Tele-education as a digital technology for permanent health education for SUS workers: challenges and perspectives

Abstract

This study explores the potencial and challenges of using digital information and communication technologies as a strategy for permanent health education, based on a case study of the tele-education model implemented by Saúde Digital UFSC (2021-2024). This mixed-methods study draws on technical reports, educational content, and indicators of course delivery, participation, and completion. During the period, 329 web conferences and 60 cohorts across 13 online courses were delivered; 12,981 health workers attended the web conferences and 4,220 completed the courses. The model, grounded in the integration of between education, service delivery, and management, ensured the relevance of topics to everyday work and supported engagement and territorial reach. However, training occurred mostly outside protected working hours, with barriers related to clinical workload, connectivity, and digital skills. In light of the micropolitics of health work, the professional field and unequal distribution of capitals, along with the conditions required for transformative learning, the findings suggest that tele-education can strengthen permanent health education, provided it is supported by institutional conditions for workers, adequate infrastructure, and digital inclusion strategies.

Keywords:
Continuing Education; Digital Health; Information Technology; Unified Health System; Health Personnel

Resumo

O estudo analisou potencialidades e desafios do uso de tecnologias digitais de informação e comunicação como estratégia de educação permanente em saúde, a partir do estudo de caso do modelo de tele-educação do Saúde Digital UFSC (2021-2024). Trata-se de pesquisa quanti-qualitativa, com análise de relatórios técnicos, conteúdos educacionais e indicadores de oferta, participação e conclusão. No período, foram realizadas 329 webconferências e 60 turmas de 13 cursos; 12.981 trabalhadores participaram das webconferências e 4.220 concluíram. O modelo pautado pela articulação educação, serviço e gestão, garantiu a pertinência dos temas ao cotidiano dos trabalhadores e favoreceu engajamento e alcance territorial. Contudo, a formação ocorreu majoritariamente fora do horário de serviço, com barreiras relacionadas à sobrecarga assistencial, conectividade e habilidades digitais. À luz das micropolíticas do trabalho em saúde, do campo profissional e da distribuição desigual de capitais, e das condições necessárias à aprendizagem transformadora, conclui-se que a tele-educação têm potencial para fortalecer a educação permanente em saúde, desde que acompanhada de condições institucionais para os trabalhadores, infraestrutura e estratégias de inclusão digital.

Palavras-chave:
Educação Permanente; Saúde Digital; Tecnologia da Informação; Sistema Único de Saúde; Trabalhadores da Saúde

Resumen

Este estudio analizó las potencialidades y los desafíos del uso de tecnologías digitales de información y comunicación como estrategia de educación permanente en salud, a partir del estudio de caso del modelo de teleeducación del Saúde Digital UFSC (2021-2024). Se trata de una investigación de métodos mixtos, con análisis de informes técnicos, contenidos educativos e indicadores de oferta, participación y finalización. En el período se realizaron 329 webconferencias y 60 cohortes de 13 cursos; 12.981 trabajadores de salud participaron en las webconferencias y 4.220 concluyeron los cursos. El modelo, basado en la articulación entre educación, servicios y gestión, garantizó la pertinencia de los temas para el trabajo cotidiano y favoreció el compromiso y el alcance territorial. Sin embargo, la formación ocurrió mayoritariamente fuera del horario laboral protegido, con barreras relacionadas con la sobrecarga asistencial, la conectividad y las habilidades digitales. A la luz de las micropolíticas del trabajo en salud, del campo profesional y de la distribución desigual de capitales, y de las condiciones necesarias para el aprendizaje transformador, se concluye que la teleeducación tiene potencial para fortalecer la educación permanente en salud, siempre que esté acompañada de condiciones institucionales para los trabajadores, infraestructura adecuada y estrategias de inclusión digital.

Palabras clave:
Educación Continua; Salud Digital; Tecnología de la Información; Sistema Único de Salud; Personal de Salud

Introduction

Continuous training for workers in the Unified Health System (SUS) is essential to ensure an effective, equitable, universal, and efficient system¹. However, the effectiveness of this training depends on the pedagogical framework that guides the training processes and how these are articulated with one’s daily work in health. Permanent Health Education (Educação Permanente em Saúde - EPS), in the field of Public Health, constitutes a political-pedagogical proposal that shifts the training of workers from the logic of technical updating to the problematization of work in action. As Ceccim² argues, EPS is configured as a conceptual tool that allows for the production of self-analysis processes of daily work, as well as the engagement and transformation of practices within health collectives. From this perspective, training is not limited to the provision of courses or training, but rather involves the shared construction of meanings in the context of services.

