Undergraduate training in public health in Brazil and its adherence to the National Curricular GuidelinesAbstract
This study examines the adherence of Bachelor’s degree programs in Public Health in Brazil to the 2024 National Curricular Guidelines (Diretrizes Curriculares Nacionais - DCNs). This research employs an analytical-descriptive methodology, relying on a documentary analysis of the Political-Pedagogical Projects (PPP). An analytical framework was developed consisting of four dimensions and 24 indicators, using a five-point Likert scale to evaluate the conformity of the programs. The Synthetic Adherence Index (SAI) was computed and compared by region and program shift, with differences evaluated using the Kruskal-Wallis test. A total of twenty-one programs were identified, predominantly located in federal institutions (81.0%) and concentrated in the North and South regions (23.8% each). Despite improvements in overall performance relative to the DCNs, 33% of the programs did not fulfill the minimum workload of 3,200 hours, and 19% fell short of the required minimum internship of 500 hours. The SAI exhibited significant variation by shift (p=0.0051) but not by region (p=0.4455). The findings highlight both advances and challenges in the implementation of the DCNs, underscoring the need for strategies to enhance professional training in Public Health.
Key words:
Public Health; Curriculum; Educational Assessment
Resumo
Este estudo analisa a adequação dos cursos de bacharelado em Saúde Coletiva no Brasil em 2024 às Diretrizes Curriculares Nacionais (DCN). Trata-se de uma pesquisa analítico-descritiva baseada na análise documental dos Projetos Político-Pedagógicos (PPP). Foi estruturada uma matriz analítica composta por quatro dimensões e 24 indicadores, aplicando uma escala Likert de cinco pontos para avaliar a adequação dos cursos. O Índice Sintético de Aderência (ISA) foi calculado e comparado segundo região e turno do curso, com diferenças testadas pelo teste de Kruskal-Wallis. Foram identificados 21 cursos, majoritariamente em instituições federais (81,0%) e concentrados nas regiões Norte e Sul (23,8% cada). Apesar da elevada aderência geral às DCN, 33% dos cursos não atingiram a carga horária mínima de 3.200 horas e 19% não cumpriram o estágio mínimo de 500 horas. O ISA variou significativamente por turno (p=0,0051), mas não por região (p=0,4455). Os resultados destacam avanços e desafios na implementação das DCN, sugerindo a necessidade de estratégias para fortalecer a formação profissional em Saúde Coletiva.
Palavras-chave:
Saúde Pública; Currículo; Avaliação Educacional
Resumen
Este estudio analiza la adecuación de las licenciaturas en Salud Pública en Brasil en 2024 a las Directrices Curriculares Nacionales (DCN). Se trata de una investigación analítico-descriptiva basada en el análisis documental de Proyectos Político-Pedagógicos (PPP). Se estructuró una matriz analítica compuesta por cuatro dimensiones y 24 indicadores, aplicándose una escala Likert de cinco puntos para evaluar la idoneidad de los cursos. El índice de adherencia sintética (SAI) se calculó y comparó según la región y el cambio de curso, y las diferencias se probaron mediante la prueba de Kruskal-Wallis. Fueron identificados 21 cursos, en su mayoría en instituciones federales (81,0%) y concentrados en las regiones Norte y Sur (23,8% cada una). A pesar de la alta adherencia general a la DCN, el 33% de los cursos no alcanzó la carga horaria mínima de 3.200 horas y el 19% no cumplió con la pasantía mínima de 500 horas. El ISA varió significativamente por turno (p=0,0051), pero no por región (p=0,4455). Los resultados resaltan avances y desafíos en la implementación de la DCN, sugiriendo la necesidad de estrategias para fortalecer la formación profesional en Salud Pública.
Palabras clave:
Salud Pública; Curriculum; Evaluación Educativa
Introduction
The construction of a universal and equitable health system requires the training of qualified professionals to work on different fronts, including management, planning, health surveillance, and primary care. In this sense, the creation of Bachelor’s degree courses in Public Health emerged as a response to the need to structure specific training for public health professionals, ensuring the qualification of professionals who will work in strengthening the Unified Health System (SUS) and in the formulation, implementation, and evaluation of public health policies1,2.
