Interprofessionalism in continuing health education practices in the Brazilian context: a perspective from graduates, facilitators, and coordinatorsAbstract
This article aims to understand, from the perspective of graduates, facilitators, and coordinators of continuing health education programs, the challenges and barriers to incorporating interprofessionalism in these programs within the Brazilian context. This is a qualitative study, carried out in five states across different regions of Brazil, in 2022, in which the data were collected through semi-structured interviews with coordinators and facilitators, and a questionnaire containing open-ended questions for those who had participated in continuing health education initiatives. All material was organized using thematic content analysis and interpreted in light of the frameworks of interprofessionalism and continuing health education. Our results point to obstacles to the integration of interprofessionalism in continuing health education programs across different dimensions: relational, procedural, organizational, and contextual. In conclusion, overcoming these challenges requires integrated public policies, critical training for educators, valuing teamwork, and institutional strengthening, recognizing that interprofessionalism is not a technical ideal, but a political project for the transformation of care and training in health within the Brazilian Unified Health System.
Keywords
human resources training in health; interprofessional education; continuing education in health
Resumo
Este artigo teve por objetivo compreender, na ótica de egressos, facilitadores e coordenadores de ações de educação permanente em saúde, os desafios e as barreiras à incorporação da interprofissionalidade em ações educativas desenvolvidas no contexto brasileiro. Trata-se de uma pesquisa qualitativa, realizada em cinco estados de diferentes regiões do Brasil, em 2022, na qual os dados foram produzidos mediante entrevistas semiestruturadas com coordenadores e facilitadores e um formulário que continha perguntas abertas para os egressos de ações de educação permanente em saúde. Todo o material foi organizado com base na análise temática do conteúdo e interpretado à luz dos referenciais da interprofissionalidade e da educação permanente em saúde. Os resultados apontam desafios para a inserção da interprofissionalidade nas ações educativas em diferentes dimensões: relacionais, processuais, organizacionais e contextuais. Como conclusão, superar esses desafios exige políticas públicas integradas, qualificação crítica dos educadores, valorização do trabalho em equipe e fortalecimento institucional, reconhecendo que a interprofissionalidade não é um ideal técnico, mas um projeto político para a transformação do cuidado e da formação no Sistema Único de Saúde.
Palavras-chave
capacitação de recursos humanos em saúde; educação interprofissional, educação permanente em saúde
Resumen
Este artículo busca comprender, desde la perspectiva de egresados, facilitadores y coordinadores de acciones de educación permanente en salud, los retos y barreras para la incorporación de la interprofesionalidad en dichos programas en el contexto brasileño. Se trata de una investigación cualitativa, realizada en cinco estados de diferentes regiones de Brasil, em 2022, en la que los datos se obtuvieron a partir de entrevistas semiestructuradas con coordinadores y facilitadores, y de un cuestionario que incluía preguntas abiertas para los exparticipantes de las acciones de educación permanente en salud. El material se organizó mediante análisis de contenido temático y se interpretó a la luz de los marcos teóricos de la interprofesionalidad y la educación permanente en salud. Nuestros resultados señalan obstáculos para la integración de la interprofesionalidad en los programas de educación permanente en salud en diferentes dimensiones: relacional, procedimental, organizacional y contextual. En conclusión, superar estos desafíos requiere políticas públicas integradas, capacitación crítica para educadores, valoración del trabajo en equipo y fortalecimiento institucional, reconociendo que la interprofesionalidad no es un ideal técnico, sino un proyecto político para la transformación de la atención y la formación en salud dentro del Sistema Único de Salud brasileño.
Palabras clave
capacitación de recursos humanos en salud; educación interprofesional, educación permanente en salud
Introduction
The training and work of health professionals have historically constituted a field of contention shaped by the model of health care, which on the one hand can be a hegemonic medical model characterized by epidemiologically inefficient care technologies, single-professional knowledge, a lack of dialogue, and social injustice; or, on the other hand, one guided by health surveillance based on the socio-epidemiological needs of local communities and their social determinants (Méllo, Albuquerque, and Santos, 2022).
In this context, Continuing Health Education (CHE) has established itself as a fundamental learning strategy that takes place in and for health care work, guided by the complexities and daily challenges of health services. Its purpose is to promote the collective development of meaningful care practices for workers, users, and managers of the Unified Health System (Brazilian Unified Health System – SUS) (Jesus and Rodriguez, 2022; Ferraz et al., 2025). These principles became part of the SUS’s priority agenda with the creation and institutionalization of the National Policy on Continuing Health Education (PNEPS) in 2004, when health education and practice assumed a strategic role in Brazilian public policies (Jesus and Rodriguez, 2022).
