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Program

Mais Médicos Program

Problem
Shortage of physicians in the priority regions of the SUS (Unified Health System); Law 12,871/2013 sought to reduce it in order to lessen regional inequalities and strengthen the provision of primary care services.
Who it serves
Priority regions of the SUS (Unified Health System); participants include physicians trained in Brazil or with a revalidated diploma, Brazilians trained abroad and foreigners qualified abroad.
How it works
Established in 2013 by President Dilma Rousseff, by a provisional measure converted into Law 12,871/2013, with actions to place physicians with scholarships, for medical training and for the infrastructure of primary health care units. Law 14,621/2023 amended the program and established the National Strategy for the Training of Health Specialists.

Health

Relation to the Lula governments

Reshaped under Lula · Third term (since 2023) · since March 2023

Provisional Measure No. 1,165 of March 20, 2023, signed by Luiz Inácio Lula da Silva, established the National Strategy for the Training of Health Specialists, within the Mais Médicos Program, and amended Law 12,871/2013.[1]

Law No. 14,621 of July 14, 2023 (conversion of MP 1,165/2023), signed into law by Lula, establishes the National Strategy for the Training of Health Specialists within the Mais Médicos Program, to integrate training, staffing and work-based education programs in the SUS, and amends Laws 12,871/2013, 13,959/2019 and 13,958/2019 to create new incentives and rules in the Mais Médicos para o Brasil Project and in Revalida and to transform Adaps into AGSUS.[2]

Origin and precursors

Origin milestone: founding legal act, Between governments (2011 to 2022).

Provisional Measure (MP) No. 621 of July 8, 2013, signed by President Dilma Rousseff, established the Mais Médicos Program, with the purpose of training human resources in the medical field for the SUS (Unified Health System).[3]

Precursors

  • Program for Bringing Health Work to the Interior (PITS, 2001) similar initiative, no succession stated by the source Decree No. 3,745 of February 5, 2001, signed by Fernando Henrique Cardoso, established the Program for Bringing Health Work to the Interior (Programa de Interiorização do Trabalho em Saúde), to encourage the placement of university-educated health professionals in municipalities with proven shortages.[4]
  • PROVAB (2011, Dilma Rousseff government), cited in Interministerial Ordinance 1,369/2013 similar initiative, no succession stated by the source Interministerial Ordinance 1,369/2013, which implemented the Mais Médicos para o Brasil Project, cites in its recitals Interministerial Ordinance No. 2,087/2011, which established PROVAB.[5]
  • UNA-SUS (Decree 7,385/2010, Lula's second term), cited in Interministerial Ordinance 1,369/2013 earlier technical basis Interministerial Ordinance 1,369/2013 cites in its recitals Decree No. 7,385/2010, which established UNA-SUS.[6]

Precursor investigation: new structure established (October 14, 2026).

Scope: MP 621/2013, Law 12,871/2013, Interministerial Ordinance 1,369/2013, Law 13,333/2016, MP 890/2019, Law 13,958/2019, MP 1,165/2023, Law 14,621/2023 (Planalto); calls for applications 2013 to 2024; TCU Ruling 1764/2025 (PDF via TCU open data); academic studies.

Responsibilities

  • Ministries of Health and Education federal management

    Law 12,871/2013 assigns the coordination of the Mais Médicos para o Brasil Project to the Ministries of Education and Health, which regulate by joint act the participation of public higher education institutions and the operating rules.[7]

  • Participating municipalities municipal implementation

    Under Ordinance 1,369/2013, it falls to the Federal District and the participating municipalities, among other obligations, to place the physicians in the primary care teams provided for in the National Primary Care Policy.[8]

  • Pan American Health Organization (cooperation with Cuba, 2013 to 2018) partnership

    According to PAHO, Cuban physicians began working in 2013 in Basic Health Units through international cooperation among Brazil, Cuba and PAHO; PAHO arranged the agreements, did not enter into contracts with physicians, and the cooperating Cubans were hired by the Cuban government.[9]

  • National Congress (conversion of MP 621 and MP 1,165) legislative approval

    Law No. 12,871 of October 22, 2013, the conversion of MP 621/2013, signed into law by Dilma Rousseff, established the Mais Médicos Program.[10]

  • Federal Court of Accounts (TCU) oversight

    In Ruling 1764/2025-Plenary (session of August 6, 2025, rapporteur Jhonatan de Jesus), an operational audit by the TCU of the Mais Médicos para o Brasil Project after the restructuring under Law 14,621/2023 pointed to flaws in the diagnosis, the absence of an analysis of options, insufficient cost-effectiveness targets and indicators, and the absence of risk management, and made recommendations to the Ministry of Health.[11]

Timeline

Timeline of Mais Médicos Program
DatePhaseWhat happened
July 2013Legal actMP 621/2013 establishes the program (Dilma Rousseff government).[3]
October 2013Legal actLaw 12,871/2013, conversion of MP 621.[10]
2019Legal actLaw 13,958/2019 creates Médicos pelo Brasil, without altering the execution of the Mais Médicos Project.[12]
March 2023Legal actMP 1,165/2023 amends the program.[1]
2023Legal actLaw 14,621/2023 amends Law 12,871/2013.[2]

What was established

Among the objectives set by Law 12,871/2013 are reducing the shortage of physicians in the priority regions of the SUS, in order to reduce regional inequalities, and strengthening the provision of primary care services.[13]

Law 12,871/2013 established, within the Mais Médicos Program, the Mais Médicos para o Brasil Project, offered to physicians trained in Brazil or with a revalidated diploma and to physicians trained abroad, through international medical exchange.[14]

How it works

According to a note from PAHO, the program, created in 2013 by the Brazilian government, has three axes: improving the infrastructure of health services; emergency staffing with Brazilian and foreign physicians; and expanding places in medical schools and residencies, with curriculum changes.[15]

Under Law 12,871/2013, the Project's places are filled in this order of priority: physicians trained in Brazil or with a revalidated diploma, including retirees; Brazilians trained abroad; and foreigners qualified abroad.[16]

In the original wording of Law 12,871/2013, the exchange physician practiced medicine exclusively in the activities of the Project, with exemption from diploma revalidation during the first 3 years; Law 14,621/2023 changed the exemption to only the first 4 years of participation.[17]

Law 12,871/2013 provides for scholarships in the forms of training scholarship (bolsa-formação), supervision scholarship (bolsa-supervisão) and tutoring scholarship (bolsa-tutoria), in addition to a settling-in allowance limited to 3 training scholarships; activities in the Project do not create an employment relationship.[18]

Interministerial Ordinance 1,369/2013, in its original wording, provided: a training scholarship with a monthly value of R$10,000.00 (ten thousand reais) will be granted to the participating physician, which may be paid for a maximum period of 36 (thirty-six) months, extendable only in the case provided for in § 1 of art. 8 of Provisional Measure No. 621 of 2013.[19]

In the training axis, Law 12,871/2013 made the authorization of private medical courses conditional on a public call with pre-selection of municipalities and set as a goal, by December 31, 2018, that medical residencies offer each year a number of places equivalent to the number of graduates of the previous year.[20]

In the infrastructure axis, Law 12,871/2013 gave the SUS a period of 5 years to provide basic health units with quality equipment and infrastructure, to be defined in the multiyear plans.[21]

Decree No. 8,126/2013 assigned to the Ministry of Health the enrollment of the exchange physician and the issuance of a single registration and identification card that authorizes him or her to practice medicine only within the scope of the Project.[22]

Law 14,621/2023 created an indemnity for physicians who work without interruption in a hard-to-retain area: 20% of the total scholarships received over 48 months in an area of vulnerability and 10% in the others; for those who studied Medicine with Fies, a differentiated indemnity of 80% or 40% of the amount received over 48 months.[23]

Who it serves

Law 14,621/2023 added to Law 12,871/2013 that the Special Indigenous Health Districts, quilombo remnant communities and riverside communities will be considered priority regions, based on vulnerability criteria.[24]

According to the TCU audit report (2025), the Project's main product is the placement of physicians in places where it is difficult to retain them, and the main beneficiaries are the populations living in those places.[25]

Governance

Law 12,871/2013 authorizes the Ministries of Education and Health to enter into cooperation agreements with international organizations, educational institutions, federated entities, consortia and private entities, including with the transfer of funds.[26]

On November 19, 2018, Brazil, Cuba and PAHO determined that about 8,300 Cuban physicians would gradually leave the program by December 12 of that year, after the Cuban government's decision to end its participation; they were in about 2.8 thousand municipalities and in the 34 DSEI (Special Indigenous Health Districts), and their number had fallen from more than 11 thousand to about 8.3 thousand in five years.[27]

The TCU attributes the drop in placements starting in 2018 to the unilateral termination of the agreement between Cuba and PAHO/WHO on November 13, 2018; Law 13,958/2019 provided for the reinstatement in the Project, for 2 non-extendable years, of exchange physicians who were active on November 13, 2018 under the 80th Technical Cooperation Agreement with PAHO, who were dismissed because of the breakdown of the agreement and who remained in the country.[28]

Changes

Law No. 13,333 of September 12, 2016 (conversion of MP 723/2016), signed into law by Michel Temer, extended by three years the period of exemption from revalidation under art. 16 of Law 12,871/2013 and the period of the exchange physician's temporary visa.[29]

Provisional Measure No. 890 of August 1, 2019, signed by Jair Bolsonaro, provided that the Médicos pelo Brasil Program will be carried out by the Agency for the Development of Primary Health Care (Adaps), under the technical guidance and supervision of the Ministry of Health, and revoked art. 6 and art. 7 of Law No. 12,871 of October 22, 2013.[30]

According to the Statement of Reasons of MP 890/2019, signed by Luiz Henrique Mandetta and Paulo Roberto Nunes Guedes, one of the measures provided for by the Médicos pelo Brasil Program is to correct the distribution of places previously defined by the Program and Project provided for in Law No. 12,871 of October 22, 2013, whose applied criterion provides for the creation of about 12,000 places for urban municipalities and only 5,000 for places in Brazil that are hard to staff or highly vulnerable; the text also cites the need to correct the weaknesses of the Program and Project linked to Law No. 12,871 of October 22, 2013.[31]

Law No. 13,958 of December 18, 2019 (conversion of MP 890/2019), signed into law by Jair Bolsonaro, established the Médicos pelo Brasil Program and authorized the creation of Adaps; it revoked arts. 6 and 7 of Law 12,871/2013.[32]

According to the TCU (2025), since Law 12,871/2013 was not revoked, from 2019 there came to be two simultaneous programs for placing physicians in places that are hard to staff: Mais Médicos and Médicos pelo Brasil.[33]

Law 14,621/2023 included among the objectives of the Mais Médicos Program ensuring comprehensive care across life cycles and expanding the supply of professional specialization in areas strategic to the SUS.[34]

With Law 14,621/2023, the training of participants came to take place through improvement courses or lato or stricto sensu graduate programs, with a period of up to 4 years, extendable for an equal period (previously: up to 3 years).[35]

Law 14,621/2023 also provided for an indemnity corresponding to the outstanding Fies balance for those who complete without interruption the 24 months of residency in Family and Community Medicine with a specialist title, and determined that the regulations set percentages of places reserved for physicians with disabilities and from ethnic-racial groups.[36]

Law 14,621/2023 determined monitoring and evaluation processes for the Project's effectiveness in training physicians, in retaining them in hard-to-reach areas and in improving health indicators, with publication of data and an annual report on a website.[37]

According to the TCU (2025), from Law 14,621/2023 onward, Mais Médicos and Médicos pelo Brasil were unified as Federal Government Staffing Programs, even though they have different management and participation rules.[38]

The compiled text of Law 12,871/2013 records the inclusion, by MP 1,301/2025 and then by Law 15,233/2025, of the Mais Médicos Especialistas Project, within the Mais Médicos Program, for staffing professionals with a view to reducing waiting times in specialized care, exclusive to physicians trained in Brazil or with a revalidated diploma and certified as specialists.[39]

MS/MEC Interministerial Ordinance No. 604 of May 16, 2023, signed by Ministers Nísia Trindade Lima (Health) and Camilo Santana (Education), provides for the execution of the Mais Médicos para o Brasil Project and revoked Interministerial Ordinance No. 1,369 of July 8, 2013.[40]

Implementation

A Ministry of Health page records Public Call No. 39/2013, which invited physicians trained in Brazil and abroad to join the Mais Médicos para o Brasil Project, established by MP 621/2013.[41]

The Ministry of Health, through the SGTES, held Public Call No. 22/2018 of the Mais Médicos para o Brasil Project, for the purpose of filling vacant places under the cooperation with an international organization, should places remain from the call governed by SGTES/MS Notice No. 18 of November 19, 2018.[42]

Ministry of Health public call pages record notices of the Mais Médicos para o Brasil Project in every year from 2019 to 2022, among them No. 11/2019 (18th cycle), No. 5/2020 (19th cycle, enrollment for 1 year, in the context of the COVID-19 emergency), No. 15/2021 (rehiring of exchange physicians for 1 year, 25th cycle) and No. 15/2022 (27th cycle).[43]

Budget and spending

Figures are nominal unless stated otherwise. Announced, authorized, committed, liquidated and paid amounts are different things and appear with the type indicated. In SIOP lines, "paid" means paid within the same fiscal year (arrears settled later are not counted), and one budget action can fund more than one program: the text says when the action is only part of a program.