Since their implementation, undergraduate courses in Public Health have been consolidating themselves as an essential space for the training of public health professionals, aligning with the principles of universality, comprehensiveness, and equity. The curricular structure of these courses reflects the critical and interdisciplinary perspective of Public Health, based on values such as solidarity, emancipation, equality, justice, and democracy. Differing from traditional technocratic and biomedical approaches, training in the area emphasizes the analysis of the social determinants of health, participatory management, and intersectorality in public policies1.
To ensure the coherence of academic training with the needs of the health system, the National Curriculum Guidelines (Diretrizes Curriculares Nacionais - DCNs) were established for Bachelor’s degree courses in Public Health. The DCNs, approved by the Ministry of Education in 2022, constitute a guiding framework for the formulation of Political-Pedagogical Projects (PPP), defining the essential competencies and skills that must be developed throughout the training3. The standardization of these guidelines seeks to guarantee that the courses are aligned with the demands of SUS, thus promoting the training of professionals capable of working in management, planning, surveillance, and health care.
The process of constructing the DCNs for undergraduate courses in Public Health was conducted collaboratively and interinstitutionally within the scope of the Public Health Undergraduate Forum (Fórum de Graduação em Saúde Coletiva - FGSC) of the Brazilian Association of Public Health (Associação Brasileira de Saúde Coletiva - Abrasco). Since 2013, the FGSC has played a strategic role in the interconnection between higher education institutions, promoting debates on the curricular structure and the definition of the professional profile of graduates, with a view to strengthening their insertion in the job market. After an extensive process of deliberation and validation of the proposal by the Forum, the guidelines were submitted to and approved by the National Education Council (Conselho Nacional de Educação - CNE) in 2017. Since then, the FGSC has been monitoring the implementation of the DCNs, promoting discussions on the adherence of courses to the established parameters and supporting initiatives aimed at improving academic training4.
Despite the advances provided by the standardization of the DCNs, challenges persist in their effective implementation, making it essential to analyze how courses structure their PPPs to meet the established guidelines5. Aspects such as workload, regulation of supervised internships, and connections with health services are determining factors for the qualification of the training of public health professionals, and their incorporation into curricular matrices may vary between institutions. Although there are studies that discuss the consolidation of these courses and the training of professionals6,7, comparative and detailed analyses of the PPPs are still scarce in the literature5,8,9.
This finding reveals a gap in knowledge, which demands investigations into the adequacy of the courses according to the DCNs and their impact on training. Therefore, this study aims to answer the following question: “To what extent do the PPPs of undergraduate courses in Public Health currently operating in Brazil adhere to the DCNs?” To answer this, a systematic evaluation of the PPPs was carried out, with the aim of verifying their adherence to the DCNs and their capacity to respond to the demands of SUS.
The adequacy of these courses to the guidelines is strategic to guaranteeing the qualification of professionals who will work to strengthen the public health system. Conducting this research within the scope of the Abrasco Forum on Undergraduate Studies in Public Health reinforces its relevance, as it integrates into a collective effort of academic qualification and alignment of courses with the needs of the field of Public Health. Thus, this study aims to analyze the adequacy of undergraduate courses in Public Health currently operating in Brazil according to the 2024 DCNs for this type of course.
Methodology
This is an analytical-descriptive study with a qualitative and quantitative approach based on the documentary analysis of PPPs of Bachelor’s degree courses in Collective Health.
All Bachelor’s degree courses in Collective Health, Public Health, and Management of Health Systems and Services that were registered in the National Registry of Higher Education Courses and Institutions (e-MEC Registry) and that had PPPs available in the repository of the Abrasco FGSC were included in the analysis.
The PPP available in the repository of the Abrasco FGSC, available at: https://abrasco.org.br/comissoes-gts-comites-e-foruns/forum-de-graduacao-em-saude-coletiva/, were analyzed. All projects of the identified courses are available in this repository.