However, 21 years later, challenges still remain in implementing CHE actions guided by a rupture with traditional forms of teaching (Freire Filho et al., 2019; Ogata et al., 2021), to integrate professional teams into what is known as collaborative interprofessional work—that is, “when two or more workers from different professional fields intentionally interact with one another, collaborating, engaging in dialogue, and building a healthcare process aimed at comprehensiveness and effectiveness” (Barbosa et al., 2022, p. 68).
The international literature has made progress in defining collaborative competencies, developing regulatory frameworks, and describing interprofessional experiences, with a particular focus on systematic reviews that point to positive changes in professionals’ attitudes and behaviors, although evidence regarding direct impacts on clinical outcomes remains limited (WHO, 2010; Reeves et al., 2016; Saragih et al., 2024; PAHO, 2025). However, more recent reviews have strengthened this body of evidence by demonstrating that interprofessional practice is associated with improved clinical and organizational outcomes, including better management of chronic diseases, reduced clinical errors and length of hospital stay, greater satisfaction among patients and professionals, and lower levels of stress and burnout among healthcare workers (Pascucci et al., 2021; Carron et al., 2021). These findings reinforce interprofessionalism as a strategy capable of simultaneously improving the quality of care, work processes, and the sustainability of health systems.
In Brazil, the vast majority of studies have analyzed the incorporation of interprofessionalism into undergraduate curricula and actions such as the Education through Work for Health Program (PET-Health), with a view toward its institutionalization and sustainability (Marques and Costa, 2023; Mazzi et al., 2023; Moraes and Medeiros, 2023). However, little is known about how interprofessionalism has been expressed (or not) in Primary Health Care (PHC) practices, as well as the challenges faced in its implementation, which can lead to multiple negative consequences: the fragmentation of care practices, which remain centered on professional groups rather than on users’ needs; limiting the educational potential of CHE, which tends to reproduce disciplinary and top-down models of teaching; and weakening teamwork processes, hindering the development of collaborative practices and comprehensive health care. These gaps highlight the need to deepen the understanding of the political, institutional, and pedagogical conditions that may restrict the incorporation of interprofessionalism into continuing health education actions.
Thus, this article aimed to understand—from the perspective of graduates, facilitators, and coordinators of continuing health education actions—the challenges and barriers to incorporating interprofessionalism into these actions in the Brazilian context.
Methodology
This is a qualitative study on continuing education actions that were part of the project entitled “Evaluation of the Implementation of the Continuing Education Policy in the States,” which aimed to develop a theoretical and methodological framework for monitoring and evaluating the National Policy on Continuing Education in Health (PNEPS) in Brazil (Brazil, 2018). Therefore, educational actions recommended by the state health departments (SES) from different regions of the country were selected, taking into account the diversity in the actions’ formats, target audiences, purposes, and themes.
Eleven educational actions were part of the aforementioned project. However, for the purposes of this study, only five of these actions were selected—a number considered sufficient to achieve theoretical saturation, understood as the point at which the inclusion of new cases ceases to yield new analytical elements for understanding the phenomenon under study (Rahimi and Khatooni, 2024). The decision was based on the repetition of patterns, convergence among the findings, and sufficient density to support the analytical categories. The study included educational actions from Tocantins, Mato Grosso, Mato Grosso do Sul, Espírito Santo, and Santa Catarina, carried out between 2017 and 2020 (Table 1).
This study included 69 participants, comprising nine coordinators, 13 faculty members or facilitators, and 47 graduates of the educational actions. Participants were identified using information provided by the department responsible for CHE actions at the State Health Secretariats. Participants were contacted via email and WhatsApp, taking into account the context of social distancing during the study’s conduct.
To collect data on the perceptions of coordinators and facilitators, semi-structured interviews (Minayo, 2014) were conducted, guided by the following trigger questions: “How was this action planned and developed from its conception through its implementation, and what challenges were encountered throughout this process?” Other questions stemmed from these, using an approach that sought to delve deeper into aspects related to the organization of educational actions and the obstacles encountered during their development. This flexibility allowed us to capture not only the linearity of the processes but also their contradictions, tensions, and the meanings attributed by the participants to their lived experience. The interviews were conducted from January to June 2022, during the COVID-19 pandemic, which is why they took place virtually on Zoom. The interviews were recorded and transcribed in full, with an average duration of 57 minutes.