The Statement of Reasons of MP 1,165/2023 estimated a budgetary and financial impact of R$712.5 million in 2023, covered by the 2023 Annual Budget Law (LOA), and expenditures on the order of R$3 billion for the following two fiscal years.[44]

According to the TCU, based on SIOP, about R$20.2 billion in federal funds were committed to the Mais Médicos Program from 2018 to 2024 (sum of actions 00QC, 214U and 21BG), of which R$4.1 billion in 2024; action 21BG replaced 214U in 2020.[45]

In the TCU table (source: SIOP), the amounts committed under the provision action (214U through 2019; 21BG from 2020) were R$2,790,368,601.00 (2018), R$2,788,106,601.00 (2019), R$2,028,165,711.00 (2020), R$2,924,293,516.00 (2021), R$2,644,326,881.00 (2022), R$2,336,524,517.00 (2023) and R$3,993,380,926.00 (2024); the scholarships action 00QC ranged between R$81,422,825.00 (2023) and R$128,570,838.00 (2024).[46]

In 2016, budget action 214U (Implementation of the Mais Médicos Program) had an authorized appropriation of R$2,844,000,000, commitments of R$2,835,763,515, liquidation of R$2,621,592,319 and payment in the fiscal year of R$2,621,151,790, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Of the committed amount, R$2,527,755,950 was under the budget plan 'Mais Médicos Program (staffing)' and R$225,455,900 under the plan 'Mais Médicos / Program for the Valorization of Primary Care Professionals, Provab (staffing)'; the remainder was under other plans of the action.[47]

In 2017, budget action 214U (Implementation of the Mais Médicos Program) had an authorized appropriation of R$3,263,560,000, commitments of R$3,263,444,328, liquidation of R$3,088,982,493 and payment in the fiscal year of R$3,087,247,773, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Of the committed amount, R$2,880,997,625 was under the budget plan 'Mais Médicos Program (staffing)' and R$60,769,231 under the plan 'Mais Médicos / Program for the Valorization of Primary Care Professionals, Provab (staffing)'; the remainder was under other plans of the action.[48]

In 2018, budget action 214U (Implementation of the Mais Médicos Program) had an authorized appropriation of R$2,790,586,337, commitments of R$2,790,368,601, liquidation of R$2,455,667,303 and payment in the fiscal year of R$2,345,507,800, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Of the committed amount, R$2,651,087,380 was under the budget plan 'Mais Médicos Program (staffing)' and R$16,890,143 under the plan 'Mais Médicos / Program for the Valorization of Primary Care Professionals, Provab (staffing)'; the remainder was under other plans of the action.[49]

In 2019, budget action 214U (Implementation of the Mais Médicos Program) had an authorized appropriation of R$2,788,236,000, commitments of R$2,788,106,601, liquidation of R$2,755,608,329 and payment in the fiscal year of R$2,583,838,358, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Of the committed amount, R$2,687,617,823 was under the budget plan 'Mais Médicos Program (staffing)' and R$11,000 under the plan 'Mais Médicos / Program for the Valorization of Primary Care Professionals, Provab (staffing)'; the remainder was under other plans of the action.[50]

In 2020, budget action 21BG (Training and Provision of Professionals for Primary Health Care) had an authorized appropriation of R$2,028,990,791, commitments of R$2,028,165,711, liquidation of R$2,016,657,153 and payment in the fiscal year of R$1,885,692,793, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Under this action, the budget plan 'Mais Médicos Program' had commitments of R$1,997,447,464 and payment in the fiscal year of R$1,866,477,941; the remainder was under other plans of the action.[51]

In 2021, budget action 21BG (Training and Provision of Professionals for Primary Health Care) had an authorized appropriation of R$2,924,570,153, commitments of R$2,924,293,516, liquidation of R$2,907,679,607 and payment in the fiscal year of R$2,735,886,649, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Under this action, the budget plan 'Mais Médicos Program' had commitments of R$2,222,281,898 and payment in the fiscal year of R$2,034,312,244, and the plan 'Médicos pelo Brasil Program - Agency for the Development of Primary Health Care - ADAPS' had commitments of R$103,000,000; the remainder was under other plans of the action.[52]

In 2022, budget action 21BG (Training and Provision of Professionals for Primary Health Care) had an authorized appropriation of R$2,644,356,952, commitments of R$2,644,326,881, liquidation of R$2,629,149,748 and payment in the fiscal year of R$2,627,801,478, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Under this action, the budget plan 'Mais Médicos Program' had commitments of R$1,939,919,529 and payment in the fiscal year of R$1,928,857,604, and the plan 'Médicos pelo Brasil Program - Agency for the Development of Primary Health Care - ADAPS' had commitments of R$505,000,000; the remainder was under other plans of the action.[53]

In 2023, budget action 21BG (Training and Provision of Professionals for Primary Health Care) had an authorized appropriation of R$2,336,550,388, commitments of R$2,336,524,517, liquidation of R$2,241,609,423 and payment in the fiscal year of R$2,228,864,062, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Under this action, the budget plan 'Mais Médicos Program' had commitments of R$2,182,268,662 and payment in the fiscal year of R$2,169,215,421; the remainder was under other plans of the action.[54]

In 2024, budget action 21BG (Training and Provision of Professionals for Primary Health Care) had an authorized appropriation of R$3,993,456,994, commitments of R$3,993,380,926, liquidation of R$3,943,165,688 and payment in the fiscal year of R$3,614,015,358, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Under this action, the budget plan 'Mais Médicos Program' had commitments of R$3,775,068,753 and payment in the fiscal year of R$3,438,966,862; the remainder was under other plans of the action.[55]

In 2025, budget action 21BG (Training and Provision of Professionals for Primary Health Care) had an authorized appropriation of R$4,148,039,234, commitments of R$4,147,967,464, liquidation of R$4,116,730,568 and payment in the fiscal year of R$3,777,989,345, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Under this action, the budget plan 'Professional Staffing Program for Primary Health Care (APS)' had commitments of R$4,097,641,399 and payment in the fiscal year of R$3,737,539,457; the remainder was under other plans of the action.[56]

In 2018, budget action 00QC (Granting of Scholarships of the Mais Médicos Program) had an authorized appropriation of R$123,988,495, commitments of R$121,143,774, liquidation of R$101,196,090 and payment in the fiscal year of R$100,836,959, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)).[57]

In 2019, budget action 00QC (Granting of Scholarships of the Mais Médicos Program) had an authorized appropriation of R$98,181,960, commitments of R$97,713,766, liquidation of R$77,124,783 and payment in the fiscal year of R$76,799,958, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)).[58]

In 2020, budget action 00QC (Granting of Scholarships of the Mais Médicos Program) had an authorized appropriation of R$85,914,744, commitments of R$83,625,718, liquidation of R$76,275,718 and payment in the fiscal year of R$75,932,052, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)).[59]

In 2021, budget action 00QC (Granting of Scholarships of the Mais Médicos Program) had an authorized appropriation of R$89,034,877, commitments of R$88,510,034, liquidation of R$80,942,034 and payment in the fiscal year of R$80,607,034, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)).[60]

In 2022, budget action 00QC (Granting of Scholarships of the Mais Médicos Program) had an authorized appropriation of R$84,072,820, commitments of R$83,352,321, liquidation of R$78,114,321 and payment in the fiscal year of R$77,784,321, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)).[61]

In 2023, budget action 00QC (Granting of Scholarships of Health Education Development Programs) had an authorized appropriation of R$81,423,017, commitments of R$81,422,825, liquidation of R$68,582,415 and payment in the fiscal year of R$68,252,415, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)).[62]

In 2024, budget action 00QC (Granting of Scholarships for Supervision of the Mais Médicos Program) had an authorized appropriation of R$128,671,838, commitments of R$128,570,838, liquidation of R$118,140,559 and payment in the fiscal year of R$117,790,559, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)).[63]

In 2025, budget action 00QC (Granting of Scholarships for Supervision of the Mais Médicos Program) had an authorized appropriation of R$139,905,250, commitments of R$139,905,250, liquidation of R$128,628,467 and payment in the fiscal year of R$128,278,467, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)).[64]

In 2023, budget action 21DX (Maintenance of the Management Contract with the Agency for the Development of Primary Health Care (ADAPS) - Médicos pelo Brasil Program) had an authorized appropriation of R$1,022,945,188, commitments of R$1,022,945,187, liquidation of R$1,022,945,187 and payment in the fiscal year of R$1,022,945,187, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)).[65]

Beneficiaries

Annual flow, a monthly stock and a cumulative total cannot be added together.

The Statement of Reasons of MP 1,165 (March 20, 2023, Ministers Nísia Trindade, Camilo Santana and Fernando Haddad) states that the program once had 18,240 physicians in 4,058 municipalities and 34 DSEI, began to be reduced from 2017, with intensification from 2019, and then had 8,613 professionals in service.[66]

According to the TCU, citing annual management reports of the Ministry of Health, 7,786 physicians were placed in 2014 (14,462 when added to those of 2013) and 3,778 in 2015, reaching 18,240 physicians working in the program.[67]

According to the Ministry of Health's 2022 Annual Management Report, in December 2022 the Mais Médicos para o Brasil Program and the Médicos pelo Brasil Program reached 13,535 places filled (74.21%), of which 8,680 were filled by Mais Médicos para o Brasil and 4,855 by Médicos pelo Brasil, in 3,967 municipalities and 34 Special Indigenous Health Districts.[68]

According to the Ministry of Health's 2023 Annual Management Report, in December 2023 there were 30,485 places made available to municipalities in the staffing programs, of which 25,439 (83.45%) were filled, with 20,557 in the Mais Médicos Program (20,065 in municipalities, 474 in Special Indigenous Health Districts and 18 under state management) and 4,882 in Médicos pelo Brasil.[69]

According to the Ministry of Health's 2024 Annual Management Report, in December 2024 there were 26,468 places filled in the staffing programs, with 22,395 in the Mais Médicos Program (21,816 in municipalities, 561 in Special Indigenous Health Districts and 18 under state management) and 4,073 in Médicos pelo Brasil.[70]

According to the Ministry of Health's 2025 Annual Management Report, in December 2025 there were 27,329 places filled in the physician staffing programs, with 23,990 in the Mais Médicos Program (23,288 in municipalities, 682 in Special Indigenous Health Districts and 20 under state management) and 3,339 in the Médicos pelo Brasil Program.[71]

Deliverables

Announcement, contracting, completion and operation are different phases.

According to the TCU, for 2024, the physical target for the physician staffing programs in primary health care (APS) was 23,553 places filled and the target achieved was 26,756, reaching 113.6% of the target; for 2025, this target is 27,000 places filled, and the target set in the PNS 2024 to 2027 at the end of the four-year period is 29,613 physicians.[72]

Observed results

A result observed during a term may have causes other than the program.

According to the TCU, the goal of the National Health Plan (PNS) 2016 to 2019 was to reach 20,335 physicians working in priority regions through Mais Médicos and PROVAB; the physical targets achieved were 18,240 (2016 and 2017), 16,001 (2018) and 14,490 (2019), and the PNS goal was not reached.[73]

According to the TCU, the goal of the PNS and of the Multiyear Plan (PPA) 2020 to 2023 was to fill more than 85% of the places in the federal staffing programs (Mais Médicos + Médicos pelo Brasil); the rates achieved were 90.8% (2020), 85.3% (2021), 74.2% (2022) and 83.5% (2023), and the 2023 Annual Management Report (RAG) attributes the failure to reach the goal to the increase in places offered from 18,240 to 30,485.[74]

Based on a Ministry of Health spreadsheet, the TCU observed a drop in the number of program physicians in 2018, with the end of the contract with PAHO, a recovery in 2019 that was not sustained, and a new decline in 2021 and 2022 in all vulnerability strata; the total number of physicians in primary health care (APS), however, grew from 2012 to 2024.[75]

Impact evaluations

Evaluations with a causal design are flagged; association is not proof of effect.

