Title : Workforce development for universal health coverage: Lessons from the qualifica-APS program

Background: Strengthening Primary Health Care (PHC) is widely recognized as a cornerstone for achieving Universal Health Coverage (UHC) and improving population health outcomes. The World Health Organization emphasizes the importance of a well-trained, motivated, and adequately distributed health workforce as a critical component of resilient health systems. In low- and middle-income countries, however, challenges such as workforce shortages, high turnover, limited access to continuing professional development, and regional inequities continue to hinder the effectiveness of PHC services. In Brazil, the Unified Health System (Sistema Único de Saúde–SUS) relies on PHC as the primary gateway to healthcare. Despite significant advances, disparities in workforce qualification and retention persist, particularly in socially vulnerable, rural, and remote areas. To address these challenges, the Capixaba Institute for Teaching, Research and Innovation in Health (ICEPi), in partnership with the Espírito Santo State Department of Health, implemented the Qualifica-APS Program, a statewide initiative focused on in-service education and workforce development. This study describes the implementation of the program and examines its contributions to strengthening PHC services and advancing the goals of UHC.

Methods: This study presents a descriptive and exploratory experience report based on the implementation of the Qualifica-APS Program between January 2019 and December 2024 in the state of Espírito Santo, Brazil. Data were obtained through analysis of institutional documents, legal and regulatory frameworks, technical reports, monitoring systems, and educational records produced throughout the program’s implementation. The analysis focused on three dimensions: (1) pedagogical strategies and educational methodologies, (2) operational and governance arrangements, and (3) outcomes related to workforce development and service delivery. The program was implemented across all 69 municipalities of the state and involved more than 1,300 PHC professionals, including physicians, nurses, dentists, and other members of multidisciplinary health teams. The educational model integrated workplace-based learning, active teaching methodologies, digital learning platforms, structured mentoring, and competency-based assessments. Program activities were developed collaboratively with municipal health managers and state health authorities to ensure alignment with local healthcare needs and priorities.

Results: The Qualifica-APS Program demonstrated substantial contributions to workforce qualification and health service strengthening. More than 1,300 healthcare professionals successfully participated in educational activities, enhancing technical competencies, clinical decision-making, and organizational problem-solving skills within PHC settings. The program promoted stronger integration between education and healthcare services, enabling professionals to apply newly acquired knowledge directly to everyday practice. This approach fostered continuous learning and encouraged the adoption of evidence-informed practices across participating municipalities. Implementation in vulnerable territories contributed to greater workforce retention and reduced professional turnover, particularly in areas traditionally facing recruitment and retention difficulties. Furthermore, the initiative strengthened collaboration among health professionals, managers, and educational institutions, creating sustainable networks for professional development.At the system level, the program enhanced the institutional recognition of permanent health education as a strategic tool for improving healthcare quality, access, and equity. The use of digital technologies also expanded educational reach and facilitated participation among professionals working in geographically dispersed locations.

Conclusions: The Qualifica-APS Program represents a successful example of large-scale workforce development within a public health system. By integrating education with service delivery and emphasizing competency-based learning, the initiative strengthened PHC capacity and contributed to more equitable healthcare provision across diverse territories. The experience highlights the potential of in-service education programs to support workforce retention, improve healthcare quality, and advance progress toward Universal Health Coverage. Replication and adaptation of similar models in other regions may contribute to strengthening health systems, particularly in settings facing workforce shortages and persistent health inequities.  

Keywords: Primary Health Care; Continuing Education in Health; Professional Training; Universal Health Coverage.

Dr. Luís Carlos Lopes-Júnior, PhD, is an Associate Professor at the Federal University of Espírito Santo (UFES), Brazil, and a CNPq Research Productivity Fellow. He holds a specialization in Healthcare Management and completed postdoctoral training at the Pan American Health Organization/World Health Organization (PAHO/WHO), Washington, DC. He serves as a faculty mentor at the QUALIFICA-APS of Capixaba Institute for Teaching, Research and Innovation in Health (ICEPi), with emphasis on Public Health and Primary Health Care workforce development. His research focuses on oncology, cancer epidemiology, symptom science, health-related quality of life, and health systems strengthening. Dr. LopesJúnior has authored more than 170 scientific publications and actively collaborates with international research networks.