Furthermore, training processes in SUS are traversed by micropolitical dynamics, in which power relations, institutional disputes, and different care projects are expressed. As Franco and Merhy³ and Feuerwerker⁴ point out, health work and the production of care take place amidst negotiations, tensions, and daily choices. In this sense, EPS can operate both as a device for transforming practices and as a mechanism for reproducing traditional training models, depending on how it is articulated with concrete work processes.

In the context of public policies, EPS was institutionalized with the creation of the National Policy for Permanent Education in Health (Política Nacional de Educação Permanente em Saúde - PNEPS) in 2004. Based on the principles of transformative education, decentralization, and the valorization of local realities, the PNEPS is structured on the premise that education should be integrated into the work process, recognizing the local and contextual challenges of health teams^5,6. The policy encourages states and municipalities to lead training initiatives adapted to the regional specificities of SUS, thereby fostering a culture of lifelong learning⁷.

However, the management of work and education in health (gestão do trabalho e da educação na saúde - GTES) faces historical and contemporary challenges that compromise its effectiveness among SUS workers. Problems, such as precarious work, regional inequalities, insufficient integrated policies, and the impact of the technological revolution, represent barriers that hinder the implementation of educational actions. These challenges were intensified during the COVID-19 pandemic, which further highlighted the structural inequalities affecting health workers⁸.

The SUS Digital Strategic Action-Telehealth emerges as a possibility to overcome geographic and structural barriers in both the training of workers and the qualification of practices in SUS. Among the types of care services offered by SUS Digital, tele-education stands out as a solution to integrate education and work, based on the use of digital information and communication technologies (ICTs), with the potential to democratize access to training, especially in remote locations, where infrastructure limitations make it difficult to carry out face-to-face educational actions^9-11. Furthermore, tele-education has demonstrated relevance in expanding the health system’s response capacity in emergency and crisis situations, as evidenced during the COVID-19 pandemic¹².

The incorporation of ICTs does not, in itself, guarantee the production of EPS processes. The expansion of access to training content can coexist with educational practices focused on technical updating disconnected from daily work, straining the very conception of EPS as a device for transforming practices. In addition, such problems as insufficient technological infrastructure, limitations in digital literacy, and cultural resistance to the use of new technologies compromise the reach of these tools, especially in remote locations¹³. Thus, it becomes essential to analyze to what extent such strategies are aligned with the guidelines of PNEPS and, above all, with the conception of EPS as a transformative practice of work in health.

Given this scenario, the present study aims to identify and analyze the potential and challenges for the development and implementation of ICTs in health education strategies, based on the case study of the Digital Health Center of the Federal University of Santa Catarina (Saúde Digital UFSC). By adopting EPS in its conceptual and micropolitical dimension as an interpretative axis, this study interconnects different analytical operators (the problematization of work in action; the integration between education, service and management; the analysis of structural inequalities in the professional field; and the notion of transformative learning) to examine not only the reach of training actions, but also their capacity to produce shifts in the ways of organizing care. Thus, this article intends to contribute with both empirical evidence and an analytical reflection on the structural limits and effective possibilities of tele-education in the context of health worker training.

Methods

Study design

This is a single case study, with a quantitative-qualitative approach and an exploratory and analytical in nature, aimed at a deeper understanding of the tele-education model of the UFSC Digital Health Center. The methodological strategy combined analysis of quantitative data relating to the offer, adherence, and completion of training actions with qualitative analysis of participants’ perceptions and experiences.

The case study was adopted because it allows for the contextualized investigation of complex institutional processes, considering both their measurable results and the organizational and micropolitical dynamics that permeate the implementation of ICT in the field of GTES. The time frame covered the actions developed between 2021 and 2024.