The normative basis for the study was considered the Opinion of the National Education Council (Conselho Nacional de Educação - CNE) No. 242/2017, approved and published in the Official Gazette of the Union (D.O.U.) on 10/14/2022, Section 1, Page 89, which establishes the DCNs for an Undergraduate Course in Public Health3.
For data analysis, we adopted Bardin’s10 content analysis framework and Minayo’s11 contributions for qualitative research, taking DCNs and PPPs as institutional documents produced in specific political-pedagogical contexts. The content analysis was conducted in a directed/deductive manner (a priori categories), using the DCN text as a basis to builds an evaluative matrix structured in four dimensions and 24 indicators. This matrix guided the structured reading of the PPP, with the recording of textual evidence (mentions and descriptions) per indicator, which supported the assignment of scores on the Likert scale of adherence.
The document analysis was organized into six main stages:
Stage 1 - Descriptive Analysis: First, a characterization of the undergraduate courses was carried out, considering variables such as course nomenclature, geographic region, administrative category, shift, total workload, workload allocated to supervised internship, and year of preparation of the PPP.
Step 2 - Analysis of the DCNs for an Undergraduate Course in Public Health: The DCN text was systematically examined to identify and organize the guiding elements of the training (principles, guidelines, and competencies), which served as the basis for the construction of the evaluation matrix.
Step 3 - Defining an Analysis Matrix: Based on the elements identified in the DCN, a matrix structured in four dimensions was developed: (1) Curriculum Organization and Undergraduate Profile; (2) Integration with SUS and Supervised Internship; (3) Evaluation and Knowledge Production; and (4) Additional Aspects. These dimensions included 24 guiding questions/indicators (Chart 1), which guided the standardized reading of the PPPs and the subsequent assignment of adherence scores on the Likert scale. For each indicator, the type of textual evidence to be sought in the PPP was defined in order to support the score.
Step 4 - Defining Analysis Criteria Using a Likert Scale: To quantify the information extracted from the PPPs, a Likert-type scale consisting of five increasing, ordinal, and two-dimensional points, ranging from “non-adherent” to “strongly adherent,” was integrated into the analysis matrix. The scale did not include a neutral point option, considering the need for decisive judgments to meet the study’s objectives. The scale points were defined as follows:
-
1 = Non-adherence: The PPP does not contain information about the item or completely diverges from the parameter.
-
2 = Weak adherence: The PPP contains information in a cited form, without description or in-depth analysis of the actions, or partially diverges from the parameter.
-
3 = Regular adherence: The PPP contains information in a cited form, with description, but without detailed information on the action or diverges regularly from the parameter.
-
4 = Moderate adherence: The PPP contains cited information, with description, but with insufficient information to understand the action, or partially agrees with the parameter.
-
5 = Strong adherence: The PPP contains cited information, with description and sufficient information to understand the action, or completely agrees with the parameter.
Step 5 - Data processing and interpretation: Based on the matrix constructed from the DCNs, the PPPs were subjected to a structured reading per indicator, with recording of the textual evidence (mentions and descriptions) corresponding to each item. The scores were then assigned on the Likert scale for each indicator, according to previously defined criteria, ensuring standardization of judgment. The choice of a Likert scale without a neutral point was intentional, aiming to favor more consistent classification decisions regarding the degree of adherence of the PPP to the normative parameter.
Step 6 - Data Consolidation: For the quantitative analysis, the average performance of each course in each dimension was calculated by dividing the sum of the indicator results by the total number of indicators for each dimension.
From these results, the Synthetic Index of Adherence of the PPP (SAI) was calculated, a summary measure that assesses the adherence of the PPP to the DCNs. The SAI was obtained by summing the indices of each dimension and dividing by the total number of dimensions (4).
Graphs suitable to view Likert scale data were created to present the results of each variable and dimension. In addition, boxplot graphs were set up to illustrate the distribution of the SAI of the PPP and the performance of the courses in each of the dimensions presented. For each boxplot, the median, minimum, maximum, first, and third quartile values were calculated, allowing for a detailed analysis of the variability of the data.