To gather information from the graduates, the “effects dimension” instrument, developed in the aforementioned project, was used. The instrument aimed to assess the results obtained in daily work based on educational actions, consisting of five sections regarding perception of educational action, learning assessment, institutional support, changes in the work process, and incorporation of innovations into services. For the purposes of this study, we analyzed the responses to the open-ended questions in section 4 (changes in the work process), which included questions about the challenges faced.
The transcribed interview material, as well as the open-ended responses from the questionnaire administered to graduates, was subjected to thematic content analysis (Minayo, 2014). This approach allowed us to capture the meanings and significance present in the participants’ statements through a systematic process involving skimming, coding, categorization, and critical interpretation. To support and enhance this analytical process, NVivo software was used, which enabled the organization, coding, and visualization of the data units, as well as facilitated cross-referencing between categories and the identification of emerging patterns, a method already well-established in the literature (Tonin et al., 2023).
Data interpretation was conducted in light of the theoretical, conceptual, and methodological frameworks of interprofessionality (WHO, 2010; Reeves et al., 2016; Saragih et al., 2024; PAHO, 2025), as well as the CHE (Brazil, 2018). To better understand the specific challenges that emerged from the analysis of the interviews, we drew on the typology proposed by Reeves et al. (2010), which identifies four interdependent dimensions (relational, process-oriented, organizational, and contextual) as the structural foundations of interprofessional work. Although originally designed to describe factors (rather than challenges) that influence collaboration in the context of health care practices—and not specifically geared toward the field of education—this typology was employed here as an analytical lens to interpret the challenges faced in incorporating interprofessionalism into CHE actions that emerged from the empirical data analyzed in this study. The four dimensions described in Table 2, although distinct, are interrelated, requiring an integrated analytical approach that is sensitive to the multiple layers that permeate health work and education (Reeves et al., 2010).
In the study presented here, participants were identified by the acronyms “Coord,” “Fac,” or “Grad,” followed by a number.
Results and discussion
An analysis of the discourses of the facilitators and coordinators reveals contradictions between what is prescribed and what is experienced, between the desire for a change and the structures that resist collaborative work. These findings align with the results obtained from the analysis of graduates’ responses, which indicate the presence of barriers related to management support, work organization, and the availability of conditions for applying what was learned in the daily operations of the services.
Regarding the relational challenges identified, the discourses reveal disputes over status and difficulties in mutual recognition among professionals, especially among coordinators and facilitators, since
Generally, we try to defend what we believe in within our profession, and sometimes we don’t have a qualified listener. This was one of the elements I noticed: the lack of a holistic perspective, of teamwork, of recognizing that all professions are necessary in a single act. As a nurse, there are certain moments in care that I cannot handle on my own; I need help from another colleague (Fac13).
When you think about why networks are difficult to coordinate, it’s because people struggle to communicate and relate to one another, to make those connections (Coord4).
These aspects are not limited to communication breakdowns or isolated incidents but also reflect the historical entrenchment of training and work models guided by a single-profession logic, which naturalizes disciplinary boundaries and hierarchies among fields of knowledge. This logic reinforces what Frenk et al. (2010) called the “tribalism of professions,” that is, the tendency for professions to operate in isolation or even in competition with one another—a tendency that manifests in symbolic and institutional structures that confine them to isolated territories of knowledge, hindering the coordination of collaborative practices (Frenk et al., 2010; Peduzzi et al., 2013).
Promoting learning about the roles and contributions of different professionals through interprofessional socialization broadens the understanding of teamwork as a shared and collaborative practice. Furthermore, well-conducted experiences of interprofessional socialization result in improvements in communication, cohesion among team members, and concrete in care outcomes (Dolan and Nowell, 2025; Khowaja et al., 2024).
It is worth noting that interprofessional communication stands out among relational challenges. Recognized as a collaborative competency, it is not merely a mechanism for exchanging information but an ethical-political process that underpins the development of shared practices, as it enables the negotiation of meanings and responsibilities within teams (Gleeson et al., 2023). However, according to the triangulated data, there is a lack of clarity in its understanding, as illustrated in the following statements:
The challenge for us was to recognize the work being carried out in each sector, in each area. To understand the scope of each department’s work and its responsibilities, because at times they overlap and intersect—the boundary is blurred (Fac6).