Case Context

The UFSC Digital Health Center, funded by the Ministry of Health, supports states and municipalities in implementing telehealth services aimed at providing care and permanent education for health workers, with an emphasis on strengthening Primary Health Care (PHC) in SUS. Since 2010, tele-education has been one of the pillars of the Center, through the provision of accessible and free training activities for professional qualification¹¹.

In addition to tele-education, the Center supports the implementation of telecare, teleconsultation, and telediagnosis actions for states and municipalities, and carries out health communication actions and the production of Second Opinion Reports (SOR). All these initiatives follow the guidelines of the SUS Digital Strategic Action - Telehealth, are aligned with public health policies, and meet the needs of SUS. Through these actions, the Center aims to qualify healthcare workers based on local demands and the best scientific evidence, contributing to strengthening the problem-solving capacity of healthcare teams and the quality of services offered.

Data collection

Data collection was carried out using multiple sources of information. Among the sources used, the following stand out:

• Technical reports and institutional documents from the UFSC Digital Health Center on tele-education actions;

• Content available in the Virtual Learning Environment (VLE) used by the Center (Moodle);

• Tele-education data panel on the Center’s official website (saudedigital.ufsc.br);

• Monitoring and evaluation reports of the courses offered;

• Records of web conferences held by the Center, stored in the Telemedicine and Telehealth System (STT).

The Center’s tele-education activities are accessible through the STT, a system that requires prior registration to participate. This system is integrated with CadSUS and the National Registry of Health Establishments (Cadastro Nacional de Estabelecimentos de Saúde - CNES), which allows for the identification of a wide range of user data, such as the municipalities of professional affiliation and the occupations of the workers. For the quantitative analysis, data from users registered in the STT who did not have a professional affiliation with health institutions were excluded. This filtering ensured that only information related to health sector workers linked to SUS was considered in the analysis.

Data collection covered the period from July 2021 to December 2024. This period was defined to complement a previous study that analyzed tele-education data from the UFSC Digital Health Center between 2010 and 2019. Although the Center has been supporting tele-education initiatives since 2010, funding was interrupted in 2020, resuming the following year, with activities restarting in July 2021.

Data analysis

The data analysis was conducted using a quantitative-qualitative integration strategy between performance indicators of the training actions and interpretive analysis of the qualitative data produced by the participants.

The quantitative analysis was based on indicators of production, reach, and completion of the tele-education actions carried out during the period, including the number of participants, territorial distribution, professional profile, and completion rate. This data was organized and described using descriptive statistics, allowing for the characterization of territorial capillarity, adherence to the training path, and the insertion of the actions in the context of PHC.

The qualitative analysis was carried out using an interpretive procedure guided by analytical categories previously defined based on the EPS, especially regarding problematization; the articulation between education, service, and management; and the institutional conditions for incorporating learning. Data processing involved in-depth reading, identification of core meanings, and thematic organization, seeking to understand how participants perceive the relevance, limitations, and possibilities of tele-education in their professional lives.

The integration of the two datasets allowed for the examination of convergences, tensions, and paradoxes between formative reach and the effective incorporation of learning. The final interpretation was guided by EPS frameworks, the analysis of the micropolitical dynamics of work in health, Pierre Bourdieu’s notion of field and capital, and Jack Mezirow’s Theory of Transformative Learning, mobilized as analytical operators to understand the limits and potential of tele-education in the context of SUS.

Ethical considerations

This study is part of the Macroproject for the Evaluation of Digital Health Services offered by UFSC Digital Health within the scope of the SUS, approved by the Research Ethics Committee with Human Beings from UFSC (CEPSH/UFSC), logged under opinion number 6.776.907/2024. The ethical principles established by Resolution 466/2012 of the National Health Council, which regulates research involving human beings, were followed.

Results

Tele-education Model of the UFSC Digital Health Center

The UFSC Digital Health Center developed a tele-education model aimed at assisting states and municipalities in implementing health education initiatives, prioritizing PHC workers within the SUS. This model is based on both EPS theoretical frameworks-especially the concept of problematizing work; the articulation between teaching, service and management; and the centrality of living work in action-and the normative frameworks that structure health education policy in SUS, such as PNEPS, the National Primary Care Policy, and the guidelines for digital health in SUS. Based on this theoretical and normative foundation, the model is organized around three main premises:

1. Integration among teaching, service, and management: connects the university to health services and managers, enabling the development of content aligned with the practices and needs of workers.