Considering that the SAI is derived from ordinal scores (Likert scale) and that normality was not assumed, the Kruskal-Wallis test (rank analysis of variance) was used to compare the distribution of the SAI by shift (full-time, morning/afternoon, and evening) and region of the country. This is a non-parametric test recommended to evaluate differences between three or more independent groups, often described as an extension of the Mann-Whitney test for multiple groups12,13. All statistical analysis was performed using R Studio software (version 2024.12.0+467).
The research was conducted through a documentary analysis of the PPPs made publicly available by the Educational Institutions, through the repository of the Abrasco FGSC. The data are presented in aggregate form, without individual identification of the results for each course.
Results
Twenty-one Bachelor’s degree programs in Public Health operating in Brazil in 2024 were identified, all with their respective updated PPPS available in the repository of the FGSC. Most courses use the term “Public Health” (76.2%), while other names, such as “Public Health”, “Health Management”, “Health Services Management”, “Indigenous Public Health Management”, and “Administration in Health Systems and Services”, are less frequent (4.8% each) (Table 1).
Regarding geographic distribution, the courses are present in all regions of Brazil, with a higher concentration in the North and South regions (23.8% each), followed by the Northeast and Southeast (19.0% each) and the Midwest (14.3%). As regards the administrative category, 81.0% of the courses are offered by federal public institutions, while the remaining 19.0% are guaranteed by state public institutions. In terms of shift, the evening shift predominates (38.1%), followed by the full-time shift (28.6%), morning shift (19.0%), and afternoon shift (9.5%) (Table 1).
An analysis of the total course load revealed that 66.7% of the courses have a workload equal to or greater than 3,200 hours, while 33.3% are below this parameter. Regarding the supervised internship workload, most courses (52.4%) offer between 500 and 600 hours, while 28.6% have more than 600 hours and 19.0% have less than 500 hours of internship. In addition, 71.4% of the courses had the updated version of the PPP developed after 2017, while 28.6% still used previous PPPs.
The adherence of the PPPs to the DCNs was evaluated through four dimensions. In dimension 1 - “curricular organization, skills and undergraduate profile”, the indicators for the inclusion of complementary activities (D1.9), regulation of the Course Conclusion Work (D1.8), and promotion of interdisciplinarity and integrated practices (D1.7) show strong or moderate adherence in all courses. However, 33% of the courses did not meet the minimum workload of 3,200 hours, as recommended by the National Curriculum Guidelines (Figure 1).
Adherence of the PPPs of the undergraduate courses in public health to the DCNs of the course according to the dimensions and variables of the study.
In the dimension of integration with SUS and supervised internship, most criteria showed high adherence (moderate or strong) in 95% of the courses, with the exception of the supervised internship with a minimum workload of 500 hours (D2.3), in which 19% of the courses were considered non-adherent. In addition, 10% of the courses showed regular adherence with regard to the integration of the dimensions of education, management, and health care in a supervised internship (D2.5) (Figure 1).
In the dimension of assessment methodology and knowledge production, most courses (more than 95%) showed strong or moderate adherence in three of the five criteria analyzed. However, regular adherence was observed in 14% and 19% of the courses in the criteria of continuous and reflective assessment of competencies (D3.3) and use of digital resources and innovative tools in training (D3.5), respectively.
All courses demonstrate the integration of teaching, research, and extension in their pedagogical projects (D4.2), and 95% show strong or moderate adherence to the criterion “social participation as a structuring axis.” However, 24% of the courses did not adhere or have weak adherence to the criterion of considering the DCNs of the course in the PPP (D4.3) (Figure 1).
The SAI of the PPPs was calculated for all courses and their dimensions. The overall median SAI score was 4.51, with values ranging from 3.34 to 4.83. Dimension 2 (integration with SUS and supervised internship) showed the best performance, with a median of 4.53, while dimensions 1 (curricular organization, competencies, and undergraduate profile) and 4 (additional aspects) obtained medians of 4.67, although the latter showed greater variability among the courses (Figure 2).