So, it was a tense moment because, at times—such as during clinical case studies—some people from different departments or units thought it was the responsibility of one group or another. So, I think we need to acknowledge and discuss our roles, our competencies, and our responsibilities, and, above all, recognize our weaknesses (Fac11).
Interprofessional communication should not be limited to interactions among professional groups; it extends to relationships between technical areas, administrative sectors, different levels of health care, technical professionals in primary education, managers, and, above all, patients. In all these settings, communication is fundamental, as it enables the flow of clinical and managerial information, the alignment of practices, and facilitates the coordination of care, especially in contexts marked by complex health needs (Hamid et al., 2016; Prado et al., 2023). When hindered by strict hierarchies, a lack of active listening, or failures in institutional channels, communication becomes an obstacle to collaboration, compromising the comprehensiveness of care (Gleeson et al., 2023).
In terms of organizational challenges, the data reveal shortcomings in the support structure for Primary Health Care (PHC) and a reductionist view of in-service training as a public policy. Furthermore, the data highlight the lack of pedagogical and political expertise among educators, which affects both training processes and the ability to sustain actions aligned with the principles of interprofessionalism, patient autonomy, and the transformation of practices in the daily operations of the SUS.
This issue of authorizing managers to have time off to take training is difficult. Not everyone sees its importance. They think they’re throwing money away. They even went so far as to say that there are many courses on Saturdays and Sundays, so they prefer to pay for this professional to take them without having to take time off work (Fac5).
The challenge lies in the lack of acceptance among most coworkers when faced with a new work strategy. Change causes discomfort, and this discomfort leads to dissatisfaction and delays in improving work processes. Not everyone has made an effort to study developments in the SUS work process, such as continuing education (Grad17).
The narrow view that workers are “given time off” for training—and that this constitutes a “waste of time” or “unnecessary expense”—reveals not only a conceptual misunderstanding of Continuing Professional Education (CPE) but also a narrow conception of health care management, still marked by productivist and technocratic rationales. This is evident in the open-ended responses to the questionnaire administered to graduates of the educational programs, who highlighted managers’ low regard for CHE, coupled with a lack of involvement and commitment. This perception overlooks the fact that CHE is not a supplement to care activities, but rather a management technology that operates through critical analysis and, therefore, is also work (Feuerwerker, 2005; Brasil, 2018).
I see a lack of support from the immediate manager, and in the face of the pressures experienced, individual problem-solving at the expense of collective problem-solving meets this demand from the manager, since [individual] problem-solving is faster, albeit less complete and, at times, mistaken (Grad25).
Within the CHE framework, management and workers do not occupy hierarchically opposed positions but rather form a two-way relational dynamic: just as management can set the agenda for strategic issues, teams must have the legitimacy to bring everyday challenges into the discussion. However, the process is not smooth. Openness to questioning can be uncomfortable for managers who resist the democratization of decision-making or lack the structure to address emerging problems; similarly, it can cause discomfort among workers who, when faced with the new and the unstable, tend to reproduce conservative practices. Even so, it is precisely in this field of tensions that the power of CHE as a management strategy lies (Feuerwerker, 2005).
Still within the realm of organizational challenges, a weakness emerged in the training of the teachers and facilitators themselves involved in CHE actions. Facilitators and coordinators report having been trained for the social work field rather than for teaching practice, feeling insecure about leading emancipatory pedagogical processes and incorporating the theoretical, conceptual, and methodological frameworks of interprofessionalism. These findings are similar to the results of other studies that point to challenges related to teacher training (Ahmady, Mirmoghtadaie, and Rasouli, 2020; Schlicker, Nitsche, and Ehlers, 2023). Although this challenge was present in the discourse of the facilitators and coordinators of the actions, it did not emerge in the perceptions of the graduates.
The role of the teacher or facilitator is recognized as central, not only because of their function as an educational mediator, but also because of their ability to foster learning environments that promote dialogue, respect among different forms of knowledge, and the negotiation of meanings within teams. Thus, educators must possess competencies that integrate theoretical mastery, ethical sensitivity, and practical experience. Furthermore, knowledge of the health professions, an understanding of interprofessional tensions, familiarity with participatory methodologies, and concrete experience in collaborative contexts are attributes considered essential for performing this role (Reeves, Goldman, and Oandasan, 2007; Hall and Zierler, 2015; Ratka, Zorek, and Meyer, 2017).
With regard to procedural challenges, the statements of facilitators and coordinators revealed a lack of dedicated time for teams to meet and collectively reflect on their work process.