2. Sustainability and knowledge transfer: promotes local autonomy through the active participation of workers and managers in the planning and execution of actions, ensuring solutions adapted to regional realities.

3. Use of current technologies and pedagogical resources: uses interactive systems, multimedia resources, and VLEs to provide attractive and safe educational experiences, integrating synchronous and asynchronous activities.

This model offers two main types of tele-education activities: web conferences and courses, both online and freely accessible to users registered with STT. Web conferences allow for the participation of several workers in virtual rooms with a pre-scheduled date and time. These activities, lasting 1 to 2 hours, feature speakers who lead presentations and discussions on defined topics. Interactive tools, such as slides, shared notes, videos, and polls, are used to enrich the experience. Held between 8 am and 5 pm, these activities are aligned with the operating hours of the Basic Health Units, favoring the integration of educational actions into the work routine.

The topics of the web conferences are defined in conjunction with state and municipal health departments, or are based on frequently asked questions identified in other telehealth modalities offered by the Center, especially teleconsultations, and on the priorities of the national and state health agendas. In addition to live broadcasts, all web conferences are recorded and made available for asynchronous access on STT, on the YouTube channel of the UFSC Digital Health Center (https://www.youtube.com/@SaudeDigitalUFSC) and on the Center’s official website (https://saudedigital.ufsc.br/). Participants receive electronically authenticated certificates endorsed by the Center.

The courses are offered exclusively in an asynchronous and self-instructional format, allowing for independent learning without direct interaction with tutors or teachers. With a maximum workload of 100 hours and a minimum duration of 30 days and a maximum of 1 year, the courses may be offered more than once throughout the year. Designed for large-scale teaching and broad geographic reach, they can be classified as Massive Open Online Courses (MOOCs).

The course topics are defined in conjunction with the health departments, addressing strategic topics of SUS, training for other telehealth actions of the Center, or topics related to digital health, such as the General Data Protection Law.

The VLE is organized in a didactic and sequential manner, with video tutorials and documents that assist in navigation and execution of activities. Depending on the characteristics of the course, additional support may be provided, such as a virtual tutor with artificial intelligence, a forum for questions, a notice board, WhatsApp communities for important information, and a dialogue room for interaction between participants.

The courses are structured into learning units comprised of lessons and assessment activities. Each lesson includes video lessons of up to 30 minutes, subtitled and accompanied by mandatory and supplementary support materials. The assessment activities verify the understanding of the content and the development of the expected skills, while practical activities can simulate real situations to reinforce the application of theoretical knowledge.

The Center’s tele-education team regularly monitors student progress and makes individualized contact via email or WhatsApp to encourage participation and completion of activities. After completion, students evaluate the courses in technical and pedagogical dimensions, classifying them as excellent, good, fair, or poor.

For students who did not complete the course, they are asked to fill out a form to identify the reasons for dropping out, allowing for pedagogical and operational adjustments aimed at reducing dropout rates. Graduates students receive certificates endorsed by UFSC.

Scope of tele-education initiatives

Between July 2021 and December 2024, 329 web conferences and 60 cohorts across 13 different courses were held, totaling 4,038 hours of tele-education activities. During this period, the web conferences reached 12,981 SUS workers, while 4,220 workers completed the courses and were certified, demonstrating the impact of the actions on a large scale.

The geographic distribution of the activities revealed that professionals from 958 municipalities participated in the initiatives, covering 26 Brazilian states (96.3%). Only for the state of Alagoas was there no record of participation in the web conferences or completion of courses by workers linked to SUS. The South region concentrated 87.8% of the workers reached, standing out for the strong support of local partnerships. In the Northern region, states like Roraima and Pará have demonstrated significant progress in municipal coverage, attributed to partnerships promoted by the Ministry of Health to overcome geographic challenges in accessing telehealth services (Figure 1).

Figure 1
Municipal coverage of tele-education actions by the UFSC Digital Health Center. July 2021 to December 2024.

Table 1 illustrates the regional distribution of worker participation in web conferences and courses. Although the Southern region predominated in absolute numbers, the data highlight the importance of more recent partnerships in the Northern region, which ensured a significant number of workers who were reached in states with geographic and structural challenges.

