ABSTRACT:
Ensuring adequate and safe means of transportation is essential for maintaining and improving the health and well-being of rural communities worldwide. This study maps and analyzes distances, modalities, and means of transportation used by populations living in Brazilian rural territories to access routine and emergency health care services. Multiple case studies were conducted in Brazilian rural municipalities, using a qualitative approach based on interviews with key informants-managers and health professionals. Secondary data from national information systems were also analyzed to identify distances and travel costs between rural areas, municipal headquarters, health regions, and state capitals. National health policies do not include arrangements or financing mechanisms to ensure elective medical transportation, which in some localities represents a more significant barrier than the availability of health services itself. In rural territories, travel involves both intermunicipal and intramunicipal flows—from rural areas to the municipal headquarters. Demands for urgent and emergency care are partially met by a national policy known as the Mobile Emergency Care Service (SAMU). Multiple arrangements are established by municipal governments and users to ensure transportation by land, river, and air. Travel costs and distances—which may reach up to 46 hours to access specialized care in the capital of an Amazonian state—result in catastrophic expenditures for families when not covered by public resources. At the same time, the provision of health transportation under the exclusive responsibility of municipalities proves to be unfeasible. Insufficient availability, along with restrictions on days, schedules, and routes of health transportation, leads to the selection of beneficiaries based on socioeconomic criteria in areas of high vulnerability and limited investment in road infrastructure. For populations living in rural territories, the absence of policies ensuring sufficient, continuous, and timely provision of health transportation fuels cycles of inequity and compromises the universal right to health.