A difference-in-differences study with 5,565 municipalities (2008 to 2017) estimated that the program was associated with an increase of 15.1 per 100,000 inhabitants in primary care physicians hired by the program, but, with large-scale substitution of existing physicians, the net increase was only 5.7 per 100,000; the authors estimated a reduction in avoidable mortality of 1.06 per 100,000 per year, greater in priority municipalities and in those with a low density of physicians before the program.[76]

A difference-in-differences study with propensity score matching (municipalities, 2010 to 2016) found a significant reduction in hospitalizations for primary care-sensitive conditions in the treated municipalities, with an effect growing from the second year.[77]

A difference-in-differences study with matching (5,570 municipalities, 2008 to 2017), with PAHO co-authors, estimated a 2.9% reduction in hospitalizations for primary care-sensitive conditions (p<0.10) and a 3.7% reduction in their costs (p<0.01).[78]

A difference-in-differences study (5,565 municipalities, 2007 to 2018) found no significant association of the program with infant or neonatal mortality in the aggregate; it found a reduction in infant mortality only in municipalities with the highest infant mortality before the program.[79]

A study with a generalized synthetic control (microregions, 2008 to 2017) found no significant impact of the increase in program physicians on hospitalizations or mortality; the authors cite as possible explanations substitution of other professionals, long-term effects and poor allocation within regions.[80]

A study that exploits the timing of the Cuban physicians' departure from the program found persistent reductions in the care of chronic diseases, rapid recovery in the use of services for conditions requiring immediate care, and no change in health outcomes.[81]

A commentary by Rudi Rocha (2025) on the study by Thomas et al. states that the evidence indicates limited effects of the program: it improved access in underserved regions, with little impact on outcomes such as mortality.[82]

Audits

In an official news item of August 8, 2025, the TCU reported that, despite the flaws, no illegalities were found in the program, and that coordination and monitoring are working well.[83]

The TCU report concludes that the Ministry of Health did not consider alternatives beyond the 'resumption' of the program to address the shortage of physicians in vulnerable areas; it records the MS's justification that Médicos pelo Brasil had been effectively implemented only in 2022, with unfavorable numbers, and that 'the management's choice was the resumption and improvement' of Mais Médicos; and it points to the lack of an assessment of the overlap between the two programs.[84]

The TCU describes MP 1,165/2023, converted into Law 14,621/2023, as the period of 'policy reformulation' and records that the MS decided on the 'reformulation and intensification' of the program, with proposals for improvements to strengthen its training character.[85]

The TCU concluded that, although the possible causes of the problem are identified, the evidence does not confirm the immediate cause (difficulty in staffing and retaining physicians in primary health care (APS) in vulnerable areas), since the drops in federal staffing in 2018 and 2022 were not accompanied by a reduction in physicians working in APS.[86]

Limitations

Law 12,871/2013 limits the number of foreign physicians in the Project to 10% of the number of Brazilian physicians with permanent registration in the CRMs (Regional Councils of Medicine), and makes the number of participants conditional on the available budget resources.[87]

Hone et al. (2020) conclude that the program's potential benefits were reduced by the widespread allocation of physicians to non-priority areas and by local substitution effects.[88]

According to a TCU news item, the program's legal objectives are generic, the targets are limited to the number of places, there are no indicators showing the real impact on the population, the efficiency and effectiveness indicators have neither targets nor periodicity, and a cost-benefit analysis is lacking.[89]

A PAHO note on the departure of the Cuban physicians records that hospitalization rates for primary care-sensitive conditions had already been declining in Brazil before the program, by 7.9% from 2009 to 2012, and that, according to PAHO, the decline was greater after the implementation of Mais Médicos, at 9.1% between 2012 and 2015.[90]

Context

The Statement of Reasons of MP 1,165/2023 states that the federal programs for placing physicians in primary health care (APS) had the lowest number of physicians in service since 2014 and that about two thousand physicians were due to be dismissed in the following eight months; it estimates at 14.7 million the number of Brazilians who stopped being covered by these programs.[91]

The Statement of Reasons of MP 1,165/2023 describes the proposal as improvements to the Mais Médicos Program to strengthen its training character, with a four-year cycle (two-year lato sensu specialization plus a professional master's degree).[92]

Origin

Interministerial Ordinance No. 1,369 of July 8, 2013, of the Ministers of Health and Education, provided for the implementation of the Mais Médicos para o Brasil Project, based on MP 621/2013.[93]

A study by Pinto and Côrtes (Ciência & Saúde Coletiva, 2022), with documentary analysis and interviews, concludes that the action of President Dilma Rousseff and of policy entrepreneurs was decisive for the formulation of the program, based on legacies of earlier policies, and challenges the explanation, put forward by one strand of the literature, that it was built hastily in response to the 'Jornadas de Junho' (June Journeys); the authors note, however, that the Jornadas de Junho and the drop in government approval precipitated the launch of the program.[94]

Precursors

Interministerial Ordinance No. 2,087 of September 1, 2011, signed by Ministers Alexandre Padilha (Health) and Fernando Haddad (Education), established the Program for the Valorization of Primary Care Professionals (PROVAB), for physicians, nurses and dentists in municipalities with difficult access and staffing or with more vulnerable populations.[95]

Decree No. 7,385 of December 8, 2010, signed by Luiz Inácio Lula da Silva, established within the Ministry of Health the Open University System of the SUS (UNA-SUS), for the training and continuing education of SUS workers through distance education.[96]

According to Pinto and Côrtes (2022), the PMM was made up of three axes: the infrastructure axis was an expansion of the Requalifica-UBS program, created in 2011; the training axis incorporated the Pro-Residência program, created in 2009; and the staffing axis can be seen as part of a trajectory that involved the creation of Pits, in 2001, and of Provab, in 2011. Respondents stated that the structure of the Open University of the SUS, created in 2010, had been essential to ensure in-service training for the physicians recruited by the PMM.[97]

According to Pinto and Côrtes (2022), during the Lula government Ministry of Health leaders presented proposals such as mandatory civil service and the recognition of foreign medical diplomas, without success, owing to the actions of organizations of the medical profession and to opposition from the MEC; in the discussion, the authors add that, in 2003 to 2010, the neutral or opposing positions of the core of the government and of the MEC prevented more significant proposals for change from advancing. For the authors, unlike in the previous period (2003 to 2010), in the period 2011 to 2013 it was possible to promote changes that culminated in the program.[98]

According to Joint Ordinance No. 4 of April 2, 2012, Interministerial Ordinance No. 1,001 of October 22, 2009, established the National Program to Support the Training of Medical Specialists in Strategic Areas (Pró-Residência), with the aim of promoting the training of specialists, in the form of medical residency, in specialties and priority regions defined by common agreement with SUS managers.[99]

Responsibilities

According to the TCU (2025), the Ministry of Health unit responsible for the Project is the Secretariat for Primary Health Care (SAPS), through the DGAPS; at a meeting on May 6, 2025, managers reported that the coordination was being transferred to the SGTES.[100]

In May 2024, the Ministry of Health issued Notice No. 3/2024 for the enrollment and renewal of enrollment of municipalities and the Federal District in the Project, with places funded by the federal government and places with cost sharing, for the 38th cycle, with staffing for 48 months.[101]

Sources and evidence

Excerpts are quoted in the original language of the source.

  1. 1. Provisional Measure No. 1,165 of March 20, 2023, signed by Luiz Inácio Lula da Silva, established the National Strategy for the Training of Health Specialists, within the Mais Médicos Program, and amended Law 12,871/2013.

    • Medida Provisória nº 1.165, de 20 de março de 2023 · Presidency of the Republic (Planalto) Official legal act
      Where: summary. Accessed October 13, 2026.
      “Institui a Estratégia Nacional de Formação de Especialistas para a Saúde, no âmbito do Programa Mais Médicos, e altera a Lei nº 12.871, de 22 de outubro de 2013.”
    • Medida Provisória nº 1.165, de 20 de março de 2023 · Presidency of the Republic (Planalto) Official legal act
      Where: closing and signatures. Accessed October 13, 2026.
      “Brasília, 20 de março de 2023; 202º da Independência e 135º da República. LUIZ INÁCIO LULA DA SILVA Fernando Haddad Camilo Sobreira de Santana Nísia Verônica Trindade Lima”

  2. 2. Law No. 14,621 of July 14, 2023 (conversion of MP 1,165/2023), signed into law by Lula, establishes the National Strategy for the Training of Health Specialists within the Mais Médicos Program, to integrate training, staffing and work-based education programs in the SUS, and amends Laws 12,871/2013, 13,959/2019 and 13,958/2019 to create new incentives and rules in the Mais Médicos para o Brasil Project and in Revalida and to transform Adaps into AGSUS.

    • Lei nº 14.621, de 14 de julho de 2023 · Presidency of the Republic (Planalto) Official legal act
      Where: header and summary. Accessed October 13, 2026.
      “LEI Nº 14.621, DE 14 DE JULHO DE 2023 Vigência Conversão da Medida Provisória nº 1.165, de 2023 Institui a Estratégia Nacional de Formação de Especialistas para a Saúde no âmbito do Programa Mais Médicos; e altera as Leis nºs 12.871, de 22 de outubro de 2013, 13.959, de 18 de dezembro de 2019, e 13.958, de 18 de dezembro de 2019, para criar novos incentivos e regras no âmbito do Projeto Mais Médicos para o Brasil”
    • Lei nº 14.621, de 14 de julho de 2023 · Presidency of the Republic (Planalto) Official legal act
      Where: art. 1. Accessed October 13, 2026.
      “Art. 1º Fica instituída a Estratégia Nacional de Formação de Especialistas para a Saúde no âmbito do Programa Mais Médicos, com vistas à integração de programas de formação, provimento e educação pelo trabalho na esfera do Sistema Único de Saúde (SUS).”
    • Lei nº 14.621, de 14 de julho de 2023 · Presidency of the Republic (Planalto) Official legal act
      Where: art. 5. Accessed October 13, 2026.
      “Art. 5º A Agência para o Desenvolvimento da Atenção Primária à Saúde (Adaps), cuja instituição foi autorizada pela Lei nº 13.958, de 18 de dezembro de 2019 , fica transformada em Agência Brasileira de Apoio à Gestão do SUS (AGSUS).”
    • Lei nº 14.621, de 14 de julho de 2023 · Presidency of the Republic (Planalto) Official legal act
      Where: closing and signatures. Accessed October 13, 2026.
      “Brasília, 14 de julho de 2023; 202º da Independência e 135º da República. LUIZ INÁCIO LULA DA SILVA Fernando Haddad Camilo Sobreira de Santana”

  3. 3. Provisional Measure (MP) No. 621 of July 8, 2013, signed by President Dilma Rousseff, established the Mais Médicos Program, with the purpose of training human resources in the medical field for the SUS (Unified Health System).

    • Medida Provisória nº 621, de 8 de julho de 2013 · Presidency of the Republic (Planalto) Official legal act
      Where: art. 1, caput. Accessed October 13, 2026.
      “Art. 1º Fica instituído o Programa Mais Médicos, com a finalidade de formar recursos humanos na área médica para o Sistema Único de Saúde - SUS e com os seguintes objetivos:”
    • Medida Provisória nº 621, de 8 de julho de 2013 · Presidency of the Republic (Planalto) Official legal act
      Where: closing and signatures. Accessed October 13, 2026.
      “Brasília, 8 de julho de 2013; 192º da Independência e 125º da República. DILMA ROUSSEFF Aloizio Mercadante Alexandre Rocha Santos Padilha Miriam Belchior”

  4. 4. Decree No. 3,745 of February 5, 2001, signed by Fernando Henrique Cardoso, established the Program for Bringing Health Work to the Interior (Programa de Interiorização do Trabalho em Saúde), to encourage the placement of university-educated health professionals in municipalities with proven shortages.

    • Decreto nº 3.745, de 5 de fevereiro de 2001 · Presidency of the Republic (Planalto) Official legal act
      Where: art. 1. Accessed October 13, 2026.
      “Fica instituído o Programa de Interiorização do Trabalho em Saúde, com o objetivo de incentivar a alocação de profissionais de saúde, de nível superior, em municípios de comprovada carência de recursos médico-sanitários.”
    • Decreto nº 3.745, de 5 de fevereiro de 2001 · Presidency of the Republic (Planalto) Official legal act
      Where: closing and signatures. Accessed October 13, 2026.
      “Brasília, 5 de fevereiro de 2001; 180 o da Independência e 113 o da República. FERNANDO HENRIQUE CARDOSO José Serra”

  5. 5. Interministerial Ordinance 1,369/2013, which implemented the Mais Médicos para o Brasil Project, cites in its recitals Interministerial Ordinance No. 2,087/2011, which established PROVAB.

    • Portaria Interministerial nº 1.369, de 8 de julho de 2013 · Ministry of Health / Ministry of Education (Saúde Legis, BVS MS) Official legal act
      Where: recitals. Accessed October 13, 2026.
      “Considerando a Portaria Interministerial nº 2.087/MS/MEC, de 1º de setembro de 2011, que institui o Programa de Valorização dos Profissionais da Atenção Básica (PROVAB);”

  6. 6. Interministerial Ordinance 1,369/2013 cites in its recitals Decree No. 7,385/2010, which established UNA-SUS.

    • Portaria Interministerial nº 1.369, de 8 de julho de 2013 · Ministry of Health / Ministry of Education (Saúde Legis, BVS MS) Official legal act
      Where: recitals. Accessed October 13, 2026.
      “Considerando o Decreto nº 7.385, de 8 de dezembro de 2010, que instituiu o Sistema Universidade Aberta do Sistema único de Saúde (UNA-SUS) e dá outras providências;”

  7. 7. Law 12,871/2013 assigns the coordination of the Mais Médicos para o Brasil Project to the Ministries of Education and Health, which regulate by joint act the participation of public higher education institutions and the operating rules.