Table 1
Workers reached by the tele-education actions of the UFSC Digital Health Center by region of the country. July 2021 to December 2024.

Region/State	Participation in webconferences	Graduates in courses	Total
Brazil	12,981 (100.0%)	4,220 (100.0%)	17,201 (100.0%)
North Region	541 (4.2%)	317 (7.5%)	858 (5.0%)
Northeast Region	153 (1.2%)	147 (3.5%)	300 (1.7%)
Midwest Region	143 (1.1%)	173 (4.1%)	316 (1.8%)
Southeast Region	391 (3.0%)	229 (5.4%)	620 (3.6%)
South Region	11,753 (90.5%)	3,354 (79.5%)	15,107 (87.8%)

• Source: Authors.

Analysis of the professional profiles of those who benefited showed that categories such as nurses, nursing technicians and assistants (41.4%), physicians (25.9%) and community health workers (8.1%) represented the majority of participants (Figure 2). The presence of other occupations related to multidisciplinary teams, managers, and administrative workers also demonstrates the potential of using ICT to meet different SUS demands and expand access to health education actions for different groups of workers.

Figure 2
Distribution of workers reached by the tele-education actions of the UFSC Digital Health Center by occupation, according to the CBO (Brazilian Classification of Occupations). July 2021 to December 2024.

Thematic analysis of tele-education initiatives

The thematic analysis of tele-education activities revealed ten main categories, reflecting the priorities and challenges of SUS workers.

Regarding the topics covered, PHC was the main focus (22%), followed by mental health (18%) and maternal and child health (15%). Other relevant areas included chronic and communicable diseases, integrative practices, environmental health, and ICTs (Figure 3). The topics, generally defined by the partner health departments, reflect the demands of health services for the training of PHC workers, aligning with the practical needs of SUS.

Figure 3
Thematic proportion of tele-education actions of the UFSC Digital Health Center. July 2021 to December 2024.

Evaluation of the quality of tele-education initiatives

The evaluation of the quality of the courses offered involved the participation of 1,837 graduates students, who completed a form to assess technical and pedagogical dimensions. Among the technical dimensions, which include aspects such as the VLE, technical content, alignment with service demands, support materials, and resources, 89.4% of the students rated the courses as “Excellent” or “Good”. Regarding the pedagogical dimensions, which encompass course structure, pedagogical resources, practical and evaluative activities, 91.2% rated them as “Excellent” or “Good” (Table 2).

Table 2
Evaluation of courses offered by the UFSC Digital Health Center. July 2021 to December 2024.

Evaluated item		n (%)
Course Quality		1,837 (100.0%)
Technical Dimension		1,837 (100.0%)
	Excellent	968 (52.7%)
	Good	675 (36.7%)
	Average	110 (6.0%)
	Poor	76 (4.1%)
	Very Poor	8 (0.5%)
Pedagogical Dimension		1,837 (100.0%)
	Excellent	984 (53.6%)
	Good	691 (37.6%)
	Average	106 (5.8%)
	Poor	53 (2.9%)
	Very Poor	3 (0.1%)
Training during working hours		1,837 (100.0%)
	Always	231 (12.6%)
	Sometimes	411 (22.4%)
	Never	1,195 (65.0%)

• Source: Authors.

However, only 12.6% of all students reported completing the course entirely during working hours, while 65% did so outside of those hours.

To understand the factors associated with not completing the courses, a form was made available to the students who dropped out. Of the 2,280 students who did not complete the courses, 734 responded to the form. The main reasons reported were: lack of time (58%), inability to take the course during working hours (36%), difficulty connecting to the internet (16%), difficulty accessing the course (12%), course quality (7%), and difficulty achieving the required grade in assessment activities (7%). It is important to note that students could indicate more than one reason, which broadens the understanding of the barriers faced.

Moreover, regarding quality assessment, the course completion rate was 59.4% during the analyzed period.

Discussions

Taking EPS as an analytical category focused on problematizing work², the results indicate that the tele-education model analyzed in this study is not limited to expanding training opportunities in SUS. Its territorial reach and focus on PHC workers give relevance to the experience, as it reaches the operational core of healthcare production and creates concrete conditions to challenge practices and reconfigure meanings attributed to work^2-4,15.

