Primary Health Care in remote rural municipalities: context, organization, and access to integral care in the Brazilian National Health System
1
Escola Nacional de Saúde Publica Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
2
Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, Brazil
3
Instituto Leonidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
4
Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brazil
5
Instituto de Saúde Coletiva, Universidade Federal do Oeste do Pará, Santarém, Brazil
6
Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
ABSTRACT:
The historical concentration of goods and services in more economically developed urban centers poses enormous access difficulties for populations living in remote rural areas1, 2. Making health services accessible and opportune in small communities dispersed over a vast territory implies facing difficulties in attracting the workforce, transportation costs and lack of service provision3, 1, 4. The objective of the study is to analyze the specificities of the organization and access to primary health care (PHC) in the Brazilian National Health System (SUS) in remote rural municipalities (MRR). To that end a study with a qualitative approach, based on a multiple case study in 27 MRR was carried out5. Thematic content analysis of 211 semi-structured interviews with managers and health professionals and a triangulation of information to explore and recognize the forms of organization, strategies, and challenges for the access to health were performed.
RESULTS:
It was identified that the geographical access barriers involve great distances, times, costs, poor road conditions, and transportation; the characteristics of remote rural contexts condition the provision of PHC; there are differences in the ways of offering health actions and greater gaps in care coverage in the most rarefied and remote areas of the municipalities; organizational accessibility is hindered by the insufficient offer of consultations, exams, medications, restrictions on the days of operation, and itinerant actions, accentuated by the high professional turnover; the support for specialized care is precarious, with difficulties in supply, regulation, transportation, and communication; there are contradictions between national PHC funding and the characteristics of territories marked by population sparseness and long distances; and the shortage of the workforce is a common challenge among the cities studied. It is, thus, necessary to consider the territorial, social, and access characteristics to health services to propose public policies that meet the needs of the MRR.
The historical concentration of goods and services in more economically developed urban centers poses enormous access difficulties for populations living in remote rural areas1, 2. Making health services accessible and opportune in small communities dispersed over a vast territory implies facing difficulties in attracting the workforce, transportation costs and lack of service provision3, 1, 4. The objective of the study is to analyze the specificities of the organization and access to primary health care (PHC) in the Brazilian National Health System (SUS) in remote rural municipalities (MRR). To that end a study with a qualitative approach, based on a multiple case study in 27 MRR was carried out5. Thematic content analysis of 211 semi-structured interviews with managers and health professionals and a triangulation of information to explore and recognize the forms of organization, strategies, and challenges for the access to health were performed.
RESULTS:
It was identified that the geographical access barriers involve great distances, times, costs, poor road conditions, and transportation; the characteristics of remote rural contexts condition the provision of PHC; there are differences in the ways of offering health actions and greater gaps in care coverage in the most rarefied and remote areas of the municipalities; organizational accessibility is hindered by the insufficient offer of consultations, exams, medications, restrictions on the days of operation, and itinerant actions, accentuated by the high professional turnover; the support for specialized care is precarious, with difficulties in supply, regulation, transportation, and communication; there are contradictions between national PHC funding and the characteristics of territories marked by population sparseness and long distances; and the shortage of the workforce is a common challenge among the cities studied. It is, thus, necessary to consider the territorial, social, and access characteristics to health services to propose public policies that meet the needs of the MRR.
| eISSN: | 2654-1459 |
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