    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 13, § 3. Accessed October 13, 2026.
      “§ 3º A coordenação do Projeto Mais Médicos para o Brasil ficará a cargo dos Ministérios da Educação e da Saúde, que disciplinarão, por meio de ato conjunto dos Ministros de Estado da Educação e da Saúde, a forma de participação das instituições públicas de educação superior e as regras de funcionamento do Projeto,”

  8. 8. Under Ordinance 1,369/2013, it falls to the Federal District and the participating municipalities, among other obligations, to place the physicians in the primary care teams provided for in the National Primary Care Policy.

    • Portaria Interministerial nº 1.369, de 8 de julho de 2013 · Ministry of Health / Ministry of Education (Saúde Legis, BVS MS) Official legal act
      Where: art. 10, main provision and item III. Accessed October 13, 2026.
      “Art. 10. Compete ao Distrito Federal e aos Municípios participantes do Projeto Mais Médicos para o Brasil, sem prejuízo de demais responsabilidades a serem definidas em editais específicos e termo de adesão e compromisso:”
    • Portaria Interministerial nº 1.369, de 8 de julho de 2013 · Ministry of Health / Ministry of Education (Saúde Legis, BVS MS) Official legal act
      Where: art. 10, item III. Accessed October 13, 2026.
      “III - inserir os médicos em equipes de atenção básica nas modalidades previstas na Política Nacional de Atenção Básica”

  9. 9. According to PAHO, Cuban physicians began working in 2013 in Basic Health Units through international cooperation among Brazil, Cuba and PAHO; PAHO arranged the agreements, did not enter into contracts with physicians, and the cooperating Cubans were hired by the Cuban government.

  10. 10. Law No. 12,871 of October 22, 2013, the conversion of MP 621/2013, signed into law by Dilma Rousseff, established the Mais Médicos Program.

    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: header and summary. Accessed October 13, 2026.
      “LEI Nº 12.871, DE 22 DE OUTUBRO DE 2013. Conversão da Medida Provisória nº 621, de 2013 Mensagem de veto Institui o Programa Mais Médicos, altera as Leis nº 8.745, de 9 de dezembro de 1993, e nº 6.932, de 7 de julho de 1981, e dá outras providências.”
    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 1, main provision (original wording). Accessed October 13, 2026.
      “Art. 1º É instituído o Programa Mais Médicos, com a finalidade de formar recursos humanos na área médica para o Sistema Único de Saúde (SUS) e com os seguintes objetivos:”
    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: closing and signatures. Accessed October 13, 2026.
      “Brasília, 22 de outubro de 2013; 192º da Independência e 125º da República. DILMA ROUSSEFF Aloizio Mercadante Alexandre Rocha Santos Padilha Miriam Belchior Luís Inácio Lucena Adams”

  11. 11. In Ruling 1764/2025-Plenary (session of August 6, 2025, rapporteur Jhonatan de Jesus), an operational audit by the TCU of the Mais Médicos para o Brasil Project after the restructuring under Law 14,621/2023 pointed to flaws in the diagnosis, the absence of an analysis of options, insufficient cost-effectiveness targets and indicators, and the absence of risk management, and made recommendations to the Ministry of Health.

  12. 12. Law 13,958/2019 states that it does not alter the execution of the Mais Médicos para o Brasil Project, provided for in Law 12,871/2013, nor the other norms on the subject.

    • Lei nº 13.958, de 18 de dezembro de 2019 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 37. Accessed October 13, 2026.
      “Art. 37. Esta Lei não altera a execução do Projeto Mais Médicos para o Brasil, previsto na Lei nº 12.871, de 22 de outubro de 2013 , nem as demais normas sobre o tema.”

  13. 13. Among the objectives set by Law 12,871/2013 are reducing the shortage of physicians in the priority regions of the SUS, in order to reduce regional inequalities, and strengthening the provision of primary care services.

    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 1, items I and II (original wording). Accessed October 13, 2026.
      “I - diminuir a carência de médicos nas regiões prioritárias para o SUS, a fim de reduzir as desigualdades regionais na área da saúde; II - fortalecer a prestação de serviços de atenção básica em saúde no País;”

  14. 14. Law 12,871/2013 established, within the Mais Médicos Program, the Mais Médicos para o Brasil Project, offered to physicians trained in Brazil or with a revalidated diploma and to physicians trained abroad, through international medical exchange.

    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 13, main provision and items. Accessed October 13, 2026.
      “Art. 13. É instituído, no âmbito do Programa Mais Médicos, o Projeto Mais Médicos para o Brasil, que será oferecido: I - aos médicos formados em instituições de educação superior brasileiras ou com diploma revalidado no País; e II - aos médicos formados em instituições de educação superior estrangeiras, por meio de intercâmbio médico internacional.”

  15. 15. According to a note from PAHO, the program, created in 2013 by the Brazilian government, has three axes: improving the infrastructure of health services; emergency staffing with Brazilian and foreign physicians; and expanding places in medical schools and residencies, with curriculum changes.

    • Mais Médicos: profissionais cubanos da cooperação internacional sairão do Brasil até 12 de dezembro · Pan American Health Organization (PAHO/WHO) International organization
      Where: section 'About Mais Médicos'. Accessed October 13, 2026.
      “Um exemplo é o programa Mais Médicos, criado em 2013 pelo governo brasileiro para ampliar a atenção primária em saúde e suprir a carência de médicos. A iniciativa é composta por três eixos: o primeiro prevê a melhoria da infraestrutura nos serviços de saúde. O segundo se refere ao provimento emergencial de médicos, tanto brasileiros (formados dentro ou fora do país) quanto estrangeiros”
    • Mais Médicos: profissionais cubanos da cooperação internacional sairão do Brasil até 12 de dezembro · Pan American Health Organization (PAHO/WHO) International organization
      Where: section 'About Mais Médicos'. Accessed October 13, 2026.
      “O terceiro eixo é direcionado à ampliação de vagas nos cursos de medicina e nas residências médicas, com mudança nos currículos de formação para melhorar a qualidade da atenção à saúde.”

  16. 16. Under Law 12,871/2013, the Project's places are filled in this order of priority: physicians trained in Brazil or with a revalidated diploma, including retirees; Brazilians trained abroad; and foreigners qualified abroad.

    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 13, § 1. Accessed October 13, 2026.
      “§ 1º A seleção e a ocupação das vagas ofertadas no âmbito do Projeto Mais Médicos para o Brasil observarão a seguinte ordem de prioridade: I - médicos formados em instituições de educação superior brasileiras ou com diploma revalidado no País, inclusive os aposentados; II - médicos brasileiros formados em instituições estrangeiras com habilitação para exercício da Medicina no exterior; e III - médicos estrangeiros com habilitação para exercício da Medicina no exterior.”

  17. 17. In the original wording of Law 12,871/2013, the exchange physician practiced medicine exclusively in the activities of the Project, with exemption from diploma revalidation during the first 3 years; Law 14,621/2023 changed the exemption to only the first 4 years of participation.

    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 16, main provision (original wording). Accessed October 13, 2026.
      “Art. 16. O médico intercambista exercerá a Medicina exclusivamente no âmbito das atividades de ensino, pesquisa e extensão do Projeto Mais Médicos para o Brasil, dispensada, para tal fim, nos 3 (três) primeiros anos de participação, a revalidação de seu diploma”
    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 16, main provision (wording given by Law 14,621/2023). Accessed October 13, 2026.
      “dispensada, para esse fim, apenas durante os primeiros 4 (quatro) anos de sua participação, a revalidação de seu diploma nos termos do § 2º do art. 48 da Lei nº 9.394, de 20 de dezembro de 1996. (Redação dada pela Lei nº 14.621, de 2023)”

  18. 18. Law 12,871/2013 provides for scholarships in the forms of training scholarship (bolsa-formação), supervision scholarship (bolsa-supervisão) and tutoring scholarship (bolsa-tutoria), in addition to a settling-in allowance limited to 3 training scholarships; activities in the Project do not create an employment relationship.

    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 19, main provision and § 1. Accessed October 13, 2026.
      “Art. 19. Os médicos integrantes do Projeto Mais Médicos para o Brasil poderão perceber bolsas nas seguintes modalidades: I - bolsa-formação; II - bolsa-supervisão; e III - bolsa-tutoria.”
    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 19, § 1. Accessed October 13, 2026.
      “a União concederá ajuda de custo destinada a compensar as despesas de instalação do médico participante, que não poderá exceder a importância correspondente ao valor de 3 (três) bolsas-formação.”
    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 17. Accessed October 13, 2026.
      “Art. 17. As atividades desempenhadas no âmbito do Projeto Mais Médicos para o Brasil não criam vínculo empregatício de qualquer natureza.”

  19. 19. Interministerial Ordinance 1,369/2013, in its original wording, provided: a training scholarship with a monthly value of R$10,000.00 (ten thousand reais) will be granted to the participating physician, which may be paid for a maximum period of 36 (thirty-six) months, extendable only in the case provided for in § 1 of art. 8 of Provisional Measure No. 621 of 2013.

    • Portaria Interministerial nº 1.369, de 8 de julho de 2013 · Ministry of Health / Ministry of Education (Saúde Legis, BVS MS) Official legal act
      Where: art. 22, § 1 (original wording; the compiled text also carries a later wording with R$10,513.01). Accessed October 13, 2026.
      “§ 1º Ao médico participante será concedida bolsa-formação com valor mensal de R$ 10.000,00 (dez mil reais), que poderá ser paga pelo prazo máximo de 36 (trinta e seis) meses”

  20. 20. In the training axis, Law 12,871/2013 made the authorization of private medical courses conditional on a public call with pre-selection of municipalities and set as a goal, by December 31, 2018, that medical residencies offer each year a number of places equivalent to the number of graduates of the previous year.

    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 3, caput. Accessed October 13, 2026.
      “Art. 3º A autorização para o funcionamento de curso de graduação em Medicina, por instituição de educação superior privada, será precedida de chamamento público, e caberá ao Ministro de Estado da Educação dispor sobre:”
    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 5. Accessed October 13, 2026.
      “Art. 5º Os Programas de Residência Médica de que trata a Lei nº 6.932, de 7 de julho de 1981, ofertarão anualmente vagas equivalentes ao número de egressos dos cursos de graduação em Medicina do ano anterior. Parágrafo único. A regra de que trata o caput é meta a ser implantada progressivamente até 31 de dezembro de 2018.”

  21. 21. In the infrastructure axis, Law 12,871/2013 gave the SUS a period of 5 years to provide basic health units with quality equipment and infrastructure, to be defined in the multiyear plans.

    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 30, § 2. Accessed October 13, 2026.
      “§ 2º O SUS terá o prazo de 5 (cinco) anos para dotar as unidades básicas de saúde com qualidade de equipamentos e infraestrutura, a serem definidas nos planos plurianuais.”

  22. 22. Decree No. 8,126/2013 assigned to the Ministry of Health the enrollment of the exchange physician and the issuance of a single registration and identification card that authorizes him or her to practice medicine only within the scope of the Project.

    • Decreto nº 8.126, de 22 de outubro de 2013 · Presidency of the Republic (Planalto) Official legal act
      Where: art. 1, caput and § 1. Accessed October 13, 2026.
      “§ 1º O Ministério da Saúde emitirá número de registro único para cada médico intercambista e a respectiva carteira de identificação, que o habilitará para o exercício da medicina no âmbito do Projeto Mais Médicos para o Brasil.”
    • Decreto nº 8.126, de 22 de outubro de 2013 · Presidency of the Republic (Planalto) Official legal act
      Where: art. 1, caput. Accessed October 14, 2026.
      “Art. 1º A inscrição do médico intercambista participante do Projeto Mais Médicos para o Brasil será realizada no Ministério da Saúde, nos termos do art. 16 da Lei nº 12.871, de 22 de outubro de 2013.”
    • Decreto nº 8.126, de 22 de outubro de 2013 · Presidency of the Republic (Planalto) Official legal act
      Where: art. 2, caput. Accessed October 14, 2026.
      “Art. 2º O médico intercambista exercerá a medicina exclusivamente no âmbito do Projeto Mais Médicos para o Brasil, na forma do disposto no art. 16 da Lei nº 12.871, de 2013.”

  23. 23. Law 14,621/2023 created an indemnity for physicians who work without interruption in a hard-to-retain area: 20% of the total scholarships received over 48 months in an area of vulnerability and 10% in the others; for those who studied Medicine with Fies, a differentiated indemnity of 80% or 40% of the amount received over 48 months.