Boxplot of the Synthetic Adherence Indicator (SAI) of the PPPs of undergraduate courses in public health to the DCNs according to dimension. Brazil - 2024.
When stratifying the SAI by course shift, it was observed that morning and afternoon courses showed the highest medians (4.78), followed by evening courses (4.41) and full-time courses (4.20). In full-time courses, greater variability was observed, with SAI values ranging from 3.34 to 4.75. The differences between the median SAI by shift were statistically significant (p=0.0051) (Figure 3).
Boxplot of the Synthetic Indicator of PPP Adherence (ISA) of undergraduate courses in public health to the DCN second shift (A) and region (B) of the course. Brazil - 2024.
By contrast, in the analysis by region, the median SAI values were higher for courses in the Southeast (4.79), South (4.67), and Midwest (4.65) regions, while courses in the North and Northeast regions showed lower median values. However, these regional differences were not statistically significant (p=0.4455) (Figure 3).
Discussion
This study analyzed the adequacy of undergraduate courses in Public Health operating in Brazil according to the 2024 DCN, based on the analysis of the PPP, providing an overview of their structure and adherence to the guidelines. The research findings indicate a strong adherence of the courses to the DCNs, especially in curricular organization, undergraduate profile, and integration with SUS. However, challenges persist, such as insufficient workload, implementation of supervised internships, evaluation methodologies, and knowledge production. In addition, disparities in performance according to the course shift suggest the influence of institutional factors on curricular structuring. These results highlight the need for institutional strategies that guarantee the qualification of training and strengthen the articulation between teaching, service, and management in health.
From a theoretical point of view, the DCNs can be understood not only as a technical-normative prescription, but also as a political-pedagogical device that materializes consensuses and disputes concerning the training project of the public health professional and their insertion in SUS. Thus, reading the PPPs as institutional texts reveals how curricular choices are mediated by local conditions and by conceptions about work in health, citizenship, and rights, core dimensions in the Social and Human Sciences in Health1,14.
The predominance of the term “Collective Health” as the nomenclature of the courses (76.2%) suggests progress in consolidating the professional identity of the public health professional. However, the coexistence of other denominations, such as “Management in Indigenous Collective Health” and “Administration in Health Systems and Services”, points to regional specificities and adaptation to the local needs of SUS. This diversity can be positive in expanding the possibilities of action for undergraduate students, but it also raises questions about the impact of this variability on the training and recognition of the profession. It may also lead to a departure from the guiding use of the DCNs for Bachelor’s degrees in Collective Health, as observed in this study.
The variations in course nomenclature reflect specificities of the training, whether due to the pedagogical focus, as in courses with an emphasis on management; the student profile, such as courses aimed at indigenous communities; or the institutional trajectory, such as the “Bachelor’s Degree in Public Health” at the University of São Paulo (USP). This diversity refers to the very history of Collective Health in Brazil, characterized by different projects and conjunctures. In this sense, the plurality existing in the field challenges the construction of a unified professional identity, while reinforcing the need for articulation between different formative perspectives15.
The regional distribution of courses revealed a greater concentration in the North and South regions, while the Midwest presented the lowest proportion of courses, corroborating what has already been observed by previous studies15. Considering the population differences between the regions, a homogeneous distribution would not be expected, and the presence of Undergraduate Courses in Collective Health (Cursos de Graduação em Saúde Coletiva - CGSC) in all five regions of the country can be considered a significant advance. However, it is important to note that the Southeast Region, which has the largest population in the country and concentrates important academic centers, was not the leader in the number of courses, contrasting with the historical concentration of higher education in health in the Southeast region, both at the undergraduate and postgraduate levels15. This finding suggests an inequality in the supply of training in Public Health in the country and the influence of factors such as educational or institutional policies in the creation of these courses.
The availability of courses in public institutions reflects the recognition of training in Public Health as strategic for SUS. The emergence of undergraduate courses in public health is associated with the creation of Institutes of Public Health and similar institutions in public universities, committed to the Brazilian Health Reform project and the implementation of SUS4.
