensions, such as the labor power commodification; relaxed labor rights; dismantled social protection policies; work management and organizational models that prioritize “efficiency” to the detriment of humane conditions; deteriorated workplace safety and health conditions; isolation and loss of bonds and belonging; weakened unions and forms of collective struggle and representation; and, furthermore, the crisis of labor law, evidenced by attacks on the Consolidation of Labor Laws (CLT) and the unrestricted legalization of outsourcing. Outsourcing incorporates and synthesizes the social precarization of labor that affects the health of SUS health workers30. These factors also need to be incorporated into workforce management processes.
In the Brazilian Health sector, all of these precarious work features have deepened since the 1990s. The Unified Health System is currently characterized by varied and flexible management models that heighten the fragility of employment ties and working conditions. These models include worker credentialing, Civil Society Social Organizations (OSS), Social Organizations of Public Interest (OSCIPs), Public-Private Partnerships (PPP), State Foundations under Private Law, among others31,32. These models have contributed to weakened labor relations, reduced labor guarantees, and worker instability.
This aspect deserves attention: which management models help reduce mental distress? It is known that the active participation of workers in decision-making processes brings major benefits. When workers exercise control over the activity they perform-whether in defining how time is used, operational modes, or work tools-the possibilities for establishing strategies to confront distress and illness are expanded. By exercising autonomy, the general work conditions can be changed, enhancing positive aspects and reducing the harmful effects caused by excessive demands11.
The Brazilian context lacks a regulation for work organization aspects, and this situation affects workers’ mental illness. Determinants of social inequities, including the sexual division of labor, unequal gender relations, harassment, lack of social recognition, high demands, disqualification, and lack of autonomy and control over one’s own work, are considered determinants of work-related distress. These factors need to be continuously monitored in order to reduce or eliminate the harmful effects of such characteristics33.
To this end, Workforce Management should develop systematic actions focused on work processes and on reducing illness-associated factors in work organization, grounded in the active role of workers and other stakeholders involved. Also, Workforce Management must devise strategies to address violence and harassment in the workplace, reduce flexible employment ties, and expand democratic participation by workers in work environments.
In view of this, it is essential to implement a program that offers comprehensive care and health surveillance for SUS workers, focused on health promotion, prevention of illness and injury, reduction of risks in work environments, and also adequate follow-up of workers who are already mentally ill. This program should also consider the determinants of work-related illness processes, ensuring their proper oversight. Moreover, it is imperative to train health professionals to make accurate diagnoses, encompassing all stages of the process, such as diagnosis, treatment, and rehabilitation.
The limitations of this study are related to the use of secondary data from a health information system. SINAN faces challenges regarding the scope, quality, and completeness of information, the accuracy of diagnoses, and the definition of the causal link between the condition and work. Another limitation is the possible underreporting of WRMD cases, since notifications are concentrated in specialized health units, such as Workers’ Health Reference Centers (CEREST), which total 212 units in the country (27 state and 185 regional centers). To improve this situation, it is crucial to expand notification actions throughout the entire SUS healthcare network, ensuring a broader and more effective approach to recording WRMDs, focused on the training of professionals and coupled with the creation of a national protocol guiding them to perform notifications properly and increase the number of notifications, given professionals’ difficulty in establishing the causal link between pathology and the work environment and organization.
Conclusion
Our findings show that WRMDs reflect the macrostructural societal conditions (weakened bonds of solidarity within the working class, labor precarization, and overexploited labor force). To this end, microstructural actions focused solely on work-process organization will yield limited results. Thus, if this issue is to be widely made visible and debated, placing the health and safety of SUS health workers on decision-making agendas becomes an urgent challenge for Workforce Management.
Our results also point to fragile relations in the world of work, revealing a reality of precarization, insecurity, lack of social protection, distress, substandard conditions, and work overload-situations that have severely harmed workers’ lives.
However, these disorders may create opportunities for strategic Workforce Management actions regarding the organization and management of the work process. To achieve this, it is necessary to shift the approach from a purely individual focus to a collective one, reviewing and eliminating situations that predispose workers to WRMDs: low autonomy, low recognition, work intensity and intensification, harassment, violence, gender inequities, low participation in work environments, expanded reception, safety, treatment, and rehabilitation for workers who are already ill.
These strategies, together with organizational changes and the reduction of stressors in the workplace, can be protective factors for the mental health of SUS workers, promoting a healthier and more sustainable work environment to ensure excellent care for the population.
Finally, we should emphasize the need for future studies that use complementary sources and methodologies in order to delve deeper into the understanding of WRMDs among health workers and support public policies that strengthen workforce management.
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The data sources adopted in the research are indicated in the article’s body.
Source: Authors. Notifiable Diseases Information System - SINAN.
Notes: Data updated in May 2024. A total of 2,183 (72.4%) of the 3,014 diagnoses identified (86.0% of all notifications) correspond to the 10 most prevalent conditions; the remaining ICD codes were not considered due to multiple codes, totaling 146. There were no ICD codes recorded in 490 cases. Source: Notifiable Diseases Information System - SINAN.