    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 19-A (added by Law 14,621/2023). Accessed October 13, 2026.
      “Art. 19-A. O médico participante que atuar no Projeto Mais Médicos para o Brasil de forma ininterrupta em área de difícil fixação, a ser definida em ato do Ministério da Saúde, fará jus a indenização equivalente a: (Incluído pela Lei nº 14.621, de 2023) I - 20% (vinte por cento) do valor total das bolsas percebidas pelo médico participante no período de 48 (quarenta e oito) meses, se atuar em área de vulnerabilidade indicada em ato do Ministério da Saúde;”
    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 19-A, II (added by Law 14,621/2023). Accessed October 13, 2026.
      “II - 10% (dez por cento) do valor total das bolsas percebidas pelo médico participante no período de 48 (quarenta e oito) meses, se atuar nas demais áreas de difícil fixação. (Incluído pela Lei nº 14.621, de 2023)”
    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 19-B, main provision (added by Law 14,621/2023). Accessed October 13, 2026.
      “Art. 19-B. O médico participante do Projeto Mais Médicos para o Brasil que tiver realizado graduação em Medicina financiada pelo Fundo de Financiamento Estudantil (Fies), nos termos da Lei nº 10.260, de 12 de julho de 2001 , poderá requerer indenização diferenciada por atuação em área de difícil fixação, em substituição à indenização prevista no art. 19-A desta Lei.”
    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 19-B, § 1 (added by Law 14,621/2023). Accessed October 13, 2026.
      “I - 80% (oitenta por cento) da quantia a ser percebida pelo médico participante no período de 48 (quarenta e oito) meses, se atuar em área de vulnerabilidade indicada em ato do Ministério da Saúde; ou (Incluído pela Lei nº 14.621, de 2023) II - 40% (quarenta por cento) da quantia a ser percebida pelo médico participante no período de 48 (quarenta e oito) meses, se atuar nas demais áreas de difícil fixação.”

  24. 24. Law 14,621/2023 added to Law 12,871/2013 that the Special Indigenous Health Districts, quilombo remnant communities and riverside communities will be considered priority regions, based on vulnerability criteria.

    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 2-A (added by Law 14,621/2023). Accessed October 13, 2026.
      “Art. 2º-A. Para fins do disposto no inciso I do art. 1º e no inciso III do art. 2º desta Lei, serão consideradas regiões prioritárias, com base nos critérios de vulnerabilidade, os Distritos Sanitários Especiais Indígenas, as comunidades remanescentes de quilombos e as comunidades ribeirinhas. (Incluído pela Lei nº 14.621, de 2023)”

  25. 25. According to the TCU audit report (2025), the Project's main product is the placement of physicians in places where it is difficult to retain them, and the main beneficiaries are the populations living in those places.

    • Acórdão nº 1764/2025 – TCU – Plenário (TC 026.109/2024-7), relatório, voto e acórdão · Federal Court of Accounts (TCU) Audit
      Where: PDF p. 6, items 53-54 of the report. Accessed October 13, 2026.
      “principal produto do PMMB é o provimento de médicos em locais de difícil fixação desses profissionais, com o objetivo de suprir vazios assistenciais e aumentar a cobertura da APS. 2.5 Beneficiários 54. As principais beneficiárias são as populações residentes nessas localidades de difícil provimento.”

  26. 26. Law 12,871/2013 authorizes the Ministries of Education and Health to enter into cooperation agreements with international organizations, educational institutions, federated entities, consortia and private entities, including with the transfer of funds.

    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 23. Accessed October 13, 2026.
      “Art. 23. Para execução das ações previstas nesta Lei, os Ministérios da Educação e da Saúde poderão firmar acordos e outros instrumentos de cooperação com organismos internacionais, instituições de educação superior nacionais e estrangeiras, órgãos e entidades da administração pública direta e indireta da União, dos Estados, do Distrito Federal e dos Municípios, consórcios públicos e entidades privadas, inclusive com transferência de recursos.”

  27. 27. On November 19, 2018, Brazil, Cuba and PAHO determined that about 8,300 Cuban physicians would gradually leave the program by December 12 of that year, after the Cuban government's decision to end its participation; they were in about 2.8 thousand municipalities and in the 34 DSEI (Special Indigenous Health Districts), and their number had fallen from more than 11 thousand to about 8.3 thousand in five years.

  28. 28. The TCU attributes the drop in placements starting in 2018 to the unilateral termination of the agreement between Cuba and PAHO/WHO on November 13, 2018; Law 13,958/2019 provided for the reinstatement in the Project, for 2 non-extendable years, of exchange physicians who were active on November 13, 2018 under the 80th Technical Cooperation Agreement with PAHO, who were dismissed because of the breakdown of the agreement and who remained in the country.

    • Acórdão nº 1764/2025 – TCU – Plenário (TC 026.109/2024-7), relatório, voto e acórdão · Federal Court of Accounts (TCU) Audit
      Where: PDF p. 7, item 64 of the report. Accessed October 13, 2026.
      “a queda de alocação, a partir de 2018 se deu em razão do ‘encerramento unilateral do acordo entre o Governo da República de Cuba e a Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS), ocorrido em 13/11/2018’.”
    • Lei nº 13.958, de 18 de dezembro de 2019 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 34 (adds art. 23-A to Law 12,871/2013). Accessed October 13, 2026.
      “Será reincorporado ao Projeto Mais Médicos para o Brasil, na forma do inciso II do caput do art. 13 desta Lei, pelo prazo improrrogável de 2 (dois) anos, o médico intercambista que atender cumulativamente aos seguintes requisitos: I - estar no exercício de suas atividades, no dia 13 de novembro de 2018, no âmbito do Projeto Mais Médicos para o Brasil, em razão do 80º Termo de Cooperação Técnica”

  29. 29. Law No. 13,333 of September 12, 2016 (conversion of MP 723/2016), signed into law by Michel Temer, extended by three years the period of exemption from revalidation under art. 16 of Law 12,871/2013 and the period of the exchange physician's temporary visa.

    • Lei nº 13.333, de 12 de setembro de 2016 · Presidency of the Republic (Planalto) Official legal act
      Where: art. 1 and sole paragraph. Accessed October 13, 2026.
      “Art. 1º O prazo de dispensa previsto no art. 16 da Lei nº 12.871, de 22 de outubro de 2013 , fica prorrogado por três anos. Parágrafo único. Para fins do disposto no caput , fica prorrogado, por três anos, o prazo do visto temporário de que trata o art. 18 da Lei nº 12.871, de 22 de outubro de 2013 .”
    • Lei nº 13.333, de 12 de setembro de 2016 · Presidency of the Republic (Planalto) Official legal act
      Where: closing and signatures. Accessed October 13, 2026.
      “Brasília, 12 de setembro de 2016; 195º da Independência e 128º da República. MICHEL TEMER”

  30. 30. Provisional Measure No. 890 of August 1, 2019, signed by Jair Bolsonaro, provided that the Médicos pelo Brasil Program will be carried out by the Agency for the Development of Primary Health Care (Adaps), under the technical guidance and supervision of the Ministry of Health, and revoked art. 6 and art. 7 of Law No. 12,871 of October 22, 2013.

    • Medida Provisória nº 890, de 1º de agosto de 2019 · Presidency of the Republic (Planalto) Official legal act
      Where: art. 4. Accessed October 13, 2026.
      “Art. 4º O Programa Médicos pelo Brasil será executado pela Agência para o Desenvolvimento da Atenção Primária à Saúde - Adaps, nos termos do disposto no Capítulo III, sob a orientação técnica e a supervisão do Ministério da Saúde.”
    • Medida Provisória nº 890, de 1º de agosto de 2019 · Presidency of the Republic (Planalto) Official legal act
      Where: art. 31. Accessed October 13, 2026.
      “Art. 31. Ficam revogados os art. 6º e art. 7º da Lei nº 12.871, de 22 de outubro de 2013.”
    • Medida Provisória nº 890, de 1º de agosto de 2019 · Presidency of the Republic (Planalto) Official legal act
      Where: closing and signatures. Accessed October 13, 2026.
      “Brasília, 1º de agosto de 2019; 198º da Independência e 131º da República. JAIR MESSIAS BOLSONARO Paulo Guedes Luiz Henrique Mandetta”

  31. 31. According to the Statement of Reasons of MP 890/2019, signed by Luiz Henrique Mandetta and Paulo Roberto Nunes Guedes, one of the measures provided for by the Médicos pelo Brasil Program is to correct the distribution of places previously defined by the Program and Project provided for in Law No. 12,871 of October 22, 2013, whose applied criterion provides for the creation of about 12,000 places for urban municipalities and only 5,000 for places in Brazil that are hard to staff or highly vulnerable; the text also cites the need to correct the weaknesses of the Program and Project linked to Law No. 12,871 of October 22, 2013.

    • Exposição de Motivos EMI nº 00024/2019 MS ME (MP 890/2019) · Presidency of the Republic (Planalto) / Ministry of Health and Ministry of Economy Official record
      Where: PDF p. 1, item 4. Accessed October 13, 2026.
      “Uma das medidas prevista pelo Programa Médicos pelo Brasil é corrigir a distribuição de vagas anteriormente definida pelo Programa e Projeto previstos na Lei nº 12.871, de 22 de outubro de 2013. O critério aplicado com base na referida lei prevê a criação de cerca de 12.000 vagas para Municípios urbanos e apenas 5.000 para locais de difícil provimento ou alta vulnerabilidade do Brasil.”
    • Exposição de Motivos EMI nº 00024/2019 MS ME (MP 890/2019) · Presidency of the Republic (Planalto) / Ministry of Health and Ministry of Economy Official record
      Where: PDF p. 3, item 15. Accessed October 13, 2026.
      “além de corrigir as fragilidades do Programa e Projeto vinculados à Lei nº 12.871, de 22 de outubro de 2013.”
    • Exposição de Motivos EMI nº 00024/2019 MS ME (MP 890/2019) · Presidency of the Republic (Planalto) / Ministry of Health and Ministry of Economy Official record
      Where: PDF p. 3, signatures. Accessed October 13, 2026.
      “LUIZ HENRIQUE MANDETTA PAULO ROBERTO NUNES GUEDES”

  32. 32. Law No. 13,958 of December 18, 2019 (conversion of MP 890/2019), signed into law by Jair Bolsonaro, established the Médicos pelo Brasil Program and authorized the creation of Adaps; it revoked arts. 6 and 7 of Law 12,871/2013.

    • Lei nº 13.958, de 18 de dezembro de 2019 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: header and original summary. Accessed October 13, 2026.
      “LEI Nº 13.958, DE 18 DE DEZEMBRO DE 2019 Mensagem de veto Convertida da Medida Provisória nº 890 de 2019) Institui o Programa Médicos pelo Brasil, no âmbito da atenção primária à saúde no Sistema Único de Saúde (SUS), e autoriza o Poder Executivo federal a instituir serviço social autônomo denominado Agência para o Desenvolvimento da Atenção Primária à Saúde (Adaps).”
    • Lei nº 13.958, de 18 de dezembro de 2019 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 36. Accessed October 13, 2026.
      “Art. 36. Ficam revogados os arts. 6º e 7º da Lei nº 12.871, de 22 de outubro de 2013 .”
    • Lei nº 13.958, de 18 de dezembro de 2019 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: closing and signatures. Accessed October 13, 2026.
      “Brasília, 18 de dezembro de 2019; 198 o da Independência e 131 o da República. JAIR MESSIAS BOLSONARO Paulo Guedes Luiz Henrique Mandetta Onyx Lorenzoni”

  33. 33. According to the TCU (2025), since Law 12,871/2013 was not revoked, from 2019 there came to be two simultaneous programs for placing physicians in places that are hard to staff: Mais Médicos and Médicos pelo Brasil.

  34. 34. Law 14,621/2023 included among the objectives of the Mais Médicos Program ensuring comprehensive care across life cycles and expanding the supply of professional specialization in areas strategic to the SUS.

    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 1, items IX and X (added by Law 14,621/2023). Accessed October 13, 2026.
      “IX - garantir a integralidade com transversalidade do cuidado no âmbito dos ciclos de vida, por meio da integração entre educação e saúde, com vistas a qualificar a assistência especializada em todos os níveis de atenção do SUS; e (Incluído pela Lei nº 14.621, de 2023) X - ampliar a oferta de especialização profissional nas áreas estratégicas para o SUS.”

  35. 35. With Law 14,621/2023, the training of participants came to take place through improvement courses or lato or stricto sensu graduate programs, with a period of up to 4 years, extendable for an equal period (previously: up to 3 years).

    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 14, § 1 (original wording). Accessed October 13, 2026.
      “§ 1º O aperfeiçoamento de que trata o caput terá prazo de até 3 (três) anos, prorrogável por igual período caso ofertadas outras modalidades de formação”
    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 14, main provision and § 1 (wording given by Law 14,621/2023). Accessed October 13, 2026.
      “§ 1º A formação de que trata o caput deste artigo terá prazo de até 4 (quatro) anos, prorrogável por igual período, conforme definido em ato conjunto do Ministro de Estado da Saúde e do Ministro de Estado da Educação. (Redação dada pela Lei nº 14.621, de 2023)”

  36. 36. Law 14,621/2023 also provided for an indemnity corresponding to the outstanding Fies balance for those who complete without interruption the 24 months of residency in Family and Community Medicine with a specialist title, and determined that the regulations set percentages of places reserved for physicians with disabilities and from ethnic-racial groups.

