Geographical and Political Barriers to Healthcare Access in the Cancer Care Pathway for Rural Women in the Interior of Brazil
1
Graduate Program in Politics Culture and Environment, Federal University of the São Francisco Valley, Petrolina, Brazil
2
Graduate Program in Culture and Territory Studies, Federal University of Northern Tocantins, Araguaína, Brazil
3
Unidade Acadêmica Serra Talhada, Federal Rural University of Pernambuco, Serra Talhada, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
The historical exclusion of rural populations from health policies in Brazil persists even after the 1988 universalization of the health system, resulting in reduced access and poorer health indicators 1. This inequity impacts care, demanding equitable policies for complex treatments like cancer 2. This study examined barriers faced by rural women from 19 states across Brazil in accessing breast and cervical cancer diagnosis and treatment, focusing on the Unified Health System's (SUS) Out-of-Home Treatment (TFD) program 3.
METHODS:
Thirty-eight medium-sized and small municipalities from the same health regions were selected. Sample of 342 semi-structured interviews were conducted with three groups: municipal managers, cancer patients, and accompaniment persons.
RESULTS:
Analysis reveals a heterogeneous TFD policy implementation and multidimensional barriers. While 81% of the municipalities under study have implemented it, only 47% offer support houses, and a minority (8%) seek out patients in rural areas. The North, Northeast, and Midwest regions have the largest underserved areas, causing long distances traveled (759 km average). The majority of patients travel to other health regions: 42% of municipalities for diagnosis and 61% for treatment, a situation that reaches 100% in the North. The assessment of sanitary transport is marked by regional disparities: positive in the South/Southeast, mixed in the Midwest and Northeast, and critical in the North. In addition, 32% of patients paid for tests in the private network with their own resources. Health deserts and difficulties in mobility and referral, indicate systemic coordination deficiencies in the SUS, which exacerbate the vulnerability of rural women 4,5.
CONCLUSIONS:
It is concluded that the TFD, although operationalized, is insufficient to guarantee equity. Heterogeneous implementation, regional health deserts, and multidimensional barriers perpetuate historical exclusion. Policies that integrate territoriality, debureaucratization, and strengthening of networks are urgently needed to realize the right to health for rural women.
The historical exclusion of rural populations from health policies in Brazil persists even after the 1988 universalization of the health system, resulting in reduced access and poorer health indicators 1. This inequity impacts care, demanding equitable policies for complex treatments like cancer 2. This study examined barriers faced by rural women from 19 states across Brazil in accessing breast and cervical cancer diagnosis and treatment, focusing on the Unified Health System's (SUS) Out-of-Home Treatment (TFD) program 3.
METHODS:
Thirty-eight medium-sized and small municipalities from the same health regions were selected. Sample of 342 semi-structured interviews were conducted with three groups: municipal managers, cancer patients, and accompaniment persons.
RESULTS:
Analysis reveals a heterogeneous TFD policy implementation and multidimensional barriers. While 81% of the municipalities under study have implemented it, only 47% offer support houses, and a minority (8%) seek out patients in rural areas. The North, Northeast, and Midwest regions have the largest underserved areas, causing long distances traveled (759 km average). The majority of patients travel to other health regions: 42% of municipalities for diagnosis and 61% for treatment, a situation that reaches 100% in the North. The assessment of sanitary transport is marked by regional disparities: positive in the South/Southeast, mixed in the Midwest and Northeast, and critical in the North. In addition, 32% of patients paid for tests in the private network with their own resources. Health deserts and difficulties in mobility and referral, indicate systemic coordination deficiencies in the SUS, which exacerbate the vulnerability of rural women 4,5.
CONCLUSIONS:
It is concluded that the TFD, although operationalized, is insufficient to guarantee equity. Heterogeneous implementation, regional health deserts, and multidimensional barriers perpetuate historical exclusion. Policies that integrate territoriality, debureaucratization, and strengthening of networks are urgently needed to realize the right to health for rural women.
| eISSN: | 2654-1459 |
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