Our manager didn’t understand that it wasn’t just about serving the population; the team needed time to meet so it could function as a team (Fac1).
If we wanted to make a difference in primary care and at other levels, we would need to set aside time for this team to function as a team—with time to talk, evaluate the past week, and plan the next one (Coord3).
The accounts highlight the notion that teamwork requires more than the simultaneous completion of tasks; above all, it demands opportunities for dialogue, planning, and shared evaluation. The consolidation of interprofessional collaboration presupposes the existence of designated times for meetings, during which professionals can negotiate approaches, build consensus, and continuously review their practices (HPAC, 2019; McLaney et al., 2022).
However, this understanding also faces resistance in management models centered on productivity and immediate response to care demands, in which time is treated as a scarce, rigidly controlled resource, rather than as a strategic dimension of care organization. One of the graduates reported in the open-ended response field:
The challenges stem from the urgency to “do,” which often hinders the improvement of practices in an organized and thoughtful manner, interfering with “thinking” (Grad23).
Under these circumstances, moments of listening and collective analysis are perceived as deviations from the care workflow rather than components of care quality. The lack of daily opportunities for team communication and the prioritization of productivity-driven goals stand out as recurring barriers to collaborative functioning (Oandasan et al., 2009; Grant et al., 2024).
Among the contextual challenges identified, structural bottlenecks in the healthcare system and high turnover among managers and professionals converge to create macro-level challenges—both contextual and organizational—that must be overcome.
Our major difficulty is that when you discuss and open this channel of communication, you begin to address issues that are bottlenecks and exceed our capacity to resolve them within the scope of the training activity. It’s not just a matter of improving communication or organizing work better; there’s the precarious nature of services, the shortage of professionals, unstable contracts, and constant changes in management (Coord2).
There is a high turnover of managers in the SUS, and political influence plays a role in the appointments of people to management positions—and often these individuals are not trained for these roles. This ultimately creates significant barriers to the advancement of continuing education and interprofessional collaboration (Fac2).
According to the graduates, changes in management—and, consequently, in technical and healthcare professionals—interfere with the effectiveness and continuity of actions. The data highlight the tensions experienced by both graduating professionals and educators, who, in fostering spaces for listening and critical reflection, encounter systemic impasses that transcend the immediate governance of teams and educational actions themselves. Issues such as the precarious nature of services, the fragmentation of care networks, high staff turnover, the instability of public policies, and the scarcity of human and material resources emerge as barriers to the implementation of interprofessional collaboration in the macro-political context (Lawlis, Anson, & Greenfield, 2014; Souza et al., 2023).
It should be noted that, in the Brazilian context, contextual and organizational challenges are intertwined with the historical processes of defunding the SUS, the deterioration of working conditions, and the discontinuity of public policies. In this regard, the adoption of neoliberal and fiscal austerity agendas in recent years has exacerbated these vulnerabilities, further straining the system’s capacity to guarantee minimum conditions for sustainable collaborative practices (Castro et al., 2019; Méllo, Albuquerque, and Santos, 2022).
Both interviewees and graduates highlighted that monitoring the outcomes of the training process and providing support for changes in work processes were among the most prominent challenges. Both were identified as critical and limiting factors for consolidating the effects of educational interventions.
Because when you train a worker to carry out an intervention, they need support to continue that intervention. They need someone to listen—to ask how it went, whether they succeeded or failed, and what path they will take next. So, just going there and urging the person to make changes without providing support afterward is pointless (Coord7).
We take on multiple activities that would require better planning, time allocation, and human and financial resources to deliver results. This leads to burnout among professionals and management due to the mismatch between work demands and the resources available to carry out tasks and meet deliverables (Grad38).
Institutional support has been recognized as a decisive factor for the effectiveness of interprofessional collaboration in educational processes. Management commitment, resource allocation, and the involvement of engaged faculty and facilitators are foundational conditions. However, reliance on “enthusiastic” individuals reveals the institutional fragility that often confines these initiatives to the realm of volunteerism, compromising their continuity and institutionalization. In this sense, ensuring the sustainability of these initiatives requires more than occasional participation: it involves integrating them into institutional policies, with funding, planning, and structured recognition within educational institutions and health services (Reeves, Goldman, and Oandasan, 2007; HPAC, 2019).