Most courses are offered in the evening, a finding already identified in previous studies that also point to a migration to the daytime period4,5,15. Although this change responds to concrete operational demands, considering the greater difficulty in operationalizing extension activities and the proximity to the daily routine of SUS during the evening, we cannot fail to point out the potential of evening courses in inclusion and expansion of access, reversing historically consolidated patterns in higher education in health.
Regarding the course schedule, the stratified analysis of SAI revealed that morning and afternoon courses show greater adherence to the DCNs, as compared to evening and full-time courses. This finding may be related to differences in the organization of the workload, availability of teachers, and access to practical activities within SUS15. In this sense, efforts aligned with the movements to adapt to the DCNs can be made in an attempt to balance strengths and weaknesses, particularized according to local needs.
The research showed a strong adherence of the pedagogical projects to the DCNs, especially in the dimensions of curricular organization, graduate competencies, and integration with SUS. The findings are in line with previous studies that point to the convergence of training in Public Health with the DCNs, demonstrating continuous progress in consolidating teaching in the area5. In addition, the research corroborates the perspective that the competencies and skills developed in undergraduate courses in Public Health have an emancipatory character, favoring dialogue and cooperation between professionals and institutions in the health sector8.
However, the challenges in implementing the DCNs are still evident. The total workload of less than 3,200 hours in one-third of the courses and the supervised internship workload of less than 500 hours in 19% of the institutions indicate a need for curricular adaptation to the guidelines. This scenario may be related to institutional limitations, such as budgetary constraints, difficulties in structuring internships in SUS, and challenges in the articulation between teaching, service, and management, especially in evening courses. Previous studies5,9 indicate that the absence of mechanisms for the monitoring and continuous follow-up of curriculum implementation can contribute to disparities between courses.
The integration between theory and practice is crucial to training in Public Health, since the development of skills and abilities necessary for professional practice depends on the articulation between theoretical knowledge and practical experiences. Although there are advances in the structuring of thematic axes in curricula, weaknesses in the integration between theory and practice still persist, which can compromise the training of graduates8. This challenge is reflected in the moderate adherence of most courses to the integration of the dimensions of Care, Management, and Health Education in the supervised internship, pointing to the need to improve this curricular component. Medeiros16 reinforces the importance of health promotion and education in courses, emphasizing the need for content that develops a critical view and the ability of future professionals to act within SUS.
These results signal an important contradiction: while Public Health constitutes a field of knowledge and practices committed to overcoming the dichotomy between theory and action, the insufficiency in the structuring of supervised advances can compromise this formative potential. As highlighted by Pereira and Carneiro17, the supervised internship should not only be a space for applying the knowledge acquired during undergraduate studies, but also a moment to re-signify practice from a critical and reflective stance.
The findings of this research reinforce the need for institutional policies that strengthen the articulation between universities and health services, aiming to expand the offer of supervised internships and ensure compliance with the established minimum workload. In addition, it is suggested that qualitative studies be carried out to investigate the perception of teachers and students about the implementation of the DCNs and their impacts on professional training.
The approval of the DCNs by the Ministry of Education only occurred in 2022, although the DCN text had been approved by the CNE in 2017. This time gap illustrates the difficulties in the political field, considering even the context of the period, to build a rationality and sense of need for this training and professional development, which, at this moment, is in full expansion, and which may have its scenario transformed in the short term, with the increased adherence to the DCNs and consequent qualification of training processes. Since their formulation, the DCNs have been widely debated in spaces such as the Abrasco’s FGSC, and in academic meetings in the field, which is reflected in the incorporation of their guidelines into highly consolidated curricula. Furthermore, more than 70% of current PPPs were created after the guidelines were approved by the CNE, demonstrating their influence on the structuring of courses.