    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 22-A (added by Law 14,621/2023). Accessed October 13, 2026.
      “Art. 22-A. Ao médico participante de Programa de Residência em Medicina de Família e Comunidade que cumprir, de forma ininterrupta, os 24 (vinte e quatro) meses de formação com aprovação para obtenção de título de especialista e que tiver realizado a graduação em Medicina financiada pelo Fies”
    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 13, § 4 (added by Law 14,621/2023). Accessed October 13, 2026.
      “§ 4º Para fins de preenchimento das vagas disponíveis no Projeto Mais Médicos para o Brasil, o regulamento estabelecerá os percentuais de vagas reservadas para médicos com deficiência e para médicos pertencentes a grupos étnico-raciais, bem como os critérios e normas pertinentes. (Incluído pela Lei nº 14.621, de 2023)”

  37. 37. Law 14,621/2023 determined monitoring and evaluation processes for the Project's effectiveness in training physicians, in retaining them in hard-to-reach areas and in improving health indicators, with publication of data and an annual report on a website.

    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 22-B, main provision (added by Law 14,621/2023). Accessed October 13, 2026.
      “Art. 22-B. Serão desenvolvidos processos de monitoramento e de avaliação sobre a efetividade do Projeto Mais Médicos para o Brasil na formação dos médicos participantes, na alocação e fixação dos profissionais em áreas de difícil acesso e na melhoria dos indicadores de saúde da população. (Incluído pela Lei nº 14.621, de 2023)”
    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 22-B, § 1, II. Accessed October 13, 2026.
      “II - relatório circunstanciado anual com os resultados dos processos de monitoramento e de avaliação.”

  38. 38. According to the TCU (2025), from Law 14,621/2023 onward, Mais Médicos and Médicos pelo Brasil were unified as Federal Government Staffing Programs, even though they have different management and participation rules.

    • Acórdão nº 1764/2025 – TCU – Plenário (TC 026.109/2024-7), relatório, voto e acórdão · Federal Court of Accounts (TCU) Audit
      Where: PDF p. 5, item 49 of the report. Accessed October 13, 2026.
      “Em 2023, por sua vez, houve atualização do Programa Mais Médicos e instituição da Estratégia Nacional de Formação de Especialistas para a Saúde, por meio da publicação da Lei 14.621/2023. A partir dessa norma, os dois programas foram unificados como Programas de Provimento do Governo Federal, não obstante terem gestão e regras de participação diferentes.”

  39. 39. The compiled text of Law 12,871/2013 records the inclusion, by MP 1,301/2025 and then by Law 15,233/2025, of the Mais Médicos Especialistas Project, within the Mais Médicos Program, for staffing professionals with a view to reducing waiting times in specialized care, exclusive to physicians trained in Brazil or with a revalidated diploma and certified as specialists.

    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 22-D, main provision (added by Law 15,233/2025). Accessed October 13, 2026.
      “Art. 22-D. Fica instituído, no âmbito do Programa Mais Médicos, o Projeto Mais Médicos Especialistas, destinado ao provimento de profissionais com vistas à redução no tempo de espera de atendimento ao usuário do SUS, nas regiões prioritárias estabelecidas pelo Ministério da Saúde no âmbito da atenção especializada à saúde. (Incluído pela Lei nº 15.233, de 2025)”
    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 22-D, § 1. Accessed October 13, 2026.
      “§ 1º A participação no Projeto Mais Médicos Especialistas é exclusiva a médicos formados em instituições de ensino superior brasileiras ou com diploma revalidado no País, certificados como especialistas, que deverão ser selecionados por meio de editais públicos. (Incluído pela Medida Provisória nº 1.301, de 2025)”

  40. 40. MS/MEC Interministerial Ordinance No. 604 of May 16, 2023, signed by Ministers Nísia Trindade Lima (Health) and Camilo Santana (Education), provides for the execution of the Mais Médicos para o Brasil Project and revoked Interministerial Ordinance No. 1,369 of July 8, 2013.

  41. 41. A Ministry of Health page records Public Call No. 39/2013, which invited physicians trained in Brazil and abroad to join the Mais Médicos para o Brasil Project, established by MP 621/2013.

  42. 42. The Ministry of Health, through the SGTES, held Public Call No. 22/2018 of the Mais Médicos para o Brasil Project, for the purpose of filling vacant places under the cooperation with an international organization, should places remain from the call governed by SGTES/MS Notice No. 18 of November 19, 2018.

    • Chamamento Público nº 22/2018 - Projeto Mais Médicos para o Brasil (SGTES) · Ministry of Health Official record
      Where: introductory text of the call. Accessed October 13, 2026.
      “para fins de alocação nas vagas ociosas de cooperação com organismo internacional, caso haja vagas remanescentes da chamada regida pelo Edital SGTES/MS nº 18, de 19 de novembro de 2018 e respectivas alterações, conforme estabelecido neste Edital.”

  43. 43. Ministry of Health public call pages record notices of the Mais Médicos para o Brasil Project in every year from 2019 to 2022, among them No. 11/2019 (18th cycle), No. 5/2020 (19th cycle, enrollment for 1 year, in the context of the COVID-19 emergency), No. 15/2021 (rehiring of exchange physicians for 1 year, 25th cycle) and No. 15/2022 (27th cycle).

  44. 44. The Statement of Reasons of MP 1,165/2023 estimated a budgetary and financial impact of R$712.5 million in 2023, covered by the 2023 Annual Budget Law (LOA), and expenditures on the order of R$3 billion for the following two fiscal years.

    • Exposição de Motivos EMI nº 00011/2023 MS/MEC/MF (MP 1.165/2023) · Presidency of the Republic (Planalto) / Ministries of Health, Education, and Finance Official record
      Where: PDF p. 3, item 19. Accessed October 13, 2026.
      “O impacto orçamentário e financeiro para o presente exercício é de R$ 712,5 milhões, sendo integralmente coberto pelas dotações previstas na Lei Orçamentária Anual de 2023. Para os dois exercícios subsequentes, as despesas estimadas são da ordem de R$ 3 bilhões e estarão previstas nas futuras leis orçamentárias anuais.”

  45. 45. According to the TCU, based on SIOP, about R$20.2 billion in federal funds were committed to the Mais Médicos Program from 2018 to 2024 (sum of actions 00QC, 214U and 21BG), of which R$4.1 billion in 2024; action 21BG replaced 214U in 2020.

  46. 46. In the TCU table (source: SIOP), the amounts committed under the provision action (214U through 2019; 21BG from 2020) were R$2,790,368,601.00 (2018), R$2,788,106,601.00 (2019), R$2,028,165,711.00 (2020), R$2,924,293,516.00 (2021), R$2,644,326,881.00 (2022), R$2,336,524,517.00 (2023) and R$3,993,380,926.00 (2024); the scholarships action 00QC ranged between R$81,422,825.00 (2023) and R$128,570,838.00 (2024).

    • Acórdão nº 1764/2025 – TCU – Plenário (TC 026.109/2024-7), relatório, voto e acórdão · Federal Court of Accounts (TCU) Audit
      Where: PDF p. 7, Table 1. Accessed October 13, 2026.
      “2018 R$ 121.143.774,00 R$ - R$ 2.790.368.601,00 2019 R$ 97.713.766,00 R$ - R$ 2.788.106.601,00 2020 R$ 83.625.718,00 R$ 2.028.165.711,00 R$ - 2021 R$ 88.510.034,00 R$ 2.924.293.516,00 R$ - 2022 R$ 83.352.321,00 R$ 2.644.326.881,00 R$ - 2023 R$ 81.422.825,00 R$ 2.336.524.517,00 R$ - 2024 R$ 128.570.838,00 R$ 3.993.380.926,00 R$ -”

  47. 47. In 2016, budget action 214U (Implementation of the Mais Médicos Program) had an authorized appropriation of R$2,844,000,000, commitments of R$2,835,763,515, liquidation of R$2,621,592,319 and payment in the fiscal year of R$2,621,151,790, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Of the committed amount, R$2,527,755,950 was under the budget plan 'Mais Médicos Program (staffing)' and R$225,455,900 under the plan 'Mais Médicos / Program for the Valorization of Primary Care Professionals, Provab (staffing)'; the remainder was under other plans of the action.

  48. 48. In 2017, budget action 214U (Implementation of the Mais Médicos Program) had an authorized appropriation of R$3,263,560,000, commitments of R$3,263,444,328, liquidation of R$3,088,982,493 and payment in the fiscal year of R$3,087,247,773, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Of the committed amount, R$2,880,997,625 was under the budget plan 'Mais Médicos Program (staffing)' and R$60,769,231 under the plan 'Mais Médicos / Program for the Valorization of Primary Care Professionals, Provab (staffing)'; the remainder was under other plans of the action.

  49. 49. In 2018, budget action 214U (Implementation of the Mais Médicos Program) had an authorized appropriation of R$2,790,586,337, commitments of R$2,790,368,601, liquidation of R$2,455,667,303 and payment in the fiscal year of R$2,345,507,800, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Of the committed amount, R$2,651,087,380 was under the budget plan 'Mais Médicos Program (staffing)' and R$16,890,143 under the plan 'Mais Médicos / Program for the Valorization of Primary Care Professionals, Provab (staffing)'; the remainder was under other plans of the action.

  50. 50. In 2019, budget action 214U (Implementation of the Mais Médicos Program) had an authorized appropriation of R$2,788,236,000, commitments of R$2,788,106,601, liquidation of R$2,755,608,329 and payment in the fiscal year of R$2,583,838,358, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Of the committed amount, R$2,687,617,823 was under the budget plan 'Mais Médicos Program (staffing)' and R$11,000 under the plan 'Mais Médicos / Program for the Valorization of Primary Care Professionals, Provab (staffing)'; the remainder was under other plans of the action.

  51. 51. In 2020, budget action 21BG (Training and Provision of Professionals for Primary Health Care) had an authorized appropriation of R$2,028,990,791, commitments of R$2,028,165,711, liquidation of R$2,016,657,153 and payment in the fiscal year of R$1,885,692,793, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Under this action, the budget plan 'Mais Médicos Program' had commitments of R$1,997,447,464 and payment in the fiscal year of R$1,866,477,941; the remainder was under other plans of the action.

  52. 52. In 2021, budget action 21BG (Training and Provision of Professionals for Primary Health Care) had an authorized appropriation of R$2,924,570,153, commitments of R$2,924,293,516, liquidation of R$2,907,679,607 and payment in the fiscal year of R$2,735,886,649, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Under this action, the budget plan 'Mais Médicos Program' had commitments of R$2,222,281,898 and payment in the fiscal year of R$2,034,312,244, and the plan 'Médicos pelo Brasil Program - Agency for the Development of Primary Health Care - ADAPS' had commitments of R$103,000,000; the remainder was under other plans of the action.

  53. 53. In 2022, budget action 21BG (Training and Provision of Professionals for Primary Health Care) had an authorized appropriation of R$2,644,356,952, commitments of R$2,644,326,881, liquidation of R$2,629,149,748 and payment in the fiscal year of R$2,627,801,478, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Under this action, the budget plan 'Mais Médicos Program' had commitments of R$1,939,919,529 and payment in the fiscal year of R$1,928,857,604, and the plan 'Médicos pelo Brasil Program - Agency for the Development of Primary Health Care - ADAPS' had commitments of R$505,000,000; the remainder was under other plans of the action.

  54. 54. In 2023, budget action 21BG (Training and Provision of Professionals for Primary Health Care) had an authorized appropriation of R$2,336,550,388, commitments of R$2,336,524,517, liquidation of R$2,241,609,423 and payment in the fiscal year of R$2,228,864,062, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Under this action, the budget plan 'Mais Médicos Program' had commitments of R$2,182,268,662 and payment in the fiscal year of R$2,169,215,421; the remainder was under other plans of the action.

  55. 55. In 2024, budget action 21BG (Training and Provision of Professionals for Primary Health Care) had an authorized appropriation of R$3,993,456,994, commitments of R$3,993,380,926, liquidation of R$3,943,165,688 and payment in the fiscal year of R$3,614,015,358, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Under this action, the budget plan 'Mais Médicos Program' had commitments of R$3,775,068,753 and payment in the fiscal year of R$3,438,966,862; the remainder was under other plans of the action.

  56. 56. In 2025, budget action 21BG (Training and Provision of Professionals for Primary Health Care) had an authorized appropriation of R$4,148,039,234, commitments of R$4,147,967,464, liquidation of R$4,116,730,568 and payment in the fiscal year of R$3,777,989,345, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)). Under this action, the budget plan 'Professional Staffing Program for Primary Health Care (APS)' had commitments of R$4,097,641,399 and payment in the fiscal year of R$3,737,539,457; the remainder was under other plans of the action.

  57. 57. In 2018, budget action 00QC (Granting of Scholarships of the Mais Médicos Program) had an authorized appropriation of R$123,988,495, commitments of R$121,143,774, liquidation of R$101,196,090 and payment in the fiscal year of R$100,836,959, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)).

  58. 58. In 2019, budget action 00QC (Granting of Scholarships of the Mais Médicos Program) had an authorized appropriation of R$98,181,960, commitments of R$97,713,766, liquidation of R$77,124,783 and payment in the fiscal year of R$76,799,958, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)).