The high number of participants in the activities, associated with a high completion rate in the courses (59.4%), suggests sustained worker engagement over time. In online, self-instructional, asynchronous, and free courses, the completion rate is usually less than 15%¹⁶. These data highlight the potential of the tele-education model adopted by the UFSC Digital Health Center, not only for the scope of the actions, but also for its effectiveness in retaining and training SUS workers. The combined analysis of quantitative and qualitative indicators shows that such engagement stems not only from technological flexibility, but also from the relevance of the content to the demands of the services, anchored in the identification with real problems of daily care. This finding brings the analyzed experience closer to Ceccim’s formulation², in which EPS operates as a device to analyze work, shifting from the logic of technical updating to critical reflection on healthcare practices.

The contributions of the micropolitics of work in health reinforce this interpretation. Franco and Merhy³ and Feuerwerker⁴ show that the transformative power of training depends on its dialogue with the living work in action. Qualitative data reveal that, when the content is perceived as applicable to the challenges of the teams, the chances increase that the training will generate worker engagement and function as an instrument for questioning and reorganizing practices.

However, adherence and usefulness coexist with signs that training occurs outside of protected institutional time and that its sustainability depends predominantly on the individual effort of the workers, and not on organizational agreements structured for an in-service education process^3,4. Following Ceccim’s² framework, when learning occurs in private time, it tends to assume a supplementary character, approaching individual cognitive updating and reducing the chance of producing collective changes in the teams.

The micropolitics of work in health also helps to explain the phenomenon. Under productive pressure, the care dimension occupies a hegemonic place and training is pushed to the periphery. When learning time is not recognized as living work in action, the institution reinforces, even if implicitly, the idea that health education is not a component of care. Reports of overload and insufficient staffing reinforce this picture, as the lack of time and collective spaces reduces experimentation and shared validation of knowledge, keeping learning on an individual level even when the content is considered relevant by the workers^17-19.

This dynamic can also be interpreted from a sociological perspective, based on Bourdieu’s concepts. Requiring investment of personal time in qualification tends to reproduce inequalities in the professional field¹, since the accumulation of cultural capital depends on the positions held and the objective conditions of existence^20,21. Those with multiple jobs, long working hours, or family responsibilities have less room to study outside of formal hours, deepening formative asymmetries.

The experience analyzed in our study shows that when the integration among education, service, and management is recognized and organized as part of the planning and execution process of educational actions, the capacity of tele-education to contribute to EPS and to influence the production of care itself is expanded^3,4,22. However, even in this model, it was observed that the use of ICTs generates the risk of educational activities operating in parallel with the work environment^1,7.

The study also allowed us to analyze how structural inequalities and disputes in the field of health can impact the results of tele-education. Based on the concept of professional field and the unequal distribution of capital as analytical operators, the incorporation of digital technologies in health education can be understood as a socially situated process, traversed by historical hierarchies. Tele-education does not occur in a neutral space, but rather within a field marked by regional asymmetries, disputes over recognition, and differentiated positions of agents^15,20,21,23.

The qualitative analysis shows that formal access does not automatically translate into homogeneous conditions of appropriation. The expanded offer coexists with material and symbolic obstacles that modulate the capacity to transform the training opportunity into an effectively mobilizable resource^13,24. This dynamic can be interpreted as an expression of the unequal distribution of capital within the health field^20,21,23.

Proficiency in digital tools, stable internet connection, familiarity with academic devices, and integration into structured institutions acts as capital that conditions the conversion of training into recognized qualifications. Those in more consolidated organizational contexts tend to transform the offer into valued cultural capital²⁰, but workers in less structured territories face additional material and symbolic costs to achieve similar effects^13,15,20. The results reinforce that some of the difficulties do not stem from the content, but instead from the conditions of access and use of the platforms, which reinforces that technological mediation reduces distances, but introduces new technical and organizational requirements^13,24. Therefore, democratizing the offer does not eliminate inequalities of appropriation and may even reconfigure them.