It is also important to consider that the axes proposed by the DCNs for Management, Care, and Education are not sufficient to effectively qualify undergraduate courses in public health if they do not advance in frameworks that consider the sub-areas of public health, such as policy, planning and management, epidemiology, and social and human sciences, strengthening the profile of the graduating professional in defense of SUS, democracy, and life, under the aegis of the entire construction of the health reform movement. Therefore, adherence to the DCNs will also need to unfold in the reinforcement of various areas, such as promotion, education, and communication, as well as in discussions of gender, race, and sexuality that translate, for example, the challenge of incorporating the axis of social and human sciences into curricular structures, which is impossible to measure in this type of analysis5,9,14.
A curricular reform, in isolation, may not be sufficient to interfere with the structural limitations and the political and economic context that has historically determined what kind of public health professional we need and want to train in Brazil18. However, the results of this research show that the analytical matrix constructed here, which can be improved in this regard, can induce a movement of adherence to a collective indication of paths to be followed, beyond the mere formal compliance with regulations.
From a methodological point of view, the documentary analysis of the PPP proved to be a robust approach to understanding the curricular structure of the courses and their application to national guidelines, allowing for a systematic evaluation based on objective indicators. However, this methodology has limitations, since the PPP reflects the formal conception of the courses, but it does not capture the effectiveness of the practical implementation of the DCNs. To mitigate this limitation, a structured Likert scale was developed, allowing for the quantification of the courses’ adherence to the guidelines and enabling comparative analyses between different institutions. Still, it is suggested that future studies adopt complementary methodological approaches, such as qualitative investigations, which explore the perception of managers, teachers, and students about the challenges and potential of implementing the DCNs, in addition to analyzing the impact of the training of public health professionals on professional insertion and performance within SUS.
Furthermore, other regulatory movements in the field of education, such as the curricularization of extension activities, have a direct interface with the dimensions demonstrated in this study and can positively impact the quality of the courses. The connection between advancements, academic experiences, and extension programs with the practice of health services and the daily lives of communities represents an opportunity to strengthen training in Public Health, promoting emancipatory and decolonial projects that contribute to the development of professionals committed to social transformation and the defense of the right to health.
Finally, it is worth highlighting that, despite advances in the implementation of the DCNs, the absence of systematic evaluations on the quality of training and the effectiveness of supervisees still represents a gap in the literature. Therefore, it is essential to broaden the debate on the impact of the DCNs on the profile of graduates and the professional integration of public health professionals, with a view to consolidating training in Public Health and strengthening its contribution to SUS.
Conclusions
The findings of this study, which analyzed the adequacy of undergraduate courses in Public Health operating in Brazil according to the 2024 DCNs, based on an analysis of the PPPs, indicate high overall adherence to the guidelines, with good incorporation of elements related to curricular organization, undergraduate profile, and integration with SUS. This result suggests a movement towards consolidating the training design foreseen in the DCNs and reinforces the relevance of undergraduate studies in Public Health as a strategic axis for the qualification of the workforce in SUS.
However, challenges still persist that strain the materialization of this alignment at the normative-operational level. The presence of courses with total hours and/or supervised internships below the minimum parameters is noteworthy, in addition to weaknesses in aspects associated with evaluation methodologies and knowledge production described in the documents. Added to this is the fact that not all PPPs clearly state the reference to the DCNs as guidance, and the differences observed according to the course shift suggest that institutional conditions and organizational arrangements may influence how the guidelines are translated into the curricular text.
In this sense, the results highlight the need for institutional strategies that ensure concrete conditions for compliance with normative parameters and strengthen the teaching-service-management articulation, especially in the organization of internships and the qualification of practice settings within SUS. At the same time, since this is a documentary analysis, the PPPs mainly inform the formal curricular formulation, not fully capturing the daily implementation; therefore, it is recommended that future investigations complement this overview with studies on pedagogical practices, internship/extension experiences, and graduate trajectories. Finally, the matrix and the SAI used here can support periodic monitoring and review processes of the PPPs, in turn contributing to the continuous improvement of training in Public Health in Brazil.
References
- 1 Paim JS, Pinto ICM. Graduação em Saúde Coletiva: conquistas e passos para além do sanitarismo. Tempus Actas Saude Colet 2013; 7(3):13-35.