  59. 59. In 2020, budget action 00QC (Granting of Scholarships of the Mais Médicos Program) had an authorized appropriation of R$85,914,744, commitments of R$83,625,718, liquidation of R$76,275,718 and payment in the fiscal year of R$75,932,052, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)).

  60. 60. In 2021, budget action 00QC (Granting of Scholarships of the Mais Médicos Program) had an authorized appropriation of R$89,034,877, commitments of R$88,510,034, liquidation of R$80,942,034 and payment in the fiscal year of R$80,607,034, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)).

  61. 61. In 2022, budget action 00QC (Granting of Scholarships of the Mais Médicos Program) had an authorized appropriation of R$84,072,820, commitments of R$83,352,321, liquidation of R$78,114,321 and payment in the fiscal year of R$77,784,321, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)).

  62. 62. In 2023, budget action 00QC (Granting of Scholarships of Health Education Development Programs) had an authorized appropriation of R$81,423,017, commitments of R$81,422,825, liquidation of R$68,582,415 and payment in the fiscal year of R$68,252,415, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)).

  63. 63. In 2024, budget action 00QC (Granting of Scholarships for Supervision of the Mais Médicos Program) had an authorized appropriation of R$128,671,838, commitments of R$128,570,838, liquidation of R$118,140,559 and payment in the fiscal year of R$117,790,559, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)).

  64. 64. In 2025, budget action 00QC (Granting of Scholarships for Supervision of the Mais Médicos Program) had an authorized appropriation of R$139,905,250, commitments of R$139,905,250, liquidation of R$128,628,467 and payment in the fiscal year of R$128,278,467, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)).

  65. 65. In 2023, budget action 21DX (Maintenance of the Management Contract with the Agency for the Development of Primary Health Care (ADAPS) - Médicos pelo Brasil Program) had an authorized appropriation of R$1,022,945,188, commitments of R$1,022,945,187, liquidation of R$1,022,945,187 and payment in the fiscal year of R$1,022,945,187, according to SIOP (nominal values; the amount paid does not include carryover payables (restos a pagar)).

  66. 66. The Statement of Reasons of MP 1,165 (March 20, 2023, Ministers Nísia Trindade, Camilo Santana and Fernando Haddad) states that the program once had 18,240 physicians in 4,058 municipalities and 34 DSEI, began to be reduced from 2017, with intensification from 2019, and then had 8,613 professionals in service.

    • Exposição de Motivos EMI nº 00011/2023 MS/MEC/MF (MP 1.165/2023) · Presidency of the Republic (Planalto) / Ministries of Health, Education, and Finance Official record
      Where: PDF p. 2, item 10. Accessed October 13, 2026.
      “Programa chegou a ter 18.240 profissionais médicos atuando em 4.058 municípios e 34 Distritos Sanitários Especiais Indígenas em todas as regiões do Brasil, possibilitando a cobertura de 63 milhões de brasileiros.”
    • Exposição de Motivos EMI nº 00011/2023 MS/MEC/MF (MP 1.165/2023) · Presidency of the Republic (Planalto) / Ministries of Health, Education, and Finance Official record
      Where: PDF p. 2, item 12. Accessed October 13, 2026.
      “Apesar dos resultados positivos do Mais Médicos, essa política pública começou a ser reduzida a partir de 2017, sendo esse processo intensificado a partir de 2019. Como resultado, o Programa registra hoje 8.613 profissionais em atuação, muito aquém do registrado em seu auge, em 2015, quando contava com 18.240 profissionais.”
    • Exposição de Motivos EMI nº 00011/2023 MS/MEC/MF (MP 1.165/2023) · Presidency of the Republic (Planalto) / Ministries of Health, Education, and Finance Official record
      Where: PDF p. 4, signatures. Accessed October 13, 2026.
      “NÍSIA VERÔNICA TRINDADE LIMA CAMILO SOBREIRA DE SANTANA FERNANDO HADDAD”

  67. 67. According to the TCU, citing annual management reports of the Ministry of Health, 7,786 physicians were placed in 2014 (14,462 when added to those of 2013) and 3,778 in 2015, reaching 18,240 physicians working in the program.

  68. 68. According to the Ministry of Health's 2022 Annual Management Report, in December 2022 the Mais Médicos para o Brasil Program and the Médicos pelo Brasil Program reached 13,535 places filled (74.21%), of which 8,680 were filled by Mais Médicos para o Brasil and 4,855 by Médicos pelo Brasil, in 3,967 municipalities and 34 Special Indigenous Health Districts.

    • Relatório Anual de Gestão 2022 · Ministry of Health, Executive Secretariat, Undersecretariat for Planning and Budget Official record
      Where: p. 55 of the PDF (APS staffing programs). Accessed October 14, 2026.
      “Em dezembro de 2022, o Programa Mais Médicos para o Brasil (PMMB) e o Programa Médicos pelo Brasil (PMpB) alcançaram 13.535 (74,21%) vagas ocupadas, sendo 8.680 ocupadas pelo PMMB e 4.855 pelo PMpB, distribuídas em 3.967 municípios e 34 Distritos Sanitários Especiais Indígenas,”

  69. 69. According to the Ministry of Health's 2023 Annual Management Report, in December 2023 there were 30,485 places made available to municipalities in the staffing programs, of which 25,439 (83.45%) were filled, with 20,557 in the Mais Médicos Program (20,065 in municipalities, 474 in Special Indigenous Health Districts and 18 under state management) and 4,882 in Médicos pelo Brasil.

    • Relatório Anual de Gestão 2023 · Ministry of Health, Executive Secretariat, Undersecretariat for Planning and Budget Official record
      Where: p. 68 of the PDF. Accessed October 14, 2026.
      “no mês de dezembro de 2023 havia um total de 30.485 vagas disponibilizadas aos municípios, destas, 25.439 (83,45%) encontravam-se ocupadas, em 4.591 municípios e 34 Distritos Sanitários Especiais Indígenas. O total de vagas ocupadas nos programas se divide da seguinte forma: 20.557 no PMM (20.065 em Municípios, 474 em DSEI e 18 em gestão Estadual) e 4.882 no PMpB (4.838 em Municípios e 44 em DSEI).”
    • Relatório Anual de Gestão 2023 · Ministry of Health, Executive Secretariat, Undersecretariat for Planning and Budget Official record
      Where: definition of the acronym PMM, same section. Accessed October 14, 2026.
      “O Programa Mais Médicos (PMM) foi instituído pelo Governo Federal no ano de 2013, com o objetivo de diminuir a carência de médicos em regiões prioritárias para o SUS”

  70. 70. According to the Ministry of Health's 2024 Annual Management Report, in December 2024 there were 26,468 places filled in the staffing programs, with 22,395 in the Mais Médicos Program (21,816 in municipalities, 561 in Special Indigenous Health Districts and 18 under state management) and 4,073 in Médicos pelo Brasil.

    • Relatório Anual de Gestão 2024 · Ministry of Health, Executive Secretariat, Undersecretariat for Planning and Budget Official record
      Where: p. 71 of the PDF. Accessed October 14, 2026.
      “No mês de dezembro de 2024 havia um total de 26.468 vagas ocupadas, conforme dados regionalizados abaixo, sendo 25.853 em municípios, 597 em Distritos Sanitários Especiais Indígenas (Dsei) e 18 em gestão estadual. O total de vagas ocupadas nos programas se divide da seguinte forma: 22.395 no PMM (21.816 em municípios, 561 em Dsei e 18 em gestão estadual) e 4.073 no PMpB (4.037 em Municípios e 36 em Dsei).”
    • Relatório Anual de Gestão 2024 · Ministry of Health, Executive Secretariat, Undersecretariat for Planning and Budget Official record
      Where: definition of the acronym PMM, same section. Accessed October 14, 2026.
      “O Programa Mais Médicos (PMM) foi instituído pelo Governo Federal no ano de 2013, com o objetivo de diminuir a carência de médicos em regiões prioritárias para o SUS”

  71. 71. According to the Ministry of Health's 2025 Annual Management Report, in December 2025 there were 27,329 places filled in the physician staffing programs, with 23,990 in the Mais Médicos Program (23,288 in municipalities, 682 in Special Indigenous Health Districts and 20 under state management) and 3,339 in the Médicos pelo Brasil Program.

    • Relatório Anual de Gestão 2025 · Ministry of Health, Executive Secretariat, Undersecretariat for Planning and Budget Official record
      Where: p. 56 of the PDF. Accessed October 14, 2026.
      “no mês de dezembro de 2025, havia um total de 27.329 vagas ocupadas, conforme apresentado abaixo, sendo 26.603 em municípios, 706 em Distritos Sanitários Especiais Indígenas (Dsei) e 20 em gestão estadual. O total de vagas ocupadas nos programas se divide da seguinte forma: 23.990 no Programa Mais Médicos (PMM), destas 23.288 em municípios, 682 em Dsei e 20 em gestão estadual;”
    • Relatório Anual de Gestão 2025 · Ministry of Health, Executive Secretariat, Undersecretariat for Planning and Budget Official record
      Where: p. 56 of the PDF. Accessed October 14, 2026.
      “e 3.339 no Programa Médicos pelo Brasil (PMpB), das quais 3.315 vagas estavam ocupadas em municípios e 24 em Dsei.”

  72. 72. According to the TCU, for 2024, the physical target for the physician staffing programs in primary health care (APS) was 23,553 places filled and the target achieved was 26,756, reaching 113.6% of the target; for 2025, this target is 27,000 places filled, and the target set in the PNS 2024 to 2027 at the end of the four-year period is 29,613 physicians.

  73. 73. According to the TCU, the goal of the National Health Plan (PNS) 2016 to 2019 was to reach 20,335 physicians working in priority regions through Mais Médicos and PROVAB; the physical targets achieved were 18,240 (2016 and 2017), 16,001 (2018) and 14,490 (2019), and the PNS goal was not reached.

  74. 74. According to the TCU, the goal of the PNS and of the Multiyear Plan (PPA) 2020 to 2023 was to fill more than 85% of the places in the federal staffing programs (Mais Médicos + Médicos pelo Brasil); the rates achieved were 90.8% (2020), 85.3% (2021), 74.2% (2022) and 83.5% (2023), and the 2023 Annual Management Report (RAG) attributes the failure to reach the goal to the increase in places offered from 18,240 to 30,485.

  75. 75. Based on a Ministry of Health spreadsheet, the TCU observed a drop in the number of program physicians in 2018, with the end of the contract with PAHO, a recovery in 2019 that was not sustained, and a new decline in 2021 and 2022 in all vulnerability strata; the total number of physicians in primary health care (APS), however, grew from 2012 to 2024.

  76. 76. A difference-in-differences study with 5,565 municipalities (2008 to 2017) estimated that the program was associated with an increase of 15.1 per 100,000 inhabitants in primary care physicians hired by the program, but, with large-scale substitution of existing physicians, the net increase was only 5.7 per 100,000; the authors estimated a reduction in avoidable mortality of 1.06 per 100,000 per year, greater in priority municipalities and in those with a low density of physicians before the program.

  77. 77. A difference-in-differences study with propensity score matching (municipalities, 2010 to 2016) found a significant reduction in hospitalizations for primary care-sensitive conditions in the treated municipalities, with an effect growing from the second year.

  78. 78. A difference-in-differences study with matching (5,570 municipalities, 2008 to 2017), with PAHO co-authors, estimated a 2.9% reduction in hospitalizations for primary care-sensitive conditions (p<0.10) and a 3.7% reduction in their costs (p<0.01).

  79. 79. A difference-in-differences study (5,565 municipalities, 2007 to 2018) found no significant association of the program with infant or neonatal mortality in the aggregate; it found a reduction in infant mortality only in municipalities with the highest infant mortality before the program.

  80. 80. A study with a generalized synthetic control (microregions, 2008 to 2017) found no significant impact of the increase in program physicians on hospitalizations or mortality; the authors cite as possible explanations substitution of other professionals, long-term effects and poor allocation within regions.

  81. 81. A study that exploits the timing of the Cuban physicians' departure from the program found persistent reductions in the care of chronic diseases, rapid recovery in the use of services for conditions requiring immediate care, and no change in health outcomes.

  82. 82. A commentary by Rudi Rocha (2025) on the study by Thomas et al. states that the evidence indicates limited effects of the program: it improved access in underserved regions, with little impact on outcomes such as mortality.

  83. 83. In an official news item of August 8, 2025, the TCU reported that, despite the flaws, no illegalities were found in the program, and that coordination and monitoring are working well.

  84. 84. The TCU report concludes that the Ministry of Health did not consider alternatives beyond the 'resumption' of the program to address the shortage of physicians in vulnerable areas; it records the MS's justification that Médicos pelo Brasil had been effectively implemented only in 2022, with unfavorable numbers, and that 'the management's choice was the resumption and improvement' of Mais Médicos; and it points to the lack of an assessment of the overlap between the two programs.