At the procedural level, the challenges analyzed stem from the understanding that health education does not end with the one-time completion of an educational activity; it is a continuous and unfinished process that requires monitoring and support beyond the time and space of the formal activity. The knowledge and experiences mobilized in training processes need to be internalized, challenged, and recontextualized within the daily dynamics of work, requiring opportunities for reflection, active listening, support, and reassessment. This strengthens the link between training and work, allows for the reframing of lived experiences, and supports effective changes in care practices (Ceccim, 2005; Mann, Gordon, and MacLeod, 2009).
Often you have extraordinary qualities and brilliant skills, but if you’re not part of a well-structured management system, you end up unable to realize your full potential. And I think this is a major challenge as well, because sometimes it doesn’t depend on the instructor alone, nor solely on the professional. So, it’s a context, a scenario in which there are various actors, and all of them play a fundamental role in making it work. One swallow does not make a summer (Coord3).
At the organizational level, the fragility of institutional structures designed to ensure the continuity and consolidation of these training processes is evident. The lack of mechanisms for monitoring and evaluating actions—as well as qualified feedback and systematic listening to workers—compromises not only the effectiveness of CHE but also the incorporation of interprofessionalism as an institutional value and practice. The absence of monitoring that takes into account local contexts, team arrangements, and the historical intersections of work management prevents the lessons learned from becoming part of the organizational culture. As a practice that demands constant negotiation, shared responsibility, and recognition of roles, interprofessionalism cannot be sustained through isolated actions but requires institutional environments that foster its continuity and adaptation. Without this support, collaboration tends to fade and revert to the segmented approach that has historically characterized health services (HPAC, 2019; Khowaja et al., 2024).
Since this is a qualitative study, this research did not aim to generalize its findings, but rather to pave the way for new studies that explore in greater depth the multiple dimensions involved in the challenges of incorporating interprofessionalism into CHE. The study’s scope was limited to educational actions in only five Brazilian states; this narrow focus imposes limits on the breadth of the findings and suggests the need for future research in diverse institutional and regional contexts capable of capturing the multiple expressions of interprofessional work and training in the country.
Despite these limitations, the results offer valuable insights by highlighting the multiple barriers to the incorporation of interprofessionalism in CHE actions, with particular emphasis on the lack of institutional support and the role of administrators, faculty, and facilitators in this process. By articulating and discussing these challenges, the study broadens our understanding of the structural, organizational, and pedagogical factors that influence the effectiveness of interprofessional educational practices. Thus, the study aims to contribute to strengthening the public health system by identifying pathways for improving educational strategies based on ethical, political, and pedagogical principles consistent with the emancipatory project of CHE and the values of the Unified Health System (SUS).
Final remarks
The results of this study show that incorporating interprofessionalism into CHE actions goes beyond individual changes in how professionals think or act. Although these transformations are necessary, their sustainability depends on institutional and organizational conditions that foster changes in the daily work environment. Factors such as the lack of dedicated time, the fragmentation of work processes, insufficient resources, the discontinuity of educational actions, and the lack of support from management constitute structural barriers that limit the consolidation of collaborative practices. Managerial turnover emerges as a particularly significant challenge, as it compromises the continuity of actions and highlights the influence of political contexts and stable career paths in the public service on the implementation of the PNEPS and interprofessionalism.
From a pedagogical perspective, the research points to a persistent gap in the pedagogical training of teachers and facilitators. For training to be interprofessional, it requires not only new content but also epistemological and ethical-political shifts that reorient the ways of producing knowledge and care toward interdependence, active listening, and shared responsibility. As a pedagogical strategy, CHE is only fully realized when inextricably linked to work management and the existential contexts in which individuals operate, rather than as an ancillary or episodic policy.
An analysis of the challenges also shows that, in contexts marked by underfunding, institutional discontinuity, and the devaluation of the educational dimension of health work, even the best-designed training initiatives face structural limits to their consolidation. This finding calls for a shift in the focus of the analysis: we must shift our attention from “worker resistance” to the systemic structural deficiencies, recognizing that barriers to interprofessionalism may be less the result of individual failings and more an expression of an institutional pattern that normalizes fragmentation and undermines collaborative efforts.
In this regard, a future research agenda should deepen our understanding of how organizational, political, and pedagogical conditions influence the sustainability of CHE actions that incorporate interprofessionalism. Future studies could investigate, for example, the effects of different management and funding models on the continuity of collaborative practices and the mediation strategies adopted by facilitators and managers to link education, service, and the community. Furthermore, it is important to explore how regional and institutional inequalities impact the implementation of the PNEPS and the effective incorporation of interprofessionalism into the daily routine of services.
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