- 2 Teixeira CF. Graduação em Saúde Coletiva: antecipando a formação do sanitarista. Interface (Botucatu) 2003; 7(13):163-166.
-
3 Brasil. Ministério da Educação (MEC). Conselho Nacional de Educação. Câmara de Educação Superior. Parecer CNE/CES nº 242/2017 (homologado em 14 out 2022): Diretrizes Curriculares Nacionais do Curso de Graduação em Saúde Coletiva [Internet]. Brasília: MEC; 2017 [acessado 2024 jan 28]. Disponível em: http://portal.mec.gov.br/docman/setembro-2017-pdf/72431-pces242-17-pdf/file
» http://portal.mec.gov.br/docman/setembro-2017-pdf/72431-pces242-17-pdf/file - 4 Pinto I, Paim J. A Abrasco e a Experiência da Graduação em Saúde Coletiva. In: Lima NT, Santana JP, Paiva CHA, editores. Saúde coletiva: a Abrasco em 35 anos de história. Rio de Janeiro: Editora Fiocruz; 2015. p. 137-150.
- 5 Mendonça PBS, Castro JL. O ensino na graduação em saúde coletiva: o que dizem os projetos pedagógicos. Cien Saude Colet 2023; 28(6):1729-1742.
- 6 Santos L. Educação e trabalho na saúde coletiva brasileira: estudo de caso sobre a criação dos cursos de Graduação na área de Saúde Coletiva nos cenários nacional e local [tese]. Salvador: Universidade Federal da Bahia, Instituto de Saúde Coletiva; 2014.
- 7 Mangueira JO, Silva LR, Medeiros KR, Santos CR, Pinto ICM. Graduation in Public Health in Brazil: training, professional identity and insertion in the labor market. Res Soc Dev 2021; 10(5):e21810514746.
- 8 Loiola AA, Cyrino EG, Alexandre FLF. Competências e habilidades nos currículos da graduação em saúde coletiva no Brasil. Rev Baiana Saude Publica 2017; 41(1):81-97.
- 9 Sobral LF, Barros EL, Carnut L. A área de política, planejamento e gestão em saúde nas graduações em saúde coletiva no Brasil. Trab Educ Saude 2017; 15(3):879-894.
- 10 Bardin L. Análise de conteúdo. Edição revista e ampliada. São Paulo: Edições 70; 2016.
- 11 Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. 9ª ed. São Paulo: Hucitec; 2006.
- 12 Kruskal WH, Wallis WA. Use of ranks in one-criterion variance analysis. J Am Stat Assoc 1952; 47(260):583-621.
- 13 Cleophas TJ, Zwinderman AH. Non-parametric tests for three or more samples (Friedman and Kruskal-Wallis). In: Cleophas TJ, Zwinderman AH. Clinical data analysis on a pocket calculator. Cham: Springer; 2016. p. 193-197.
- 14 Trad LAB, Mota CS, Lopez YAA. O ensino das ciências sociais e humanas na graduação em saúde coletiva: entre desafios e oportunidades de transgressões. Saude Soc 2019; 28(2):11-24.
- 15 Meneses JJS, Silva MMO, Castellanos MEP, Ribeiro GS. Panorama dos cursos de graduação em saúde coletiva no Brasil entre 2008 e 2014. Trab Educ Saude 2017; 15(2):501-518.
- 16 Medeiros RHA. O ensino de promoção e educação em saúde para sanitaristas. Interface (Botucatu) 2018; 22(65):609-620.
- 17 Pereira EL, Carneiro R. O que podem nos contar os estágios supervisionados em/sobre saúde coletiva? Saude Soc 2019; 28(2):53-66.
- 18 Viana JL, Gusmão JO, Marques MCC, Castellanos MEP, Louvison MCP, Akerman M. Projetos formativos em saúde pública no Brasil: para evidenciar as influências dos contextos sociais, políticos e do mundo do trabalho ao longo do tempo. Saude Debate 2022; 46(134):710-720.
The data sources adopted in the research are indicated in the article’s body.
Source: Authors.
Source: Authors.
Source: Authors.