Cross-Border Health Challenges in a Triple-Vulnerability Context: Primary Health Care in a Brazilian–Bolivian Twin City
1
Coordenação da Atenção Básica, Secretaria Municipal de Saúde, Cáceres/MT, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A3609
ABSTRACT
BACKGROUND:
Border regions present complex public health challenges due to high population mobility, overlapping health systems, and structural inequalities. The twin city of Cáceres (Brazil) and San Matías (Bolivia) exemplifies such contexts, with continuous cross-border movement impacting service access and health system performance. This study investigates how mobility and data limitations affect primary health care (PHC) delivery, epidemiological surveillance, and equity in cross-border settings.
METHODS:
This descriptive case study used document analysis of municipal health planning records, Brazilian PHC administrative data (e-SUS), and immunization reports. We reviewed health information system performance, foreign-national access patterns, and service utilization at PHC units and strategic border outreach points. Key indicators included registration completeness, vaccination coverage, and follow-up for chronic conditions. Qualitative insights from local health managers supplemented secondary data.
RESULTS:
Significant gaps were identified in capturing cross-border health service use: a large proportion of foreign nationals (≥40% at outreach points) were not consistently recorded in national health databases, hindering accurate planning and financing. Incomplete data compromised continuity of care for chronic diseases and tuberculosis treatment follow-up. Discrepancies between Brazilian and Bolivian vaccination schedules further complicated immunization coverage estimates. Limited internet connectivity in remote rural and riverside areas contributed to underreporting and delays in data entry. These challenges led to underfunding of PHC services and inequitable access for mobile populations.
CONCLUSIONS:
Cross-border mobility generates “invisible demand” within national health systems, undermining PHC performance, financing, and equity. Strengthening interoperable health information systems, enhancing cross-national cooperation, and adopting border-sensitive public health policies are critical to ensure continuity of care and effective surveillance. Targeted interventions in border regions can advance health equity and resilience in line with global public health priorities.
Border regions present complex public health challenges due to high population mobility, overlapping health systems, and structural inequalities. The twin city of Cáceres (Brazil) and San Matías (Bolivia) exemplifies such contexts, with continuous cross-border movement impacting service access and health system performance. This study investigates how mobility and data limitations affect primary health care (PHC) delivery, epidemiological surveillance, and equity in cross-border settings.
METHODS:
This descriptive case study used document analysis of municipal health planning records, Brazilian PHC administrative data (e-SUS), and immunization reports. We reviewed health information system performance, foreign-national access patterns, and service utilization at PHC units and strategic border outreach points. Key indicators included registration completeness, vaccination coverage, and follow-up for chronic conditions. Qualitative insights from local health managers supplemented secondary data.
RESULTS:
Significant gaps were identified in capturing cross-border health service use: a large proportion of foreign nationals (≥40% at outreach points) were not consistently recorded in national health databases, hindering accurate planning and financing. Incomplete data compromised continuity of care for chronic diseases and tuberculosis treatment follow-up. Discrepancies between Brazilian and Bolivian vaccination schedules further complicated immunization coverage estimates. Limited internet connectivity in remote rural and riverside areas contributed to underreporting and delays in data entry. These challenges led to underfunding of PHC services and inequitable access for mobile populations.
CONCLUSIONS:
Cross-border mobility generates “invisible demand” within national health systems, undermining PHC performance, financing, and equity. Strengthening interoperable health information systems, enhancing cross-national cooperation, and adopting border-sensitive public health policies are critical to ensure continuity of care and effective surveillance. Targeted interventions in border regions can advance health equity and resilience in line with global public health priorities.
| eISSN: | 2654-1459 |
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