  85. 85. The TCU describes MP 1,165/2023, converted into Law 14,621/2023, as the period of 'policy reformulation' and records that the MS decided on the 'reformulation and intensification' of the program, with proposals for improvements to strengthen its training character.

  86. 86. The TCU concluded that, although the possible causes of the problem are identified, the evidence does not confirm the immediate cause (difficulty in staffing and retaining physicians in primary health care (APS) in vulnerable areas), since the drops in federal staffing in 2018 and 2022 were not accompanied by a reduction in physicians working in APS.

  87. 87. Law 12,871/2013 limits the number of foreign physicians in the Project to 10% of the number of Brazilian physicians with permanent registration in the CRMs (Regional Councils of Medicine), and makes the number of participants conditional on the available budget resources.

    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 30, main provision and § 1. Accessed October 13, 2026.
      “Art. 30. O quantitativo dos integrantes dos projetos e programas de aperfeiçoamento de que trata esta Lei observará os limites dos recursos orçamentários disponíveis.”
    • Lei nº 12.871, de 22 de outubro de 2013 (texto compilado) · Presidency of the Republic (Planalto) Official legal act
      Where: art. 30, § 1. Accessed October 13, 2026.
      “§ 1º O quantitativo de médicos estrangeiros no Projeto Mais Médicos para o Brasil não poderá exceder o patamar máximo de 10% (dez por cento) do número de médicos brasileiros com inscrição definitiva nos CRMs.”

  88. 88. Hone et al. (2020) conclude that the program's potential benefits were reduced by the widespread allocation of physicians to non-priority areas and by local substitution effects.

  89. 89. According to a TCU news item, the program's legal objectives are generic, the targets are limited to the number of places, there are no indicators showing the real impact on the population, the efficiency and effectiveness indicators have neither targets nor periodicity, and a cost-benefit analysis is lacking.

    • Tribunal avalia planejamento e implementação do Programa Mais Médicos · Federal Court of Accounts (Secom) Audit
      Where: body of the news item, list of problems. Accessed October 13, 2026.
      “Objetivos e metas limitados - Os objetivos legais são genéricos, as metas se restringem ao número de vagas e não há indicadores que mostrem o impacto real na população. Problemas nos indicadores - Os indicadores de eficiência e efetividade não têm metas definidas nem periodicidade para avaliação, além de faltar análise de custo-benefício.”

  90. 90. A PAHO note on the departure of the Cuban physicians records that hospitalization rates for primary care-sensitive conditions had already been declining in Brazil before the program, by 7.9% from 2009 to 2012, and that, according to PAHO, the decline was greater after the implementation of Mais Médicos, at 9.1% between 2012 and 2015.

  91. 91. The Statement of Reasons of MP 1,165/2023 states that the federal programs for placing physicians in primary health care (APS) had the lowest number of physicians in service since 2014 and that about two thousand physicians were due to be dismissed in the following eight months; it estimates at 14.7 million the number of Brazilians who stopped being covered by these programs.

    • Exposição de Motivos EMI nº 00011/2023 MS/MEC/MF (MP 1.165/2023) · Presidency of the Republic (Planalto) / Ministries of Health, Education, and Finance Official record
      Where: PDF p. 1, item 2. Accessed October 13, 2026.
      “Os programas federais de provimento de médicos para a Atenção Primária à Saúde (APS) apresentam, atualmente, o menor número de médicos em atividade desde 2014, prejudicando de forma significativa a assistência à população, sobretudo sua parcela mais vulnerável. Além disso, nos próximos oito meses, aproximadamente dois mil médicos devem ser desligados desses programas,”
    • Exposição de Motivos EMI nº 00011/2023 MS/MEC/MF (MP 1.165/2023) · Presidency of the Republic (Planalto) / Ministries of Health, Education, and Finance Official record
      Where: PDF p. 3, item 13. Accessed October 13, 2026.
      “Atualmente, estima-se em 14,7 milhões o número de brasileiros que deixaram de ser cobertos por programas federais de provimento de médicos, situação agravada em áreas de maior vulnerabilidade.”

  92. 92. The Statement of Reasons of MP 1,165/2023 describes the proposal as improvements to the Mais Médicos Program to strengthen its training character, with a four-year cycle (two-year lato sensu specialization plus a professional master's degree).

    • Exposição de Motivos EMI nº 00011/2023 MS/MEC/MF (MP 1.165/2023) · Presidency of the Republic (Planalto) / Ministries of Health, Education, and Finance Official record
      Where: PDF p. 3, item 14. Accessed October 13, 2026.
      “Ao mesmo tempo, são propostos aperfeiçoamentos no Programa a fim de reforçar seu caráter formativo, principalmente na ampliação do número de especialistas em Medicina de Família e Comunidade.”
    • Exposição de Motivos EMI nº 00011/2023 MS/MEC/MF (MP 1.165/2023) · Presidency of the Republic (Planalto) / Ministries of Health, Education, and Finance Official record
      Where: PDF p. 3, item 16. Accessed October 13, 2026.
      “A proposta de Medida Provisória também amplia o tempo de permanência do profissional do Programa Mais Médicos, que passa a prever formação com especialização lato sensu de dois anos mais um mestrado profissional, completando quatro anos de ciclo formativo.”

  93. 93. Interministerial Ordinance No. 1,369 of July 8, 2013, of the Ministers of Health and Education, provided for the implementation of the Mais Médicos para o Brasil Project, based on MP 621/2013.

    • Portaria Interministerial nº 1.369, de 8 de julho de 2013 · Ministry of Health / Ministry of Education (Saúde Legis, BVS MS) Official legal act
      Where: header, summary and recitals. Accessed October 13, 2026.
      “PORTARIA INTERMINISTERIAL Nº 1.369, DE 8 DE JULHO DE 2013 Dispõe sobre a implementação do Projeto Mais Médicos para o Brasil.”
    • Portaria Interministerial nº 1.369, de 8 de julho de 2013 · Ministry of Health / Ministry of Education (Saúde Legis, BVS MS) Official legal act
      Where: recitals. Accessed October 13, 2026.
      “Considerando a Medida Provisória nº 621, de 8 de julho de 2013, que dispõe sobre o Programa Mais Médicos e dá outras providências;”

  94. 94. A study by Pinto and Côrtes (Ciência & Saúde Coletiva, 2022), with documentary analysis and interviews, concludes that the action of President Dilma Rousseff and of policy entrepreneurs was decisive for the formulation of the program, based on legacies of earlier policies, and challenges the explanation, put forward by one strand of the literature, that it was built hastily in response to the 'Jornadas de Junho' (June Journeys); the authors note, however, that the Jornadas de Junho and the drop in government approval precipitated the launch of the program.

  95. 95. Interministerial Ordinance No. 2,087 of September 1, 2011, signed by Ministers Alexandre Padilha (Health) and Fernando Haddad (Education), established the Program for the Valorization of Primary Care Professionals (PROVAB), for physicians, nurses and dentists in municipalities with difficult access and staffing or with more vulnerable populations.

    • Portaria Interministerial nº 2.087, de 1º de setembro de 2011 · Ministry of Health / Ministry of Education (Saúde Legis, BVS MS) Official legal act
      Where: header and summary. Accessed October 13, 2026.
      “PORTARIA INTERMINISTERIAL Nº 2.087, DE 1º DE SETEMBRO DE 2011 Institui o Programa de Valorização do Profissional da Atenção Básica.”
    • Portaria Interministerial nº 2.087, de 1º de setembro de 2011 · Ministry of Health / Ministry of Education (Saúde Legis, BVS MS) Official legal act
      Where: art. 2. Accessed October 13, 2026.
      “I - profissionais médicos, enfermeiros e cirurgiões-dentistas que já tenham concluído sua graduação na respectiva área e que sejam portadores de registro profissional junto ao respectivo conselho de classe; e II -Municípios considerados áreas de difícil acesso e provimento ou de populações de maior vulnerabilidade”
    • Portaria Interministerial nº 2.087, de 1º de setembro de 2011 · Ministry of Health / Ministry of Education (Saúde Legis, BVS MS) Official legal act
      Where: signatures. Accessed October 13, 2026.
      “ALEXANDRE ROCHA SANTOS PADILHA FERNANDO HADDAD”

  96. 96. Decree No. 7,385 of December 8, 2010, signed by Luiz Inácio Lula da Silva, established within the Ministry of Health the Open University System of the SUS (UNA-SUS), for the training and continuing education of SUS workers through distance education.

    • Decreto nº 7.385, de 8 de dezembro de 2010 · Presidency of the Republic (Planalto) Official legal act
      Where: art. 1, caput. Accessed October 13, 2026.
      “Fica instituído, no âmbito do Ministério da Saúde, o Sistema Universidade Aberta do Sistema Único de Saúde - UNA-SUS, com a finalidade de atender às necessidades de capacitação e educação permanente dos trabalhadores do Sistema Único de Saúde - SUS, por meio do desenvolvimento da modalidade de educação a distância na área da saúde.”
    • Decreto nº 7.385, de 8 de dezembro de 2010 · Presidency of the Republic (Planalto) Official legal act
      Where: closing and signatures. Accessed October 13, 2026.
      “Brasília, 8 de dezembro de 2010; 189 o da Independência 122 o da República. LUIZ INÁCIO LULA DA SILVA Fernando Haddad José Gomes Temporão”

  97. 97. According to Pinto and Côrtes (2022), the PMM was made up of three axes: the infrastructure axis was an expansion of the Requalifica-UBS program, created in 2011; the training axis incorporated the Pro-Residência program, created in 2009; and the staffing axis can be seen as part of a trajectory that involved the creation of Pits, in 2001, and of Provab, in 2011. Respondents stated that the structure of the Open University of the SUS, created in 2010, had been essential to ensure in-service training for the physicians recruited by the PMM.

    • O que tornou possível o Programa Mais Médicos? (Pinto HA, Côrtes SMV, Ciência & Saúde Coletiva, 2022, 27(7)) · SciELO Brasil / Ciência & Saúde Coletiva Academic study
      Where: results section, paragraph on the three axes. Accessed October 13, 2026.
      “O PMM era formado por três eixos. O de “infraestrutura” foi um incremento do programa chamado “Requalifica-UBS”, criado em 2011 para a construção, ampliação e reforma de unidades básicas de saúde. O “formação” retomou e ampliou metas de expansão de cursos de medicina propostas em 2012 no Plano Nacional de Educação Médica e incorporou o programa Pro-Residência, criado em 2009,”
    • O que tornou possível o Programa Mais Médicos? (Pinto HA, Côrtes SMV, Ciência & Saúde Coletiva, 2022, 27(7)) · SciELO Brasil / Ciência & Saúde Coletiva Academic study
      Where: same paragraph. Accessed October 13, 2026.
      “O eixo de “provimento” pode ser visto como parte de uma trajetória de aperfeiçoamento de programas que, no século XXI, envolveram a criação do Programa de Interiorização do Trabalho em Saúde (Pits), em 2001, e do Provab, em 2011. Além disso, respondentes afirmaram que a estrutura da Universidade Aberta do SUS, criada em 2010, fora essencial para garantir a formação em serviço dos milhares de médicos recrutados pelo PMM”

  98. 98. According to Pinto and Côrtes (2022), during the Lula government Ministry of Health leaders presented proposals such as mandatory civil service and the recognition of foreign medical diplomas, without success, owing to the actions of organizations of the medical profession and to opposition from the MEC; in the discussion, the authors add that, in 2003 to 2010, the neutral or opposing positions of the core of the government and of the MEC prevented more significant proposals for change from advancing. For the authors, unlike in the previous period (2003 to 2010), in the period 2011 to 2013 it was possible to promote changes that culminated in the program.

  99. 99. According to Joint Ordinance No. 4 of April 2, 2012, Interministerial Ordinance No. 1,001 of October 22, 2009, established the National Program to Support the Training of Medical Specialists in Strategic Areas (Pró-Residência), with the aim of promoting the training of specialists, in the form of medical residency, in specialties and priority regions defined by common agreement with SUS managers.

    • Portaria Conjunta nº 4, de 2 de abril de 2012 (SGTES/MS e SESu/MEC) · Ministry of Health (Saúde Legis, Virtual Health Library) Official legal act
      Where: preamble. Accessed October 14, 2026.
      “nos termos da Portaria Interministerial nº 1.001, de 22 de outubro de 2009, que institui o Programa Nacional de Apoio à Formação de Médicos Especialistas em áreas Estratégicas (PRÓ-RESIDÊNCIA), com o objetivo de favorecer a formação de especialistas, na modalidade residência médica, em especialidades e regiões prioritárias definidas em comum acordo com os gestores do SUS,”

  100. 100. According to the TCU (2025), the Ministry of Health unit responsible for the Project is the Secretariat for Primary Health Care (SAPS), through the DGAPS; at a meeting on May 6, 2025, managers reported that the coordination was being transferred to the SGTES.

  101. 101. In May 2024, the Ministry of Health issued Notice No. 3/2024 for the enrollment and renewal of enrollment of municipalities and the Federal District in the Project, with places funded by the federal government and places with cost sharing, for the 38th cycle, with staffing for 48 months.

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