The distribution of participants also expresses the dynamics of the field. The predominance of doctors and nurses suggests that participation is related to positions in the technical and social division of labor¹ and proximity to academic environments, which favors familiarity with digital formats¹³. However, this concentration cannot be attributed exclusively to individual dispositions. It interacts with the very choices that structure the training agenda. Themes aligned with clinical and care priorities have an unequal impact on professional groups that have historically been central to care^22,23, showing that the educational agenda is not neutral and can reinforce already consolidated centralities, while other areas remain less considered²¹. The consolidation of tele-education as an equitable strategy in SUS is linked to the positions occupied by agents in the field and to the disputes for recognition that organize work in the health sector. Technological mediation expands possibilities, but it does not suspend the hierarchies that structure the production of care.

Even in the model analyzed in our study-designed from the articulation between education, service, and management, the structuring axis of EPS-the identified limitations reveal relevant challenges for tele-education to produce transformative learning²⁵, capable of challenging and reconfiguring ways of thinking and organizing work in health.

The findings suggest that the consolidation of this articulation depends on effective institutionalization in the services. In this scenario, transformative learning does not appear as an automatic effect of the pedagogical design, but rather from the interaction between technological mediation, work organization, and political recognition of training as a constitutive part of care.

In addition, transformative learning requires dialogue, shared problematization and the opportunity to test new ways of acting within the teams²⁵. In predominantly self-instructional modalities, the intersubjective dimension tends to be more restricted¹³, which intensifies when education remains disconnected from assistance and health management.

In short, tele-education has the potential to strengthen EPS in SUS, but its transformative power does not derive solely from technology or quantitative reach. It depends on the sustained articulation among education, service, and management, and on the creation of organizational conditions that allow learning to circulate, be debated, and translate into concrete changes in the ways of interpreting and producing care.

Limitations

This study has limitations inherent to the single case study design, which restricts the direct generalization of the findings to other institutional contexts. Although in-depth analysis allows for a more comprehensive understanding of the processes and dynamics of the investigated model, its results should be interpreted in light of the organizational specificities of the UFSC Digital Health Center.

In addition, the use of secondary data and self-reported perceptions may introduce biases related to the quality of the record and the subjectivity of the participants. The absence of longitudinal follow-up of the teams limits the evaluation of long-term structural changes in care practices.

Nevertheless, this study contributes by offering a contextualized analysis that articulates empirical evidence and theoretical operators, allowing us to problematize the conditions under which tele-education can operate as a strategy for permanent health education in SUS.

Final considerations

The findings of this study reinforce the relevance of using ICTs to qualify SUS workers in a scenario marked by regional inequalities and structural obstacles. By interconnecting education, service, and management, the tele-education strategies analyzed herein show the capacity to expand access to training and respond to the daily PHC demands, with gains in scale and territorial reach. Nonetheless, this reach does not, in itself, equate to the sustained transformation of work in health. The transition from individual learning to effective changes in care and in the organization of the work process depends on institutional conditions that allow knowledge to circulate, be collectively debated, and translate into experimentation in the service.

In this sense, barriers, such as care overload, lack of protected time for educational activities, and operational priority given to the production of care, tend to restrict the incorporation of what has been learned. It should be noted that such limitations are not exclusive to education strategies measured by ICTs and can affect face-to-face experiences. Added to this are limitations of connectivity, infrastructure, and digital skills, which can reproduce inequalities in access to training opportunities themselves.

Addressing these obstacles requires political and organizational decisions, such as incorporating permanent health education as part of the work, with local agreements, management support, pedagogical mediation appropriate to the profile of workers, and digital inclusion strategies compatible with contexts of greater technological vulnerability.

As a continuity agenda, it is recommended to advance on two complementary axes. The first involves studies evaluating the implementation and replicability of the model in different realities, identifying which components are essential, which require regional adaptation, and which contextual conditions favor or block results. The second, more critical, involves research that assesses the transformative learning capacity of tele-education. This movement is crucial to consolidate tele-education as a consistent strategy for permanent health education in SUS, not only as an expansion of supply, but as a device capable of producing concrete improvements in the daily routines of the field of health.

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• Funding
  Secretaria de Informação e Saúde Digital do Ministério da Saúde (Brazilian Ministry of Health).
• Data availability statement
  Research data is available upon request to the corresponding author.

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

Data availability

Research data is available upon request to the corresponding author.

Publication Dates

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

History

• Received
  25 Jan 2025
• Accepted
  29 Mar 2026
• Published
  31 Mar 2026